Posts for the category "Benefits"

Post 9/11 GI Bill kicks in August 1st

Troops hoping to further their education can look forward to increased financial support from the government.  A new GI bill modifies outdated benefits, which will help troops reduce educational bills, especially with rising tuition costs.

The new Post 9/11 GI Bill passed by Congress last year will become effective Saturday, August 1st.

The Post 9/11 GI Bill gives qualifying troops who served at least 90 days on or after September 11, 2001, some financial support for education. To receive full benefits, the individual must have served at least three active duty years.

An indivual must have been honorably discharged to be eligible for the bill. Individuals discharged with a service-related disability after 30 days also qualify for the bill’s benefits.

Veterans have been filing for the bill’s benefits since May 1, 2009. Apply for the bill yourself at www.gibill.va.gov.

For more information check out our Post 9/11 GI Bill FAQ page.

New online health system for Military

The Department of Defense has been testing a new e-health system called MiCare, and so far the system is a hit. If implemented as planned, this system will allow Military personnel, their families and veterans to obtain their personal health records online from Microsoft Health Vault and Google Health.

According to a DoD press release, the system will include the following information: demographic information, active medication lists, their allergy data, lab results, radiology results, personal problem list, past visits, upcoming appointments and inpatient/outpatient documentation.

The DoD is working with the VA to determine the best way to approach the system.  The system will be operated online rather than on an internal government system due to timing and cost. Security is obviously of utmost concern.

VA loans an advantage in a bad economy

It’s good to know that you have a dependable option in this declining economy, and many servicemembers and veterans are taking advantage of theirs in this difficult time.

Despite today’s housing market, VA loans continue to be sound and stable options for the military comunity.

With more than 162,000 home loan guarantees issued so far this year, the VA has seen an increase of about 31 percent since ths time last year.

One major reason for the increase? VA loans can still be obtained with no downpayment, a quality that has become increasingly difficult to find via conventional loans.

Last year more than 90 percent of VA loans were issued without any downpayments.

Consumers  VA loans also appreciate the quick and easy service. Technilogical advantages now alow a VA loan to be received electronically within 24 hours after  applying for the loan.

For more information, browse AllMilitary.com’s “VA Home Loans” link  found on the VA Benefits page.

Army Physical Disability Evaluation System (APDES)

Army Physical Disability Evaluation System (APDES)16 March 2007 

 

What You Need to Know About the Physical Disability Evaluation System Overview of the Department of the Army’s Physical Disability Evaluation System 

Each year the Army Physical Disability Evaluation System (PDES) separates thousands of Soldiers who are found unfit for continued military service. This guide answers a few general questions about the Department of the Army’s PDES.

Overview of the Department of the Army’s Physical Disability Evaluation System. 

The Secretary of the Army is charged with assuring the fitness of Soldiers, and separating or retiring those who become unfit to continue military service because of physical disability. The law provides benefits for eligible Soldiers whose military service is cut short due to a service-related disability incurred in the line of duty.

The United States Army Physical Disability Agency (USAPDA) manages the Army’s PDES and acts on behalf of the Secretary of the Army.  USAPDA is a Field Operating Agency of the Army Human Resources Command (HRC) and is headquartered in Washington DC at Walter Reed Army Medical Center.  In addition to the USAPDA HQ at Walter Reed, the agency has three Physical Evaluation Boards (PEBs), located at Walter Reed, Ft. Sam Houston, TX, and
Ft. Lewis, WA.  The PEBs are administrative boards that determine whether a Soldier’s disability prevents his/her continued performance in the Army. The PEB is comprised of two types of boards (Informal and Formal) that review medical and performance evidence to make determinations of fitness or unfitness to continue military service.

It is important to understand that this is a performance-based system.  Simply because a Soldier has a medical condition does not mean that the Soldier cannot continue to serve on active duty or in the Reserve Component. It is the impact of that medical condition upon the Soldier’s ability to perform duties appropriate to his/her rank and branch/MOS that is important. A Soldier with a serious medical condition can be found fit within the limits of his/her profile for continued service if the evidence supports that finding.

 

If the PEB determines that a Soldier is unfit to continue military service, and finds that the Soldier is eligible for disability benefits, the PEB determines the percentage of the Soldier’s disability compensation using Department of Defense Directives (DoDD) and Instructions (DoDI), Army Regulations, and current Army policy in conjunction with the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD). Depending on the severity of the illness or injury, the Soldier receives either permanent or temporary disability retirement or disability severance pay.

The Army only rates those medical conditions that result in the Soldier being determined unfit for continued military service.  The Department of Veterans Affairs generally rates a Soldier for all conditions incurred in or aggravated by military service.  Therefore, it is not uncommon for a former Soldier to receive a higher combined disability rating from the DVA than the PEB combined disability rating.

The PEB makes determinations of: • Fitness or unfitness to continue military service; • Eligibility for disability compensation;• Disability codes and percentage rating;• Disposition of the case; • Whether or not the injury or illness is combat-related.

 

When is a Soldier unfit to continue military service?

A Soldier is unfit to continue in the Army when the preponderance of evidence demonstrates that one or more physical and/or mental condition(s) significantly interferes with the Soldier’s ability to perform the duties of his/her office, grade, or rank. The PEB makes the decision on fitness by balancing the extent of a Soldier’s condition, as shown through objective medical and performance evidence, against the requirements and duties that the Soldier may reasonably be expected to perform in his/her branch/MOS and grade.  The mere fact that one or more medical conditions exist does NOT constitute an unfit determination.

The inability to deploy CANNOT be the sole basis for determining unfitness per DoD Instruction.

Typical medical evidence used by the PEB includes: • A narrative summary written by the Medical Evaluation Board (MEB). • History and treatment of the specific injury or illness. • Results of laboratory, x-ray, MRI, CAT scan, and other specialized tests. • Current Physical Profile • All referrals to physicians, specialists, and sick call (health record). • Type and frequency of medication. • Results of physical exam completed within past six months. 

Typical performance evidence includes: • Memorandum from the Soldier’s Commander addressing current ability to perform duties in MOS and unit.• Evaluation Reports• APFT• Approved Line of duty investigations.

 

I’ve been seriously hurt; what happens next?

The priority for a Soldier suffering an illness or injury is to ensure that he/she receives proper medical attention. If the Soldier’s condition improves to the point that he/she is able to return to full military duty, he/she is returned to his/her unit.

However, if the treating physician believes that the Soldier is unable to perform full military duty or is unlikely to be able to do so within a reasonable period of time (normally 12 months), the Soldier is referred to a Medical Evaluation Board (MEB) at the Medical Treatment Facility (MTF) where treatment is being provided.

Medical Evaluation Board (MEB) 

If the Soldier’s physical condition falls below medical retention standards, the attending physician refers the Soldier to the Physical Evaluation Board Liaison Officer (PEBLO) to start a MEB.  The MEB is an informal process comprised of at least two physicians who compile, assess, and evaluate the medical history of a Soldier and determine how the injury/disease will respond to treatment. 

The MEB documents the extent of the injury or illness and decides if the Soldier’s medical condition is severe enough to question his/her ability to continue serving in a full duty capacity.

The attending physician does this by relating the nature and degree of the medical impairment of the Soldier to retention standards and the duties that the Soldier may reasonably be expected to perform in his/her office, grade, or rank.

If the physician believes the Soldier will be able to return to full military duties within a reasonable period of time, and the Soldier meets medical retention standards, then a MEB is not required.

 

Referral to PEB 

The MEB normally contains all of the medical and nonmedical evidence described previously. The Soldier (or his/her next of kin if the Soldier is not deemed competent) is required to review and sign the MEB and is given an opportunity to comment, as desired, on the complete content of the MEB before it is referred to the PEB.

How can I ensure the PEB has information necessary to render an accurate determination in my case?

When a Soldier is informed by his/her medical care provider or a representative of the Medical Treatment Facility (MTF) that he/she is being referred to the PEB for a fitness determination, it is important for the Soldier to become familiar with how the disability evaluation system process works.

The Soldier’s primary counselor and information resource is the PEBLO.  The PEBLO is the Soldier’s advocate, counseling him/her on MEB/PEB findings and related rights and benefits.  Note that the PEBLO works in the Patient Administration Division (PAD) of the MTF and NOT for the PEB.

The Soldier will have an opportunity to review and comment on the medical and non-medical information referred to the PEB.  A Soldier must ensure that all medical conditions are accurately and completely listed on the forms provided during the physical examination. The examining physician will address those additional conditions, document findings, and, if appropriate, refer the Soldier to additional specialists for further evaluation that MAY result in additional medically unacceptable conditions being referred to the PEB.

 

To ensure timeliness in this processing through the PDES, it is in the best interest of the Soldier to:

- Attend all appointments – contact counselor if you can’t make an appointment.  (No shows will be reported to your Commander)

- Provide copy of Leave and Earning Statement (LES), Enlisted/Officer Record Brief (ERB/ORB), last three evaluation reports (OER/NCOER)

- Provide copies of approved retirement or separation orders

- Provide copies of orders for recent promotions or demotions.

A Soldier will be permitted to review the narrative summary (NARSUM) and any addenda regarding a medical condition that has been prepared for referral to the PEB. After completion of the MEB, the Soldier will review the findings and recommendations.  If the Soldier disagrees with the MEB or feels there is information missing or not adequately addressed, he/she will have three working days to submit a rebuttal. The Soldier wants to remain in the Army, he/she can use this opportunity to provide documentation on their ability to continue to perform their duties despite their medical condition(s).  The rebuttal is referred back to the original physician who will address the issues contained in the rebuttal and make changes as appropriate.  The reviewing physician receives the rebuttal and can decide to let the MEB stand as written, send MEB back for further medical information, or forward to PEB with attachments or additional notes.

The reviewing physician’s final disposition of the MEB can result in the following:

-          If the Soldier meets retention standards within the limits of his profile, he/she is returned to duty in his/her MOS.

-          If the Soldier does not meet retention standards, the case will be referred to the Physical Evaluation Board (PEB) for further disposition.

-          If the MEB is a MOS/Medical Retention Board (MMRB) directed MEB, the case is forwarded to the PEB regardless of the MEB findings/recommendation.

The Army has three PEBs located at Walter Reed Army Medical Center in Washington DC; Ft. Sam Houston in
San Antonio, TX; and Ft. Lewis, WA.  Each of the MTFs that conduct MEBs is aligned with one of these three PEBs.  This alignment determines which PEB will adjudicate the case.

 

 How is the PEB structured? 

The PEB is comprised of two types of boards, informal and formal. A board (Informal or Formal) is composed of a three-member panel trained on adjudication standards and procedures. The Presiding Officer will normally be a Colonel (sometimes a LTC); in addition each board has a Personnel Management Officer (normally a field grade officer or civilian equivalent) and a Medical Member (normally a DA civilian physician).  Almost all of the civilian board members at the Army PEBs are retired military with significant experience.  By law, all PEBs considering a Reserve Components (RC) Soldier will have an RC member.

Informal PEB

The MEB is initially reviewed by the Informal PEB.  A Soldier does not appear before the Informal PEB.  This board conducts a review of the medical and non-medical evidence of record contained in the MEB. The first determination made by the PEB is whether or not the Soldier is fit to continue to perform his/her primary military duties.  If determined unfit, the PEB then decides whether or not the Soldier is eligible for disability benefits.  If  the Soldier is eligible for compensation, the PEB then determines a rating percentage for the Soldier and makes a recommendation as to whether or not the Soldier should be separated with severance pay, permanently retired, or placed on the Temporary Disability Retirement List (TDRL).  Ratings are discussed later in this booklet.
The findings of this board are forwarded to the PEBLO, who is required to deliver the PEB findings to the Soldier within three working days from receipt. For this reason, Soldiers should be available to PEBLOs and should avoid regular leave, TDY, or any duty that would make the Soldier unavailable for counseling by the PEBLO.  The PEBLO will deliver the findings in person, if possible, but can satisfy the notification requirement through telephonic or other verifiable means. It is recommended that the Soldier’s AKO address be reflected on the MEB and any other frequently used e-mail address should also be noted.  Soldiers should check both AKO and other e-mail inboxes frequently during the MEB/PEB process.  The PEBLO will counsel the Soldier on the findings, assist in the completion of an election of options and notify the PEB of the Soldier’s decision on how to proceed. The Soldier must complete their election of options within a maximum of 10 calendar days. 

If found fit, the Soldier may either concur or nonconcur with the findings of the Informal PEB. If the Soldier nonconcurs, he/she may submit a written rebuttal that includes new medical information or performance data not previously available or considered by the Informal PEB. Other supporting material may also be presented.   A Soldier found fit by an informal PEB does NOT have a legal right to a hearing; however, as an exception to policy he/she may request a formal PEB hearing from the PEB President.  If a Soldier is found fit while on the TDRL, which is discussed later in this handbook, he/she is entitled to a formal hearing before the PEB.

If found unfit, the Soldier has the right to accept the findings, or can nonconcur with the findings and submit a written rebuttal and/or demand a Formal PEB with or without personal appearance.  All written rebuttals will be considered by the informal PEB, which may issue revised findings based on the information provided or may affirm their original findings.  A Soldier does not give up his/her right to a formal hearing by submitting a rebuttal.

 

Formal PEB 

As provided in law, no active duty or reserve Soldier found unfit by an Informal PEB may be retired or separated for physical disability without being given the right to a formal hearing.  A Soldier who is found unfit by the Informal PEB and wishes to appeal can demand a formal hearing, with or without personal appearance.  Army regulations require that unit commanders issue TDY orders to Soldiers to support travel to and from formal hearings.

The Formal PEB is the Soldier’s opportunity, with the assistance of legal counsel, to present evidence, testimony and documents in support of his/her case. The Soldier may appear in person and present evidence pertinent to the case.  The Soldier can be represented by an appointed Judge Advocate General Corps (JAGC) attorney, or counsel of their own choosing (a civilian attorney or a representative from a National Service Organization such as Disabled Americans Veterans).  If the Soldier elects to have civilian counsel of his/her choosing, it will be at no expense to the government.

 

I am going before a Formal PEB. What should I do? 

Counsel

Once a Soldier is scheduled for a formal hearing, he/she will be contacted by a military attorney of the JAGC assigned to the garrison Staff Judge Advocate (SJA) office where the PEB is located.   These officers are NOT assigned to the PEB; they serve as independent military counsel.

Military counsel is normally appointed and made known to the Soldier prior to the scheduled formal hearing date.   This occurs as soon after the Soldier elects a formal hearing as is practicable.  Soldiers using military counsel normally meet their counsel for the first time, face-to-face, a day or so before the formal hearing. This is an opportunity to go over the Soldier’s case and discuss any last minute questions. Changing representation (counsel) prior to the formal hearing does not constitute an automatic reason for delaying or postponing a formal hearing.

Informal VS Formal PEB 

At the moment the Formal Board convenes to consider a case, the Informal Board findings become null and void, and the Soldier CANNOT accept the Informal Board findings under any circumstance.

 

Reporting to the Formal PEB 

On the day of the formal PEB, the Soldier reports, in the appropriate uniform of the day for the locale, to the Presiding Officer of the Formal PEB.  The Formal PEB panel will inform the Soldier of his/her rights, including the right to make sworn or unsworn statements, rights under the Privacy Act and the right not to make any statements relating to the origin or aggravation of the injury. If the Soldier decides not to testify under oath, the Formal PEB panel will not question him/her.

Recording testimony

All Formal Board proceedings are electronically recorded, except during the general overview prior to convening and the deliberation phase.  A copy of the recording is available upon request by the Soldier or their counsel.

Documents to bring with you

During the Formal PEB, Soldiers should anticipate questions relating to how and when their condition occurred, treatments received, medication, and work limitations that the condition imposes. The Soldier will be provided an opportunity to discuss his/her case in detail. At the Formal PEB, the panel will usually have the Soldier’s medical records, medical reports, administrative and performance records, and statements from the Soldier’s chain of command concerning current duty performance.

To avoid undue delay and any detriment to his/her case, the Soldier should obtain, and arrive at the hearing with, their own personal copies of the above materials, especially those items that will be necessary in the presentation of his/her case. It is highly recommended that the Soldier submit any documentation not contained in his/her PEB packet to the members of the board at least 24 hours prior to the actual board date.  The Formal PEB members use all of this information in the decision-making process.

 

A chance to address board members 

Following questioning by the Board Members and the Soldier’s Counsel’s summation, the Soldier has one last opportunity to address the Board Members and has the option of making a brief statement.  Once all evidence has been reviewed and testimony concluded the Soldier and Counsel will be excused for board deliberations. Only the voting Board Members are present during deliberations.

 Board members vote and provide recommendation 

The Formal PEB members will independently vote to determine if the Soldier is fit or unfit.  If unfit, and found eligible for compensation, the PEB will also vote on the rating percentage and disposition.  All findings are decided by majority vote. The Formal PEB then reconvenes and notifies the Soldier and his/her Counsel of their decision.  A copy of the report of proceedings, which provides the PEB’s findings and recommended disposition, is provided to the Soldier before he/she departs from the PEB.  The Soldier is again provided 10 calendar days to make an election as to whether he/she concurs or nonconcurs with the Formal PEB findings.

If the decision of the board is not unanimous, the dissenting board member may choose to submit a minority report citing the rationale for disagreeing with the majority.  The minority report will be made a part of the MEB/PEB record and will cause an automatic review by the Physical Disability Agency (PDA).

 

Can I appeal the decisions of the Formal PEB?

Soldiers who disagree with the Formal PEB findings can submit a rebuttal, which will be reviewed by the Formal PEB.  The Formal PEB will either affirm their initial findings, or may issue revised findings (called a formal reconsideration).  If the latter, the Soldier will again be given an opportunity to respond to those findings by submitting another rebuttal to the Formal PEB.

Review by the Physical Disability Agency 

Final approval authority for all PEB findings and recommendations rests with the United States Army Physical Disability Agency (USAPDA).  All cases completed by the PEB are forwarded to USAPDA.  USAPDA HQ conducts an appellate review of every case where a Soldier disagreed with the final PEB findings (informal or formal), and also reviews approximately 20% of all other cases to ensure adjudicative consistency and accuracy.  The Agency has the authority to issue revised findings or return a case to the PEB for reconsideration if they determine the evidence of record does not support the PEB findings and recommendations.  If USAPDA does issue revised findings, the Soldier will once again be afforded an opportunity to agree or disagree with the revised findings, and submit a written rebuttal.  If the Soldier has not yet had a formal hearing, he/she can request one at that time.  If a Soldier has already had a formal hearing, his/her appeal will be forwarded to the Army Physical Disability Appeal Board for review at that level.

After a Soldier has been separated or retired from the Army, he/she has the right to petition the Army Board for the Correction of Military Records (ABCMR) for relief if he/she believes the case was incorrect or subject to injustice or inequity.

How does the PEB decide the percentage of disability?

If the PEB finds that a Soldier is unfit, and the Soldier is eligible for disability benefits, the PEB rates the severity of the Soldier’s injuries using Department of Defense Directives (DoDD) and Instructions (DoDI), Army Regulations, and current Army command policy in conjunction with the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The VASRD lists hundreds of physical and mental disabilities and rates these disabilities using objective medical criteria. Depending on the severity of the illness or injury, the PEB rates a Soldier from zero to 100 % disability. Each condition receives a separate rating and these are combined (see page 15).

Analogous Ratings

While the VASRD lists hundreds of physical and mental disabilities, many conditions are not specifically identified and must be rated by analogy to a listed condition which is similar in function, anatomical localization, or symptomology.

 

How does the PEB decide who receives disability retirement and who receives disability severance pay?  How are these pays computed? 

The severity of the condition determines whether a Soldier, who is eligible for disability benefits, receives disability retirement or is separated with severance pay.  Soldiers rated with a 0, 10 or 20 % disability who have less than 20 years of active service or 7200 points of combined service, will be separated with severance pay. To compute disability severance pay, multiply the Soldier’s basic pay for two months by the number of combined years (but not over 12) of active service and inactive duty points. 

NOTE:  There is no difference between a 0%, 10%, or 20% rating in the calculation of the amount of severance pay that is received.  The rating is NOT a factor in determining severance pay.

Soldiers with 20 or more years of active military service or 7200 points of combined service, or possessing a disability rated at 30 % or more, receive disability retirement. Disability retirement is either temporary or permanent depending on the stability of the Soldier’s medical condition. Temporary disability retirement pay is computed in the following manner for service members with less than 20 years of active military service (or 7200 points of combined service):

• 30%-50% disability rating = 50% of basic pay*

• 50%-70% disability rating = that percentage of basic pay*

• 80%-100% disability rating = 75% of basic pay*

*Soldiers who entered active duty after 8 September 1980 will have their basic pay computed as the average of their high 36 months of basic pay. 

For those who are permanently retired for disability, disability retired pay is computed on the basis of the actual disability rating (i.e., 30% disability rating) or the length of service rating (2.5 x years of service) up to a maximum of 75%.  The percentage is multiplied times the Soldier’s basic pay (or high 36-month average as described earlier).   Disability retired and severance pay awarded to Soldiers who were not a member of the armed forces on September 24, 1975 is considered taxable by the Internal Revenue Service (IRS).  An exception exists for a Soldier receiving separation or retired pay by reason of a combat-related injury. The PEB will make combat-related determinations on all cases considered.

The Soldiers’ grade for purposes of computing disability severance pay or retirement pay is the higher of the Soldier’s current grade, highest grade satisfactorily held, or grade to which the Soldier was pending promotion.  Enlisted Soldiers whose promotion eligibility date is after their separation date will be promoted on their last day of active duty.  Officers pending promotion receive disability retirement or severance pay at the promotion list grade but, under officer promotion law, cannot be promoted ahead of their promotion eligibility date. 

 

What does a combined rating mean (PEB math)? 

Per instruction in the VASRD, the PEB combines ratings.  The PEB arranges the rated conditions in the order of their severity, beginning with the greatest disability, and then rates each as a percentage of remaining efficiency.  For example, a Soldier with a 60% disability is considered 40% efficient.  If the Soldier also has a 30% disability, it is measured as 30% of the remaining 40%, leaving the Soldier as 28% efficient, or 72% disabled.  The 72% is rounded to 70%, which is the Soldier’s combined rating.  This system of combined ratings is complicated.  If you receive a combined rating your PEBLO can explain how it was determined. 

What does placement on the Temporary Disability Retirement List (TDRL) mean? 

Soldiers who qualify for permanent disability retirement (rated at 30% or higher or with 20 or more years of active duty or 7200 points of combined service) are placed on the TDRL if the PEB determines that their condition is not stable for rating purposes.  This happens if, in the opinion of the PEB, the Soldier’s condition can be expected to improve or worsen during the TDRL period.  While on the TDRL the disability rating doesn’t change, regardless of any change in condition of the Soldier.  Placement on the TDRL protects both the Soldier and the Army.  Soldiers placed on the TDRL will receive a minimum of 50% of basic pay (or high 36-month average as described earlier) and also receive all other retirement benefits (ID cards, TRICARE eligibility, etc.) while on the TDRL.  Soldiers on TDRL will receive a medical re-evaluation at least once every 18 months while on the TDRL, and this re-evaluation will be forwarded to a PEB for a new disability determination.  As a result of the new PEB finding the Soldier may be found fit (and may be give the opportunity to return to military service if desired), separated with severance pay (if the rating is decreased under 30%), permanently retired, or retained on the TDRL and re-evaluated again within 18 months.

Placement on the TDRL cannot be longer than five years.  At the end of those five years Soldiers must be removed and given a final rating.  If a Soldier does not keep USAPDA informed of their civilian address, or doesn’t report for scheduled TDRL re-evaluation, retirement pay and medical benefits for the Soldier (and dependents) may be stopped.

 

I suffer from a condition listed in the VASRD. Does that mean I will be found unfit and rated by the PEB? 

Just because a Soldier has a condition that matches a description in the VASRD does not mean that the PEB will find him/her unfit to continue military service.

Before a Soldier is eligible for a disability separation or retirement the Soldier’s case must show that he/she is unable to reasonably perform the duties of his/her office, grade, rank or rating and that this inability to perform is a direct result of a documented disability.

I have more than one diagnosis. If the PEB finds me unfit as the result of one of my diagnoses, does that mean all of my diagnoses are unfitting and will be rated by the PEB? 

The PEB evaluates the evidence of each diagnosis, but only rates the conditions that prevent the Soldier from performing his/her military duties.  For example, a Soldier, in a single accident, could suffer internal injuries that result in the loss of one kidney and a musculoskeletal injury that crushes two vertebrae damaging disks and impinging on nerves. The loss of a single kidney would not necessarily prevent the performance of military duties; however, the back injury may very likely result in the Soldier being unfit for continued military service. In this example the disability rating would likely be awarded for the back injury only. 

 

The PEB says my condition existed prior to service. How can this be? I never suffered from this condition before I came into the Army.

Physical or mental disabilities that make a Soldier unfit may have existed prior to entering the service (EPTS). Causes of EPTS disabilities include hereditary or congenital defects or injuries with an inception before entering active service.  There is a presumption that pre-existing conditions have been service-aggravated, but this presumption can be overcome if the PEB determines that the worsening of any condition followed the “natural progression” of the pre-existing injury or disease based on well-established medical principles.

If a Soldier has less than eight years total active service (see eight-year rule on next page) he/she could be separated from the service without disability benefits.  This would happen if the PEB deems a Soldier’s injuries EPTS and his/her condition has not been permanently aggravated by military service. By law, the Army only compensates for those conditions that were caused by, or permanently aggravated as a result of, military service.

It is possible for a Soldier to possess a physical or mental disability and never experience a problem until he/she faces the stresses of military life. The physical and emotional stress of military training can cause a latent condition to appear or an old injury to worsen to the point that the Soldier is no longer able to perform his/her military duties.

To appeal a finding of EPTS, a Soldier must present medical evidence that the condition did not exist prior to entering the service, or provide medical evidence documenting that military service permanently aggravated a pre-existing condition.

Separation without Disability Benefits, 

A Soldier may be separated without disability benefits in the following situations:

(a)    The unfitting condition results from injury which is due to intentional misconduct or willful neglect.

(b)   The disability was incurred during a period of unauthorized absence.

(c)    The disability was not incurred or aggravated as the proximate result of performing duty (for example, EPTS).

 

What is the eight-year rule? 

By law, a Soldier with over eight years active federal service is eligible for disability compensation even if his/her condition existed prior to service (EPTS). The eight years of active service does NOT have to be continuous; however, the Soldier must be on active duty orders of over 30 days for this rule to apply.

I’m a Reserve Component Soldier. Are there any differences in how my case will be processed through the PEB?

There is no difference in PEB case processing for a Reserve Component (RC) Soldier serving on a period of active duty, from that of an Active Component Soldier.  Each Soldier is entitled to the same determinations and disposition recommendations of the PEB.  However, if an RC Soldier with twenty “good years” receives a rating from the PEB that would result in separation with severance pay, he/she is provided the option of waiving the separation pay and being placed in the retired reserve and drawing retired pay and benefits at age 60.

Remember that the PDES is a military duty performance-based system.  The PDES determines if the Soldier’s medical condition makes him/her fit or unfit to perform military duty.  It does not assess the Soldier’s capacity to perform in his or her civilian position. 

RC Soldiers not on active duty who have conditions that were not incurred as a result of military service will be processed by the PEB for a fitness determination only.  These Soldiers are not entitled to disability benefits. These cases are referred by the reserve activity Commanding Officer to the PEB for a determination of fitness for continued service only. The decision to submit a case as “duty-related” or “non-duty related” resides with the Soldier’s command.  The PEB will not intervene or overturn this decision.  Normally an MEB is not conducted by an MTF on these individuals, nor is care provided by the MTF for the condition. 

 

I am a Medical Holdover (MHO) Soldier.  What special provisions apply to me? 

MHO is defined as a RC Soldier mobilized on 10 USC 12302 and who volunteers to remain on Active Duty for medical retention under 12301 (d) orders in support of contingency operations and diverted from his/her normal mobilization mission, demobilization processing, or medically evacuated from theater, who is in need of medical evaluation, treatment, and disposition including definitive health care for medical conditions identified, incurred, or aggravated while in an active duty status.

The MHO program is designed to compassionately evaluate and treat the RC MHO Soldier with the primary goal of returning the Soldier back to duty within their respective RC. If a return to duty is not possible, the MHO Soldier will be processed through the PDES in the same manner as outlined in this booklet. It is important that the MHO Soldier reads the MHO Soldier’s Handbook that is distributed to all Soldiers who voluntarily request to participate in the Medical Retention Program since it contains useful MHO specific information.

 

I am assigned to a Community Based Health Care Organization (CBHCO).  How does that differ from being located at a military MTF? 

While the overall PDES processing is the same, there are some unique aspects to an MEB that is being conducted on a Soldier located away from an MTF. In many cases, the CBHCO Soldier is receiving his/her medical care from a non-military provider. It is necessary, therefore, that the Soldier’s CBHCO Clinical and Administrative Chain of Command closely monitor the Soldier’s medical progress to determine when referral to an MEB is appropriate. Once this medical determination is made, preliminary documentation is gathered by the CBHCO which will become the basis for referral to the supporting MTF for the MEB. In most cases it will be necessary for the Soldier to report to the designated MTF for completion of the MEB and, if appropriate, referral to the PEB. The Soldier will be at the MTF for about two weeks during which time he/she will undergo medical evaluation, MEB counseling, and all other aspects of the MEB process outlined in this booklet. At the conclusion of the MEB the Soldier will be returned to the control of the CBHCO where he/she will await the outcome of the board process. It is important to note that all documentation requirements, PEBLO Counseling, and appeal rights are exactly the same for Soldiers attached to a CBHCO as for a Soldier receiving care at a military MTF. CBHCO Soldiers are encouraged to remain in close contact with their CBHCO Case Managers who will monitor the Soldiers progress throughout the process. Moreover, upon arrival at the MTF Soldiers will have frequent contact with an assigned PEBLO who will become their advocate while the Soldier is at the MTF and who will remain responsible for the Soldier’s case even after the Soldier returns to the CBHCO.

 

If I am found unfit, can I still remain on active duty or in the Reserve/National Guard? 

Certain Soldiers who are found unfit by the PEB may request to be Continued on Active Duty (COAD) or in Active Reserve (COAR) status as an exception to policy.  Approval for COAD/COAR rests with Human Resources Command and the National Guard.  The PEB does NOT approve or disapprove a COAD/COAR request.  To be considered for COAD or COAR, you must have a condition that will not require undue loss of time from duty for medical treatment, must not pose a risk to the health and safety of yourself or other Soldiers, be physically capable of performing useful duty in an MOS for which currently qualified or potentially trainable, and meet one of the following criteria:

-          Have 15 but less than 20 years of active federal service (COAD) or qualifying service for nonregular retirement (COAR), or    Be qualified in a critical skill or shortage MOS, or

-          Have a disability that resulted from combat operations or terrorism.

Normally a COAD/COAR application is submitted by a Soldier when his/her MEB is completed.  PEBLOs can provide more information on the COAD/COAR process.

Shouldn’t I have my medical conditions evaluated by the PEB to support a disability claim I plan to submit to the Department of Veterans Affairs (DVA)? 

No. The DoD and DVA disability evaluation systems are independent of one another. As stated earlier, only those conditions that render the Soldier unfit for continued military duty will be rated by the PEB. However, the DVA could potentially rate and award disability compensation for any medical condition that affects a former Soldier’s quality of life whether or not that condition would impair their earning capacity.

Although the Soldier’s medical record is used by the DVA to determine service connection, the former Soldier is given a complete medical examination by the DVA before a rating determination is made by a DVA rating specialist.

Additional information on DVA benefits can be found at www.va.gov.  In addition, DVA Benefits Counselors are available at most Army transition centers.

Conclusion 

The above information is only an overview of the Department of the Army Physical Disability Evaluation System. It is not intended as a comprehensive review of the system.

The PDES can be confusing. Soldiers going through the system should attempt to educate themselves with the help of their PEBLOs. The Secretary of the Army charges the PEBLO with the responsibility of counseling and educating Soldiers undergoing a medical board, on the entire MEB/PEB process.

Disability Evaluation System (DES)

As the result of career-ending illnesses and/or injuries, each year the Army separates thousands of Soldiers through the Physical Disability Evaluation System.

This guide answers a few general questions about the Department of the Army’s Disability Evaluation System.

• The Medical Evaluation Board (MEB)

• The Informal Physical Evaluation Board

• The Formal Physical Evaluation Board

 

COMBAT VETERAN ELIGIBILITY

Combat Veteran Eligibility

 Benefit Description: The Department of Veterans Affairs (VA) provides cost-free health care services and nursing home care for conditions possibly related to military service to veterans with combat service after November 11, 1998 for a 2-year period beginning on the date of their separation from active military service. Who’s eligible: Veterans, including activated Reservists and members of the National Guard, are eligible if they served on active duty in a theater of combat operations during a period of war after the Gulf War or; were in combat against a hostile force during a period of “hostilities” after November 11, 1998 and, have been discharged under other than dishonorable conditions. What’s meant by “hostilities”: “Hostilities” is defined as conflict in which Armed Forces members are subjected to the danger comparable to that faced in a period of war. Acceptable documentation includes: 

•service documentation that reflects service in a combat theater, or  

•receipt of combat service medals and/or,  

•receipt of imminent danger or hostile fire pay or tax benefits.  

What are combat veterans eligible for: 

•Cost-free care, including medications, for conditions potentially related to their combat service for up to 2 years following their discharge or release from active duty.  

•Enrollment into Enrollment Priority Group 6 if not otherwise qualified for a higher enrollment priority group assignment.  

•Full access to VA’s Medical Benefits Package.  

What happens after the 2-year authority expires: Veterans who enroll with VA under this authority will retain enrollment eligibility even after their 2-year post discharge period ends under current enrollment policies. At the end of that 2-year period VA will reassess the veteran’s information (including all applicable eligibility factors) and make a new enrollment decision. If the veteran was in Priority Group 6 and no other eligibility factors apply then he/she will continue enrollment in either Priority Group 7 or Priority Group 8 depending on their income level and will be required to make applicable copayments. What about combat veterans who do not enroll during this post 2-year period: For those veterans who do not enroll during this 2-year post-discharge period, eligibility for enrollment and subsequent care is based on other factors such as: a compensable service-connected disability, VA pension status, catastrophic disability determination, or the veteran’s financial circumstances. For this reason, combat veterans are strongly encouraged to apply for enrollment within 2 years of release from active duty to take advantage of the special combat veteran eligibility even if no medical care is currently needed.  

Copays: Veterans who qualify under this special eligibility are not subject to copays for conditions potentially related to their combat service. However, unless otherwise exempted, combat veterans must either disclose their prior year gross household income OR decline to provide their financial information and agree to make applicable copays for care or services VA determines are clearly unrelated to their military service. Note: While income disclosure by a recently discharged combat veteran is not a requirement, this disclosure may provide additional benefits such as eligibility for travel reimbursement, cost-free medication and/or medical care for services unrelated to combat. Dental Care: Eligibility for VA dental benefits is based on very specific guidelines and differs significantly from eligibility requirements for medical care. Combat veterans may be authorized dental treatment as reasonably necessary for the one-time correction of dental conditions if:  

•They served on active duty and were discharged or released from active duty under conditions other than dishonorable from a period of service not less than 90 days and  

•The certificate of discharge or release does not bear a certification that the veteran was provided, within the 90-day period immediately before the date of such discharge or release, a complete dental examination (including dental X-rays) and all appropriate dental service and treatment indicated by the examination to be needed and  

•Application for VA dental treatment is made within 90 days of discharge or release  

Additional information: Additional information is available at the nearest VA medical facility. VA facilities listing and telephone numbers can be found on the internet at www.va.gov/directory, or in the local telephone directory under the “U.S. Government” listings. Veterans can also call theHealth
Benefit
Service
Center toll free at 1-877-222-VETS (8387) or visit the VA health eligibility website at
www.va.gov/healtheligibility.  

DOD AND VA BEGIN PILOT DISABILITY EVALUATION SYSTEM

DoD and VA Begin Pilot Disability Evaluation System 

      The Department of Defense (DoD) and Department of Veterans Affairs (VA) recently implemented a pilot test for disability cases originating at the three major military treatment facilities and the VA hospital in the national capital region. This pilot will run for one year. The leadership of DoD and VA will review pilot progress during this period to assist in determining when the program can be expanded to other locations.       The pilot will test a new DoD and VA disability system. The pilot will be a service member-centric initiative designed to eliminate the duplicative and often confusing elements of the two current disability processes of the departments. Key features of the pilot program include one medical examination and a single-sourced disability rating. One goal of the pilot is to enable service members to more effectively transition to veteran status and provide them with their VA benefits and compensation.       The DoD and VA are examining the continuum of care they provide from the point of injury through rehabilitation to community reintegration. The objectives of the pilot are to improve the timeliness, effectiveness, and transparency by integrating DoD and VA processes, eliminating duplication, and improving information provided to service members and their families.       To ensure a seamless transition of our wounded, ill, and injured from the care, benefits, and services of DoD to the VA system, the pilot will also test enhanced case management methods and identify opportunities to improve the flow of information and identification of additional resources to the service member and family. As soon as the service members in the pilot transition from the military, the VA is poised to provide benefits and compensation to these veterans.       The scope of the pilot includes all non-clinical care and administrative activities, such as case management and counseling requirements, associated with disability case processing from the point of service member referral to a military department medical evaluation board to the point of compensation and provision of benefits to veterans by the VA.        The pilot process has been developed over the last several months and is focused on recommendations that could be implemented without legislative change from the reports of the Task Force on Returning Global War on Terrorism Heroes, the Independent Review Group, the President’s Commission on Care for America’s Returning Wounded Warriors (the Dole/Shalala Commission), and the Commission on Veterans’ Disability Benefits.        The pilot is part of a larger effort to improve care and services to our wounded, injured and ill. Some of the other ongoing initiatives include improved information technology and data sharing, facility enhancements, recruitment and retention of care professionals, new methods to care for brain injuries and mental health concerns including post-traumatic stress disorder, and the use of life long care plans to fully support wounded, ill, and injured service members from recovery through rehabilitation to community integration.

Benefits in a Nut Shell

A listing of benefits that are available depending on a veterans level of disability:

0% To 20%
• Certification of Eligibility for home loan guaranty.
• Home loan guaranty fee exemption.
• VA Priority medical treatment card.
• Vocational Rehabilitation and Counseling under title 38 USC Chapter 31 (must be at least 10%)
• Service Disabled Veterans insurance (Maximum of $10,000 coverage) must file within 2 years from date of new service connection.
• 10 point Civil Service Preference (10 points added to Civil Service test score).
• Clothing allowances for veterans who use or wear a prosthetic or orthopedic appliance (artificial limb, braces, or wheelchair) or use prescribed medications for skin condition, which tend to wear, tear or soil clothing.
• Temporary total evaluation (100%) based on hospitalization for a service connected disability in excess of 21 days; or surgical treatment for a service connected disability necessitating at least 1 month of convalescence or immobilization by cast, without surgery of more major joints.
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30% In addition to the above:
• Additional allowances for dependent(s) [spouse, child(ren), step child(ren), helpless child(ren), full-time students between the ages 18 to 23, and parent(s)]
• Additional allowances for a spouse who is a patient in a nursing home or helpless or blind or so nearly helpless or blind as to require the aid and attendance of another person.
**************************

40% In addition to the above:
• Automobile grant and/or special adaptive equipment for an automobile provided there is loss or permanent loss of use of one or both feet, loss or permanent loss of one or both hands or permanent impaired vision of both eyes with central visual acuity of 20/200 or less in better eye.
• Special adaptive equipment may also be applied for if there is ankylosis of one or both knees or one or both hips.
**************************

50% In addition to the above:
• VA Medical outpatient treatment for any condition except dental.
• Preventive health care services.
• Hospital care and medical services in non-VA facilities under an authorized fee basis agreement.
**************************

100% & TDIU In addition to the above:
• Dental treatment.
• Department of Defense Commissary privileges.
• Veteran’s employment preference for spouse.
• Waiver of National Service Life Insurance premiums.
• National Service Life insurance total disability income provisions.
**************************

100% & Some TDIU Permanent & Total  in addition to the above:
• Civilian Health and Medical Program for dependents and survivors (CHaMPVA)
• Survivors and dependents education assistance under Title 38 USC Chapter 35

• Specially adapted housing for veterans who have loss or permanent loss of use of both lower extremities or the loss or blindness in both eyes having light perception only plus loss or permanent loss of one lower extremity or the loss or permanent loss of use of one lower extremity with loss or permanent loss of use of one upper extremity or the loss or permanent loss of use of one extremity together with an organic disease which affects the function of balance and propulsion as to preclude locomotion without the aid of braces, crutches, canes or wheelchair.
• Special home adaptation Grant (for veterans who don’t qualify for Specially Adapted Housing) may be applied for if the veteran is permanently and totally disabled due to blindness in both eyes with visual acuity or 5/200 or less or loss of or permanent loss of use of both hands.

Special Benefits Continued

  

Today I want to talk  some more about special benefits, special being that you must be considered a severely disabled veteran to be awarded these benefits.

Specially Adapted Housing:

Seriously disabled veterans of any period of service, who cannot get around with out the aid of wheelchairs, braces, crutches, or canes may be entitled to a grant from the Department of Veteran Affairs for an adapted home.  These veterans must be entitled to compensation for permanent and total disability for the loss or loss of use of both legs; blindness in both eyes plus loss or loss of use of one lower extremity; or loss or loss of use of one lower extremity together with residuals of organic disease or injury which so effects the balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes or a wheelchair. (NOTE: Veterans rated TDIU may qualify for this benefit as long as they are also rated total and permanently disabled.)

Eligible veterans may receive a grant for up to 50% of the cost of their home or a maximum of $50,000.  A veteran is not required to use the total grant at one time. It can be used up to three times or until the $50,000 is exhausted.  The grant can be used as a down payment to pay part of the cost of a newly build adapted home or remodeling an existing home.  The grant may also be used to pay off the indebtedness of such homes already acquired and adapted by an eligible veteran. In addition, mortgage protection life insurance on specially adapted homes is available for up to $90,000 from the VA without further medical examination.

This grant is not paid directly to the veteran, but if awarded is placed in escrow and payment from it is controlled by written agreement between the veteran and the contractor after review of the VA Specialist in charge of the program. For more information review VA Pamphlet 2613 at:

http://www.homeloans.va.gov/pdf/VAPamphlet26-13.pdf

For application to apply for the grant,   VA FORM 26-4555 is necessary and located at:

http://www.vba.va.gov/pubs/forms/26-4555.pdf 

Also review the VA web cite at:   

 http://www.homeloans.va.gov/sah.htm 

This grant can be used in connection with a HISA grant of up to $4100. This grant is controlled at your local VA Medical Center Prosthesis Department. For more information concerning this grant review VA Handbook 1173.14 at:

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1580

Annual Clothing allowances: 

Any veteran  who is entitled to receive compensation for a service connected disability for which he or she wears or uses one or more prosthetic or orthopedic appliances, including a wheelchair, which the Department of Veterans Affairs determines tends to wear out or tear clothing, may be entitled to an annual clothing allowance . This allowance is usually paid on the last day of August each year.  This allowance is also available to veterans who have a skin condition who require the use of medication that causes irreparable damages to his/her clothing.

This benefit is administered your local VA Medical Center Prosthesis Department. You can apply for the grant using VA Form 21-8678 located at:  

http://www.vba.va.gov/pubs/forms/21-8678.pdf

You must apply for the clothing allowance every year for the first three years after the third year it is an automatic award.

Housebound Benefits: 

An additional amount of monthly compensation is provided for some seriously disabled veterans if they meet the following requirements:

The veteran must be have a  separately rated 100% service connected disability together with other service connected disability or disabilities rated at 60% or more, rending the veteran permanently housebound.  A veteran does not have to physically be housebound to receive this benefit. This benefit is payable regardless of the actual ability to leave the home or not. The benefits is payable at the S-rate of special compensation.

Aid & Attendance:  

A veteran who because of a severe service connected disability evaluated at 100% may be entitled to a special rate of monthly compensation when there is demonstrated the need for regular aid and attendance of another person. Such need exist when the veteran is unable to feed himself, dress or undress himself, or keep himself ordinarily clean and presentable. Eligibility may also be shown when the veteran is unable to attend to the wants of nature; or incapacities, physical or mental, which require care or assistance on a regular basis to protect the veteran from hazards of dangers incident to his daily environment. A veteran who is permanently bedridden because of service connected disabilities also meets the requirement for the aid an attendance benefit.  A veteran does not have to meet all of the requirements mentioned above, for example a veteran who may be able to feed his/her self but May required aid to get dressed qualifies for this compensation.

It is highly recommended that you request your primary care provider to write a letter or statement indicating the reasons that you need Aid and Attendance or House Bound compensation.

You may apply for Aid and Attendance or Housebound benefits by writing to the VA regional office having jurisdiction of the claim.   That would be the office where you filed a claim for pension benefits.  If the regional office of jurisdiction is not known, you may file the request with any VA regional office. Leave a comment if you are finding my blog entries useful or if you have a subject that you would like me to write about. Otherwise Stay tuned for my next blog entry concerning your Veterans Benefits.

Special Benefits

Today I want to talk about some special benefits, special being that you must be considered a severely disabled veteran to be awarded these benefits.

A. The Automobile Grant: 

Any veteran who as a result of an injury or disease incurred or aggravated by active service has suffered:

1. the loss or permanent loss of use of one or both feet;

2. the loss or permanent loss of use of one or both hands;

3. the permanent impairment of vision of both eyes to a certain prescribed degree: or

4. any member of the armed forces serving on active duty who is suffering from any disability described above, if such disability is the result of an injury incurred or a disease contracted in or aggravated by active military service; is entitled to assistance toward the purchase price of an automobile or other conveyance in an amount not to exceed $11000.00.

Application for this benefit is made on VA Form 21-4502, and should be referred to the Department of Veterans Affairs (your local regional office) for approval prior to any contractual agreement between the veteran and seller. As this is a one time payment only, there is no additional payment for those who may have received a prior grant.

Keep in mind you must be service connected for one of the conditions listed above,  If you request the automobile grant with out first being awarded service connection the automobile grant will be denied automatically.  You may request service connection for one of the conditions listed above at the same time you request the automobile adapted grant.

Once the approval has been made the VA Form 21-4502 will be signed by a VA representative and returned to you. Once you have received the grant you take the 21-4502 to any automobile dealer who will honor it as a cash down payment on any vehicle new or used.

Keep in mind some dealers will work with you better than others.  As an example a local dealer in San Antonio Texas will work with you to insure that you do not have to pay the Texas State sales tax at the time of purchase, while others will charge the tax, and you will have to request a refund from the state.  Some dealers will insure you know that they offer a $1000.00 rebate if you must adapt your vehicle with a wheelchair lift for example. You get this rebate regardless of who actually pays for the wheelchair lift, you or a VA program or some other grant.  Other dealers will allow you to use the adaptive equipment reimbursement program (if you are eligible) as part of your down payment if you are also granted adapted equipment.  (I will cover adaptive equipment for automobiles next.)  If you are a member of the Disabled American Veterans you will receive a special discount from Ford.  Considering all that I have mentioned a Veteran who needs a ramp equipped full size Van that has a raised roof can expect to pay about $40000.00 for such a van. Now with the right dealer and considering all the programs available as mentioned above a veteran needing such a van can expect as much as $25000.00 toward the purchased of the vehicle.  In my example the veterans own cost of the vehicle is $15000.00 which can be financed for up to 7 years (depending on the dealer).  For those veterans that need an adapted vehicle this is a wonderful program.

B. Adaptive Equipment: 

In addition to the automobile allowance of $11000, an eligible veteran or service member is also entitled to the adaptive equipment authorized by the VA as is necessary for the safe operation of the vehicle.

 The eligibility requirements for veterans to receive the adaptive equipment are based on;

1. the loss or permanent loss of use of one or both feet;

2. the loss or permanent loss of use of one or both hands;

3. the permanent impairment of vision of both eyes to a certain prescribed degree: or

4. any member of the armed forces serving on active duty who is suffering from any disability described above, if such disability is the result of an injury incurred or a disease contracted in or aggravated by active military service.

Automobile adaptive equipment eligibility may also be extended to veterans who receive disability compensation for ankylosis of one or both knees or hips. NOTE:  Veterans who have this level of disability are only eligible for the adaptive equipment and not the automobile adapted grant.

Automobile adaptive equipment may also be furnished to a Chapter 31 beneficiary when VR&E determines that adaptive equipment is necessary to overcome an employment handicap to which a service connected disability materially contributes and to achieve the goals of the program of rehabilitation.

Adapted equipment which is a part of, or added to a vehicle and which is specified for the claimant’s disability by directive of the Chief Medical Director, qualifies as adaptive equipment.

There is an exception to the above rules of eligibility.  Blind applicants nor any other case where the veteran or service member must have a driver because of physical disability or lack of a valid state drivers license or learners permit will be granted adapted equipment.

In some instances a veteran will be referred to a VA drivers training program specialist. The specialist will determine what adaptive equipment the veteran needs and will write a prescription to conform to the needs of the veteran. Unlike the automobile adaptive grant which is administered by the regional offices, the adaptive equipment program is administered at the local VA Medical Center within the Prosthesis Department.  If you are authorized adapted equipment you can only have two vehicles in the program.

For more on the automobile adaptive equipment download VA Handbook 1173.4

For more information concerning the VA Drivers Rehabilitation Program download VA Handbook 1173.16,

For application of the automobile adaptive grant and adaptive equipment download VA Form 21-4502

For adaptive equipment reinbursement rates down load VHA Directive 2006- 034

http://www.vvic.org/pdfs/Forms/VA%20Form%2021-4502.pdf

http://www.vvic.org/pdfs/Forms/VA%20Form%2021-4502.pdf

 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=435 

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1430

Look for my next installment concerning special benefits coming soon! 

Title 38: Pensions, Bonuses, and Veterans’ Relief Part 3

(Authority: 38 U.S.C. 1155)[41 FR 11293, Mar. 18, 1976, as amended at 54 FR 27161, June 28, 1989; 54 FR 36029, Aug. 31, 1989]

§ 4.26   Bilateral factor.

When a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before proceeding with further combinations, or converting to degree of disability. The bilateral factor will be applied to such bilateral disabilities before other combinations are carried out and the rating for such disabilities including the bilateral factor in this section will be treated as 1 disability for the purpose of arranging in order of severity and for all further combinations. For example, with disabilities evaluated at 60 percent, 20 percent, 10 percent and 10 percent (the two 10’s representing bilateral disabilities), the order of severity would be 60, 21 and 20. The 60 and 21 combine to 68 percent and the 68 and 20 to 74 percent, converted to 70 percent as the final degree of disability.(a) The use of the terms “arms” and “legs” is not intended to distinguish between the arm, forearm and hand, or the thigh, leg, and foot, but relates to the upper extremities and lower extremities as a whole. Thus with a compensable disability of the right thigh, for example, amputation, and one of the left foot, for example, pes planus, the bilateral factor applies, and similarly whenever there are compensable disabilities affecting use of paired extremities regardless of location or specified type of impairment.(b) The correct procedure when applying the bilateral factor to disabilities affecting both upper extremities and both lower extremities is to combine the ratings of the disabilities affecting the 4 extremities in the order of their individual severity and apply the bilateral factor by adding, not combining, 10 percent of the combined value thus attained.(c) The bilateral factor is not applicable unless there is partial disability of compensable degree in each of 2 paired extremities, or paired skeletal muscles.

§ 4.27   Use of diagnostic code numbers.

The diagnostic code numbers appearing opposite the listed ratable disabilities are arbitrary numbers for the purpose of showing the basis of the evaluation assigned and for statistical analysis in the Department of Veterans Affairs, and as will be observed, extend from 5000 to a possible 9999. Great care will be exercised in the selection of the applicable code number and in its citation on the rating sheet. No other numbers than these listed or hereafter furnished are to be employed for rating purposes, with an exception as described in this section, as to unlisted conditions. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part, or system, of the body involved; the last 2 digits will be “99” for all unlisted conditions. This procedure will facilitate a close check of new and unlisted conditions, rated by analogy. In the selection of code numbers, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With diseases, preference is to be given to the number assigned to the disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. Thus, rheumatoid (atrophic) arthritis rated as ankylosis of the lumbar spine should be coded “5002–5240.” In this way, the exact source of each rating can be easily identified. In the citation of disabilities on rating sheets, the diagnostic terminology will be that of the medical examiner, with no attempt to translate the terms into schedule nomenclature. Residuals of diseases or therapeutic procedures will not be cited without reference to the basic disease.[41 FR 11293, Mar. 18, 1976, as amended at 70 FR 75399, Dec. 20, 2005]

§ 4.28   Prestabilization rating from date of discharge from service.

The following ratings may be assigned, in lieu of ratings prescribed elsewhere, under the conditions stated for disability from any disease or injury. The prestabilization rating is not to be assigned in any case in which a total rating is immediately assignable under the regular provisions of the schedule or on the basis of individual unemployability. The prestabilization 50-percent rating is not to be used in any case in which a rating of 50 percent or more is immediately assignable under the regular provisions.

   Rating
Unstabilized condition with severe disability—  
Substantially gainful employment is not feasible or advisable

100

Unhealed or incompletely healed wounds or injuries—  
Material impairment of employability likely

50

Note (1): Department of Veterans Affairs examination is not required prior to assignment of prestabilization ratings; however, the fact that examination was accomplished will not preclude assignment of these benefits. Prestabilization ratings are for assignment in the immediate postdischarge period. They will continue for a 12-month period following discharge from service. However, prestabilization ratings may be changed to a regular scheduler total rating or one authorizing a greater benefit at any time. In each prestabilization rating an examination will be requested to be accomplished not earlier than 6 months nor more than 12 months following discharge. In those prestabilization ratings in which following examination reduction in evaluation is found to be warranted, the higher evaluation will be continued to the end of the 12th month following discharge or to the end of the period provided under §3.105(e) of this chapter, whichever is later. Special monthly compensation should be assigned concurrently in these cases whenever records are adequate to establish entitlement.Note (2): Diagnosis of disease, injury, or residuals will be cited, with diagnostic code number assigned from this rating schedule for conditions listed therein.[35 FR 11906, July 24, 1970]

§ 4.29   Ratings for service-connected disabilities requiring hospital treatment or observation.

A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established that a service-connected disability has required hospital treatment in a Department of Veterans Affairs or an approved hospital for a period in excess of 21 days or hospital observation at Department of Veterans Affairs expense for a service-connected disability for a period in excess of 21 days.(a) Subject to the provisions of paragraphs (d), (e), and (f) of this section this increased rating will be effective the first day of continuous hospitalization and will be terminated effective the last day of the month of hospital discharge (regular discharge or release to non-bed care) or effective the last day of the month of termination of treatment or observation for the service-connected disability. A temporary release which is approved by an attending Department of Veterans Affairs physician as part of the treatment plan will not be considered an absence.(1) An authorized absence in excess of 4 days which begins during the first 21 days of hospitalization will be regarded as the equivalent of hospital discharge effective the first day of such authorized absence. An authorized absence of 4 days or less which results in a total of more than 8 days of authorized absence during the first 21 days of hospitalization will be regarded as the equivalent of hospital discharge effective the ninth day of authorized absence.(2) Following a period of hospitalization in excess of 21 days, an authorized absence in excess of 14 days or a third consecutive authorized absence of 14 days will be regarded as the equivalent of hospital discharge and will interrupt hospitalization effective on the last day of the month in which either the authorized absence in excess of 14 days or the third 14 day period begins, except where there is a finding that convalescence is required as provided by paragraph (e) or (f) of this section. The termination of these total ratings will not be subject to §3.105(e) of this chapter.(b) Notwithstanding that hospital admission was for disability not connected with service, if during such hospitalization, hospital treatment for a service-connected disability is instituted and continued for a period in excess of 21 days, the increase to a total rating will be granted from the first day of such treatment. If service connection for the disability under treatment is granted after hospital admission, the rating will be from the first day of hospitalization if otherwise in order.(c) The assignment of a total disability rating on the basis of hospital treatment or observation will not preclude the assignment of a total disability rating otherwise in order under other provisions of the rating schedule, and consideration will be given to the propriety of such a rating in all instances and to the propriety of its continuance after discharge. Particular attention, with a view to proper rating under the rating schedule, is to be given to the claims of veterans discharged from hospital, regardless of length of hospitalization, with indications on the final summary of expected confinement to bed or house, or to inability to work with requirement of frequent care of physician or nurse at home.(d) On these total ratings Department of Veterans Affairs regulations governing effective dates for increased benefits will control.(e) The total hospital rating if convalescence is required may be continued for periods of 1, 2, or 3 months in addition to the period provided in paragraph (a) of this section.(f) Extension of periods of 1, 2 or 3 months beyond the initial 3 months may be made upon approval of the Veterans Service Center Manager.(g) Meritorious claims of veterans who are discharged from the hospital with less than the required number of days but need post-hospital care and a prolonged period of convalescence will be referred to the Director, Compensation and Pension Service, under §3.321(b)(1) of this chapter.[29 FR 6718, May 22, 1964, as amended at 41 FR 11294, Mar. 18, 1976; 41 FR 34256, Aug. 13, 1976; 54 FR 4281, Jan. 30, 1989; 54 FR 34981, Aug. 23, 1989; 71 FR 28586, May 17, 2006]

§ 4.30   Convalescent ratings.

A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted under paragraph (a) (1), (2) or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. The termination of these total ratings will not be subject to §3.105(e) of this chapter. Such total rating will be followed by appropriate schedular evaluations. When the evidence is inadequate to assign a schedular evaluation, a physical examination will be scheduled and considered prior to the termination of a total rating under this section.(a) Total ratings will be assigned under this section if treatment of a service-connected disability resulted in:(1) Surgery necessitating at least one month of convalescence (Effective as to outpatient surgery March 1, 1989.)(2) Surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited). (Effective as to outpatient surgery March 1, 1989.)(3) Immobilization by cast, without surgery, of one major joint or more. (Effective as to outpatient treatment March 10, 1976.)A reduction in the total rating will not be subject to §3.105(e) of this chapter. The total rating will be followed by an open rating reflecting the appropriate scheduler evaluation; where the evidence is inadequate to assign the scheduler evaluation, a physical examination will be scheduled prior to the end of the total rating period.(b) A total rating under this section will require full justification on the rating sheet and may be extended as follows:(1) Extensions of 1, 2 or 3 months beyond the initial 3 months may be made under paragraph (a) (1), (2) or (3) of this section.(2) Extensions of 1 or more months up to 6 months beyond the initial 6 months period may be made under paragraph (a) (2) or (3) of this section upon approval of the Veterans Service Center Manager.[41 FR 34256, Aug. 13, 1976, as amended at 54 FR 4281, Jan. 30, 1989; 71 FR 28586, May 17, 2006]

§ 4.31   Zero percent evaluations.

In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.[58 FR 52018, Oct. 6, 1993]