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Those veterans who have served on
active duty in a theater of combat operations are eligible for five
year's hospital care and medical services.�
COMBAT VETERAN HEALTH CARE BENEFITS AND COPAY EXEMPTION
POST-DISCHARGE FROM MILITARY SERVICE
1. PURPOSE: This Veterans Health Administration (VHA) Directive
establishes the policy and procedures for determining eligibility
for Department of Veterans Affairs (VA) health care benefits and
copayment exemption for recently discharged veterans who served in a
theater of combat operations after November 11, 1998.
2. BACKGROUND
a. Title 38, United States Code (U.S.C.), Section 1710(e)(1)(D)
states that a veteran who served on active duty in a theater of
combat operations (as determined by the Secretary of Veterans
Affairs, in consultation with the Secretary of Defense) during a
period of war after the Persian Gulf War, or in combat against a
hostile force during a period of hostilities after November 11,
1998, is eligible for hospital care, medical services, and nursing
home care for any illness, even if there is insufficient medical
evidence to conclude that such condition is attributable to such
service. For purposes of this policy, such veterans are considered
to qualify as �combat veterans.� Treatment provided under this
authority is not subject to copayment requirements.
b. Combat veterans who are treated for a condition that the VA
provider finds resulted from a cause other than combat service may,
however, be subject to copayments (see subpar. 4c(5), for conditions
that the Under Secretary for Health has determined are not related
to combat service).
c. On January 28, 2008, President George W. Bush signed into law the
�National Defense Authorization Act of 2008�(NDAA), Public Law
110-181.
This law, among other things, amended Title 38, United States Code (U.S.C.),
Section 1710(e)(3), extending the period in which a combat-theater
veteran may enroll for VA health care and receive the care and
services described in preceding paragraph 2a. The law now provides
that:
(1) Combat veterans who were discharged or released from active
service on or after
January 28, 2003, are eligible to enroll for VA health care for 5
years from the date of discharge or release and are to be placed in
Priority Group (PG) 6 (unless eligible for a higher PG placement).
This means that combat-theater veterans who were originally enrolled
in PG 6 based on their combat service, but later moved to a lower
priority category (due to the law�s former 2-year eligibility
limitation) are to be placed back in PG 6 for 5 years beginning on
the date of their discharge or release from active service. New
combat-theater veterans have 5 years from the date of their
discharge or release to enroll for VA health care. NOTE: The 5-year
enrollment period applicable to these veterans begins on the
discharge or separation date of the service member from active duty
military service, or in the case of multiple call-ups, the most
recent discharge date.
THIS VHA DIRECTIVE EXPIRES SEPTEMBER 30, 2013
(2) Combat veterans who were discharged from active duty before
January 28, 2003, but did not enroll in VA�s health care system have
3 years under this authority to enroll in VA�s health care system.
This 3-year period of enhanced eligibility begins on January 28,
2008, and expires after January 27, 2011, during which time the
combat veteran will be placed in PG 6 (unless eligible for higher PG
placement).
d. National Guard and Reserve members who were activated to serve in
the Armed Forces and served in a combat theater of operations are
eligible to receive health care benefits under
38 U.S.C. 1710(e)(1)(D) if they meet the title 38 definition of
�veteran,� as defined in 38 U.S.C. 101(2), and meet the �minimum
active duty� service requirement, set forth in 38 U.S.C. 5303A (or
are exempt from that statutory requirement).
3. POLICY: It is VHA policy that combat-theater veterans who meet
the eligibility criteria of 38 U.S.C Section 1710(e)(1)(D) and who
apply for VA health care within the applicable timeframe are to be
enrolled in PG
6 (unless eligible for a higher PG placement) and are to receive
care and services at no cost for any illness or condition possibly
related to their combat service. Combat-theater veterans who were
moved from PG 6 to a lower priority PG (based on the law�s former
2-year limitation for eligibility in this category) must be placed
back in PG 6 (unless eligible for a higher PG placement) for 5 years
beginning from the date of their discharge or release. NOTE: VA
regulations exempt combat-theater veterans from copayment
requirements that apply to the receipt of medications if the
medications were furnished for conditions covered under this special
treatment and enrollment authority.
4. ACTION
a. Under Secretary for Health. The Under Secretary for Health has
designated the Chief Business Officer (CBO), as the lead VHA officer
for establishing policy in determining veterans� eligibility for
health benefits.
b. CBO
(1) The CBO, or designee, in consultation with the Chief Public
Health and Environmental Hazards Officer (13) and the Chief
Readjustment Counseling Service Officer (15) is responsible for
providing guidance concerning locations, dates of service, and other
criteria that are used to identify service in theaters of combat
operations or subject to hostilities.
(2) The CBO is responsible for providing guidance relating to the
evidence or documentation needed to determine a veteran�s
eligibility for these combat-related health benefits. NOTE: Specific
locations that have been designated as theaters of combat or areas
subject to hostilities qualifying for combat veteran status are
provided in Attachment A and will be updated as changes in combat
designations occur.
c. Facility Director. Each facility Director is responsible for
ensuring that:
(1) Facility staff involved in the eligibility process and staff
involved in the provision of health care services are provided
guidance on verifying a combat veteran�s eligibility and providing
appropriate services, respectively.
(2) Combat-theater veterans who enroll within the applicable
enrollment timeframe are placed in PG 6 (unless eligible for higher
PG
placement) and receive free VA care and services for any condition
that may be related to their combat service, consistent with law.
(3) While combat-theater veterans enrolled in PG 6 are not required
to disclose income information, intake staff are trained to clearly
articulate the benefits of providing this income information. These
benefits may include a higher enrollment PG assignment, exemption
from copayments for care and medication provided for treatment of
non-combat related conditions, or eligibility for beneficiary travel
benefits. If the combat veteran declines to provide income
information, the combat veteran must agree to pay any applicable
copayments for care that is found by VHA not to be related to combat
service.
(4) VHA clinicians have wide latitude in determining if a veteran�s
condition may be possibly related to the veteran�s combat service.
This clinical determination does not require the same rigor or
standards used for adjudication of a service-connected claim. It is
a determination solely within the medical judgment of the treating
clinician. In general, VHA clinicians need to conclude that
illnesses and conditions requiring treatment or monitoring during
the combat veteran�s enhanced enrollment period (i.e., 5 or 3
year-period post-discharge or release, as applicable) are possibly
related to combat service. Physical or mental health evaluations
needed to rule out combat-related health concerns are to be provided
at no cost to the enrolled combat veterans and deemed to be a health
care service covered under 38 U.S.C.
1710(e)(1)(D). However, the Under Secretary for Health has
determined that certain conditions will invariably be deemed to be
due to causes other than combat service. These include, but are not
limited to:
(a) Congenital or developmental conditions, e.g., scoliosis.
(b) Conditions which are known to have existed before military
service unless there is an indication that the condition has been
aggravated or exacerbated by combat service.
(c) Conditions having a specific and well-established etiology and
that began after military combat service, e.g., bone fractures
occurring after separation from military service, a common cold,
etc.
(5) If the condition is clearly found to have resulted from a cause
other than the veteran�s combat service, the clinician must change
the Combat Veteran treatment factor value in the Computer Patient
Record System (CPRS) to �No� for that encounter and copayment
charges may apply.
(6) Appropriate staff are furnished Attachment A, which contains the
locations and periods of service that qualify as theaters of combat
operations. NOTE: These criteria are updated as necessary.
(7) Appropriate staff are aware of evidence or documentation that
may be accepted as an individual veteran�s proof of combat service,
these include: NOTE: Only one is required.
(a) Notations on the DD 214 of service in a designated theater of
combat operations;
(b) Receipt of the Afghanistan Campaign Medal, Iraq Campaign Medal,
Armed Forces Expeditionary Medal; Kosovo Campaign Medal; Global War
on Terrorism Expeditionary Medal (does not include Global War on
Terrorism Service Medal); Southwest Asia Campaign Medal; Air Force
Combat Action Medal (AFCAM) or other DoD authorized combat related
medal; and
(c) Proof of receipt of Hostile Fire or Imminent Danger Pay
(commonly referred to as �combat pay�) or combat tax exemption after
November 11, 1998.
NOTE: Other evidence may be reviewed on a case-by-case basis.
(8) Continuous enrollment for veterans who are enrolled in PG 6.
(a) Veterans will continue to be enrolled in VA�s health care system
after their enhanced enrollment period ends. At that time, VA
reassesses the veteran�s information (including all applicable
eligibility factors) and makes a new enrollment priority
determination.
(b) If the veteran was in PG 6 and no other eligibility factors
apply, then the veteran is moved to either PG 7 or PG 8 depending on
the income level. As a result of the expiration of the enhanced
enrollment period, the veteran may be required to make applicable
copayments.
(9) Combat-theater veterans who do not enroll within the applicable
enrollment period are still eligible to enroll for VA health care,
unless they are subject to the administrative ban on enrolling new
veterans in PG 8. Their enrollment must be based on factors other
than combat service, such as: a compensable service-connected
disability, VA pension status, catastrophic disability
determination, or the veteran�s financial circumstances. Even if
they have no current need for medical care or services they should
be strongly encouraged to apply for enrollment within the applicable
timeframe to preserve their eligibility for enrollment.
(10) Combat-theater veterans who are ineligible to enroll for VA
care are referred to a Vet Center for readjustment counseling
services, if appropriate, or to a community provider to obtain
services at the veteran�s expense.
(11) If a health care emergency exists for an ineligible veteran,
treatment is provided under VA�s humanitarian treatment authority.
(12) Combat veterans who believe they incurred disabilities during
service are encouraged to apply for service-connection. NOTE:
Veterans Service Organizations can be of great value in assisting
veterans with this process.
NOTE: VA Environmental Health programs (formerly designated as
Registry
programs) may provide Gulf War Registry examinations to eligible
veterans who request the examination and who served on active
military duty in Southwest Asia during the Gulf War which began in
1990 and continues to the present including Operation Iraqi Freedom.
The GW Environmental Health program is described in VHA Handbook
1303.02, accessible on Web site http://www1.va.gov/GulfWar <http://capwiz.com/trea/utr/1/EQFGJIWLAW/JQOZJIWLET/2495462101>
/.
5. REFERENCES
a. VHA Handbook 1303.5.
b. Title 38 U.S.C. Sections 101(2) and (21), 1710, 1712A, and 5303A.
c. Public Law 110-181, National Defense Authorization Act of 2008.
6. FOLLOW-UP RESPONSIBILITY: The Chief Business Officer (16) and the
Chief Public Health and Environmental Hazards Officer (13) are
jointly responsible for the content of this Directive. Questions
about combat veteran�s eligibility may be addressed to Business
Policy at (202) 254-0406. Questions about veterans seeking treatment
for health conditions claimed to be related to combat operations may
be addressed to the Environmental Agents Service (131) at (202)
273-8597.
7. RESCISSIONS: VHA Directive 2005-020, and VHA Directive 2002-049
are rescinded. This VHA Directive September 30, 2012.
Michael J. Kussman, MD, MS, MACP
Under Secretary for Health
ATTACHMENT A
COMBAT VETERAN ELIGIBILITY DETERMINATION TABLE COMBAT ZONES,
HOSTILITIES and MEDALS
The Department of Veterans Affairs (VA) utilizes the Department of
Defense (DOD) �Combat Zones� listing of designated hostile fire or
imminent danger pay areas. Although DOD Hostile Fire or Imminent
Danger pay existed prior to November 11, 1998, only proof of such
pay after November 11, 1998, is acceptable. NOTE: The table provided
at the link provided should assist in the determination of combat
veteran eligibility.
1. Definitions
a. Combat Veteran. A combat veteran is a veteran who served on
active duty in a theater of combat operations during a period of war
after the Persian Gulf War or in combat against a hostile force
during a period of hostilities after November 11, 1998.
b. Combat Zones. Combat zones are designated by an Executive Order
from the President as areas in which the United States (U.S.) Armed
Forces are engaging or have engaged in combat. An area usually
becomes a combat zone and ceases to be a combat zone on the dates
the President designates by Executive Order.
c. Minimum Active Duty Service Requirement. The minimum active duty
service requirement is the shorter of the following two periods:
(1) The full period for which they were enlisted, called or ordered
to active duty, or
(2) Twenty-four months of continuous active duty.
NOTE: There remain categories of veterans who are expressly excluded
by statute from the minimum active duty service requirement; e.g.,
veterans who were discharged or released from active duty for a
disability incurred or aggravated in line of duty, those discharged
or released from active duty under an early out or hardship
discharge, etc.
d. Hostilities. Hostilities refers to conflict in which the members
of the Armed Forces are subjected to danger comparable to the danger
to which members of the Armed Forces have been subjected in a
theater of combat operations during a period of war. To determine
whether a period of hostilities is within the scope of this special
authority, VA relies upon the same citation and criterion used to
determine eligibility for VA Readjustment Counseling Service
contained in 38 U.S.C., Section 1712A(a)(2)(B), as it applies to
veterans in service after November 11, 1998. More specifically,
criteria used to determine whether a veteran�s service meets the
qualifications required by statute include:
(1) Receipt of an expeditionary medal or other DOD authorized combat
related medal;
(2) Service in a location designated by an Executive Order as a
combat zone;
(3) Receipt of DOD Hostile Fire or Imminent Danger pay or combat pay
tax exemption for serving in the area subject to hostilities; or
(4) Other factors as may be defined in policy and regulation by the
Secretary of Veterans Affairs.
NOTE: A certificate of award, or presentation of a medal, in and of
itself, will not suffice for VA health care eligibility verification
purposes without the submission of supporting documentation (such as
DD 214, Proof of Receipt of Hostile Fire or Imminent Danger Pay,
proof of exemption of Federal tax status for Hostile Fire or
Imminent Danger Pay after November 11, 1998), other military service
records or orders indicating combat service.
e. Hostilities or Imminent Danger Pay. Hostile fire pay is defined
as pay to anyone exposed to hostile fire or mine explosion, while
imminent danger pay is paid to anyone on duty outside the United
States area who is subject to physical harm or imminent danger due
to wartime conditions, terrorism, civil insurrection, or civil war.
f. Medals. Afghanistan Campaign Medal, Iraq Campaign Medal, Armed
Forces Expeditionary Medal; Global War on Terrorism Expeditionary
Medal (does not include Global War on Terrorism Medal); Kosovo
Campaign Medal; Southwest Asia Campaign Medal; and other
DOD-authorized combat related medals.
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