Forgotten Benefits for Forgotten Men and Women
Veterans Administration Income and Health Programs
The following is an updated version of an article that appeared in
Body Positive in October 1997.
But more than 65 years later, Blondell's torchy lament still rings true: Most of us aren't aware of the benefits available to veterans -- especially disabled veterans -- and they and the benefits due them too often remain "forgotten."
Here's a brief survey of income and health programs for veterans of active duty who have received general or honorable discharges.
VA Disability Pensions
Veterans who have served at least ninety days active duty, including at least one day during wartime (see "What Is A War?"), even if they never actually entered the war zone, can receive pensions for non-service-connected disabilities (that is, disabilities not arising from the time in service) if their incomes and assets are below certain levels. In 2000, the pension level for a single veteran without dependents is $749 monthly (see table below for details).
Income and Asset Rules for VA Pensions
In spite of its name, the VA pension is, in fact, a welfare program: Those with low enough assets, and income below the pension amount, receive payments to bring them up to the pension level. Thus, other income -- except welfare payments such as Supplemental Security Income (SSI), Temporary Aid to Needy Families (TANF, formerly AFDC, Aid to Families with Dependent Children), General Assistance, and Home Relief -- reduces the pension payment dollar for dollar, and if the other income is high enough, it prevents any pension eligibility. But: The first $7,200 a year of a child's earnings are disregarded in 2000. Allowable assets include a vehicle and lived-in home of any value, and $30,000 in savings or investments.
Disability Standards for VA Pensions
To qualify for a pension, a veteran need not show that his or her disability arose from time in service, but he or she must be 100 percent presently disabled under the VA's disability schedule -- even if from a malady that started after discharge. The VA rules are similar to, but somewhat more liberal than, those of Social Security. Unlike Social Security, the VA will consider such purely "social" factors as chronic unemployability. And, by law, it must resolve all borderline or doubtful questions in favor of the veteran.
According to the VA's disability regulations, " . . . [For purposes of a pension and 100% compensation] . . . HIV-Related Illness . . . [is] . . . AIDS . . . with recurrent opportunistic infection or with secondary diseases afflicting multiple body systems; HIV-related illness with . . . debility . . . and progressive weight loss, without remission, or few or brief remissions . . . ." (38 Code of Federal Regulations, Part 4, Subpart B, Section 4.88a, #6531)
Pensions for Surviving Spouses, and Disabled Grown Children
Surviving spouses of wartime veterans can also collect VA pensions if they are poor enough. Unlike veterans, they need not show that they're disabled themselves or that the veterans they survive were disabled when alive. Even grown children of wartime veterans -- again, if they're poor enough -- can receive VA pensions, although a grown child (called a "helpless adult child" in the VA's bureaucratic terminology) must satisfy VA disability standards and show that the disability arose before the age of 18. (See table for pension levels that apply to surviving spouses and their adult children.)
Higher Pension Levels for Those Needing "Aid and Attendance"
Pension levels of veterans, surviving spouses, and disabled grown children are increased if the VA finds they need "aid and attendance." This broad class covers almost anyone with limited mobility or limited housekeeping, grooming, meal preparation, errand, social interaction, or chore capabilities. A similar increment is added to pensions of those whom the VA determines are housebound. This category defines itself, but is far less widely used -- and pays far less -- than the "aid and attendance" add-on. Pensioners cannot receive both add-ons at the same time.
VA Pensions, Supplemental Security Income (SSI) and Medicaid
VA pensions count all income to reduce (and, if the other income is high enough, to eliminate) the pension payment: wages, private pensions, Social Security Disability Insurance (SSDI) benefits, bank interest, investment income, etc. (Again, though, in 2000 up to $7,200 yearly of a child's earnings are disregarded.) But welfare-type payments, including SSI, TANF, General Assistance, Home Relief, Food Stamps, the value of medical care that Medicaid purchases for you, and housing aid don't count as income for VA pension purposes.
But the reverse is not true: SSI, TANF, General Assistance, Home Relief, Food Stamps, Medicaid, and housing programs do count VA pensions as income, even though the pension is a welfare-type payment. Mercifully, the other need programs don't count the "aid and attendance" add-on to pensions as income, recognizing it as a medical care-related item. When the issue comes up, however, the recipient or applicant must almost always explain the "aid and attendance" payment and its purpose in painstaking detail in order to have SSI, Medicaid, and other welfare programs exempt it from being counted as income.
What all this means is that the VA will not consider simultaneous receipt of a VA pension by someone who is on SSI, Medicaid, or welfare as overpayment (or even worse, fraud) . . . but SSI, Medicaid, and other programs will! It gets even more complex in the case of a family in which both a VA pension and SSI and/or Medicaid are received or are being applied for. In this situation, expert advice from an attorney or other experienced advocate is a must.
The VA Pension's "UME" Medical Expense Allowance
As mentioned above, in counting income, the VA disregards (that is, it does not count when determining eligibility or how much a pension payment will be) a child's earnings up to $7,200 yearly. In addition, income above 5 percent of the veteran's basic pension amount -- not inclusive of any add-ons to the pension level for "aid and attendance" or "housebound" status -- is not considered toward eligibility of pension payments if it is to be spent on medical care and related expenses.
These expenses can include costs not covered by health insurance, such as co-payments and deductibles; transportation to medical centers; treatments or drugs considered "experimental" by health plans; premiums for Medicare and any other health insurance; drugs not available through the VA, other medical assistance programs, or Medicaid; and even medical expenses of nonveteran family members.
For a single veteran in 2000, this means that other income over $37.45 monthly -- if it is to be spent on medical care -- will not be deducted from his or her pension amount. This feature is called the "unreimbursed medical expense," or "UME" deduction, and it is a way of shielding income meant for medical care from being counted as income in the VA pension eligibility budgeting process. To adjust your pension to take account of income spent on medical care, ask the VA for Form 21-8416.
VA Medical Care Eligibility
All veterans with honorable or general discharges who have served at least 180 days of active duty can receive care at VA medical centers, even if they aren't disabled under VA or Social Security rules and even if they have not served in a war zone or during wartime. Care available through the VA includes inpatient hospital stays, outpatient hospital services, clinic and physician services, and outpatient prescription drugs. Some, but not all, VA centers offer home health services, and in many areas there are freestanding VA outpatient clinics.
Note that, with rare exceptions, the VA does not pay for care at non-VA facilities. (With advance permission, some veterans -- usually only those who get compensation benefits (see below) -- can be treated by non-VA medical staff or facilities in Colorado, Wyoming, Utah, Montana, Idaho, and parts of central Florida under pilot programs.)
Compensationers (but not other veterans), with advance permission, can be treated by approved foreign medical providers for emergencies when overseas. Contact the Medical Administration Service (136), Foreign and Insular Affairs Unit, VA Medical Center, 50 Irving Street NW, Washington, D.C. 20422; telephone (202) 745-8242; fax (FTS) 921-8239; TWX, RUEVDHC. There are numerous authorization and billing forms that are required. Request a copy of the pamphlet Department of Veterans Affairs Foreign Medical Services Program. Nevertheless, in spite of the restriction of care to compensationers who have secured advance permission, there are anecdotal reports that other veterans who have VA patient identity cards have secured emergency care at overseas U.S. military medical facilities. This is because clerks there understandably have trouble mastering the VA's complex rules and therefore often fail to distinguish between the classes of eligible and ineligible VA patient identity cardholders.
Medical Care Rules for Income, Assets and Co-payments
Single veterans with annual incomes below $22,887 -- known as Priority Group 5 -- are eligible for free care in 2000 (except for a $2.00 co-payment per prescription), after those with service-connected disabilities, former prisoners of war, and certain other priority classes are served. (Here, too, in 2000 the first $7,200 of a child's earnings is not counted.) Allowable assets per family include a vehicle and lived-in home of any value, and $50,000 in savings or investments. If a veteran has private health insurance, the VA will bill the plan for what it can, but it will not bill the veteran if he or she has income below this level, except for the $2.00 prescription co-payment. (See table for details on VA medical care eligibility levels.)
"Space Available" Care for Wealthier Veterans
After higher-priority cases such as service-connected disabled veterans, former prisoners of war, and poor Priority Group 5 veterans are served, VA medical centers may at their option also give care to Priority Group 7 veterans -- those who have served at least 180 days active service and have received honorable or general discharges, even if their incomes or assets exceed the regular eligibility levels. In these cases, co-payments are charged, but care is still far, far cheaper than it would be for those who'd otherwise need to pay cash or do without. And if these higher-income veterans happen to have some private health insurance, the payments from the health plan to the VA for the care are deducted from the amount the veteran must pay in co-payments. (See table for VA medical care co-payments for higher income Priority Group 7 veterans.)
Compensation for Veterans with Service-connected Disabilities
The VA pays "compensation" to veterans whose disabilities arose from their time in service -- even if they resulted from something that occurred when they were off base, off duty, or on leave. These "service-connected" disabilities could include disease or injury that a veteran proves was contracted during service, even if symptoms only appeared after discharge. Military medical records -- and even evidence from nonmilitary sources -- can be used to demonstrate this. It's usually a long, legalistic process, but veterans who can demonstrate a 100 percent service-connected disability are entitled to lifetime tax-free monthly payments of approximately $2,000 in 2000. Veterans can also get service-connected compensation awards for disabilities that cause partial incapacity, in increments of from 10 percent to the full 100 percent level, with proportional adjustment of the compensation amount. Those rated at 30 percent or more can have dependent allowances added to their compensation payments. Compensation is not a needs-based program like pensions, so compensationers can have any amount in other income or assets.
Dependents, Survivors, and Their Medical Coverage
The compensation payments go up for those with dependents and include not only priority VA medical care but also medical coverage for dependents and survivors in the VA's CHAMPVA medical insurance plan. ("CHAMPVA" stands for Combined Hospital and Medical Program of the Veterans Administration; it is never, ever referred to by its full title, which would probably be unknown even to those who are otherwise familiar with the program.) The CHAMPVA medical plan is free for those who are eligible, and it offers coverage similar to that of major medical plans of large employers. (Note that CHAMPVA is only for dependents and survivors of compensationers -- not pensioners.) Survivors of deceased service-connected disabled veterans get payments called Dependency and Indemnity Compensation (DIC). For a single surviving spouse, the monthly payment is about $900 in 2000 (more if there are children). It can be higher in some cases in which the disabled veteran lived for over eight years with the disability, or if the death occurred before 1993.
Compensation and DIC Are Tax-free, Non-welfare Benefits
Compensation and DIC benefits are tax-free and, unlike pensions, are not based on need. A veteran can have additional income without affecting the payment. Even though compensation and DIC are tax-free and are not themselves welfare-type payments, however, need-based programs such as SSI, Medicaid, housing, and other welfare programs count them as income.
Veterans Group Life Insurance (VGLI) and Service-disabled Veterans' Life Insurance (SDVLI)
Veterans being discharged have the right to retain life insurance policies of up to $200,000 issued under the Servicemembers Group Life Insurance (SGLI) plan by converting them within 120 days of discharge into Veterans Group Life Insurance (VGLI) policies through the Office of Servicemen's Group Life Insurance (213 Washington Street, Newark, NJ 07102). Those who are totally disabled at the time of discharge have up to one year to convert. VGLI policies may at any time then be converted without any medical underwriting (i.e., medical history questionnaires, blood tests, or exams), through participating insurers, into individual whole life policies suitable for acceleration or viatication (i.e., the "sale" of life insurance benefits, at a discount, to investors by policyholders who are terminally ill, need nursing care, or are simply over age 62). To do this, contact the SGLI office in Newark, which can also provide lists of participating insurers for conversion.
Those found to be disabled for service-connected compensation purposes (but not just for pensions) can get $10,000 in Service Disabled Veterans Insurance (SDVLI) -- separate and apart from whatever SGLI or VGLI insurance they might or might not have -- by applying for it within two years of their service-connected disability compensation award. And if the service-connected compensation award is at least at the 30 percent rating level, they may purchase $20,000 more of SDVLI. (This insurance is designed to ignore the service-connected medical disability of the veteran. but not other medical conditions, in determining if, and for how much in premiums, the veteran can get life insurance.) Unlike SGLI and VGLI, this insurance cannot be converted, accelerated, or viaticated -- although, of course, it can provide well for loved ones after the veteran's death.
Yet it may also be possible for a still living, seriously ill veteran with SDLI to secure a private loan from a better-off relative or acquaintance with whom she or he has a longstanding, trusting relationship in exchange for naming that person the life insurance beneficiary. (While such an arrangement would not always be ironclad-enforceable under the law, it can work out where the insured person has the full trust of a relative, friend, former employer, or other person with cash to advance for such a loan or with the ability to raise that cash -- e.g., through a reverse home mortgage, in the case of an older, home-owning relative.)
The premiums for SDLI are very, very low (for example, only about $45 monthly for a male aged 35 for the full $30,000), and the first $10,000 is free for those rated 100 percent disabled. The SGLI office in Newark has further details.
Vocational Rehabilitation, Education and Job Placement
In addition to the quite well-known VA educational benefits for college, the VA also offers vocational rehabilitation and related job training, education, and placement services to those who receive compensation for service-connected disabilities. Only those pensioners whose pensions started before December 31, 1995, however, are eligible for these services. Vocational rehabilitation services can include job readiness counseling, career evaluation, job placement, career training, on-the-job training, and, in some instances, even college courses.
Those in full-time programs can receive benefits of up to about $450 monthly in 2000, and the VA can also cover books, fees, transportation, tutoring, and other miscellaneous costs. Generally, VA vocational rehabilitation programs must be completed within 48 months; in exceptional cases, an additional 18 months are allowed. In some instances, living allowances over and above compensation and pension levels may be authorized.
Once a veteran successfully completes a vocational rehabilitation program and has worked for one to twelve months, compensation and pension benefits can be ended; priority medical care eligibility, however, continues.
Back to the September 2000 Issue of Body Positive Magazine.
This article was provided by Body Positive. It is a part of the publication Body Positive.