08 Sep Eligibility and Enrollment
VA Medical Care Eligibility and Enrollment
A military discharge characterization that the VA determines is other than dishonorable is compulsory to receive VA medical care through the healthcare system. Before comprehending priority groups a veteran is applicable to, how and where to enroll, and when the VA’s services start, they must first meet the minimum military service necessities.
Minimum service requirements
Veterans are entitled for benefits with the VA healthcare program with at least one day of active-duty service before September 8, 1980 as an enlisted member, or before October 17, 1981 as an officer. If these qualifications are not possible, the veteran must have 24 months of unbroken active-duty military service in order to be granted VA medical benefits unless:
- The veteran was a Reservist or member of the National Guard who served in federal active duty, finished the whole term for which they were called
- The veteran was discharged from active duty for reasons concerning misfortune
- The veteran was discharged with an early out (an example of which would be when the military was experiencing downscaling)
- The veteran was discharged or let go from active duty in light of a disability sustained during or exacerbated by time serving
- The veteran has a service-related disability evaluated by the VA that entitles them to compensation.
- The veteran was discharged for reasons other than a disability and had a medical condition during that time considered disabling by a doctor who would justify a discharge for disability. The disability in question should be clearly documented in the veteran’s military medical records.
An individual would not be required to qualify for the minimum service requirements if they only wish to receive medical benefits in relation to:
- A service-related disability or medical condition.
- Treatment and/or counseling of sexual trauma having occurred during active military service related earlier in this chapter
- Treatment of conditions related to ionizing radiation
- Head or neck cancer concerning nose or throat radium treatment during military service
Enrolling in the right group
Congress allots a finite sum to the VA each year that doesn’t always cover all the costs the VA requires so the VA has established priority groups in which particular groups of veterans can be enrolled before others. Group 1 of eight categories, is the highest priority for enrollment in the VA healthcare system.
If a veteran happens to be eligible for more than one of these categories, the VA places them in the highest category they’re applicable to.
Though some qualifications can be more burdensome, most of the qualifications for the VA groups are uncomplicated.
Below is a list and summary of each VA veteran group:
- Group 1, 50 percent disabled: As described in chapter 6, if a veteran receives a rating by the VA as 50 percent or more disabled with a service-related disability, they’re eligible to receive the highest category. Veterans considered unemployable are also included in this category.
- Group 2, 30 percent disabled: Veterans with a service-related disability the VA rates at 30 or 40 percent disabled are categorized in Group 2.
- Group 3, 10 percent disabled: Veterans with a service-related disability the VA rates at 10 or 20 percent disabled are categorized in Group 3. Other inclusions for Group 3 include:
- Veterans who are former prisoners of war (POWs)
- Veterans award the Purple Heart medal
- Veterans who were discharged because of a disability sustained during service or was agitated in the line of duty
- Veterans who became disabled through treatment or vocational rehabilitation from a VA facility
- Group 4, veterans receiving aid: Group 4 consists of veterans that need in-home aid or assistance or are housebound and as a result receive VA pension in addition to monthly compensation from the VA.
Group 4 additionally includes veterans with irreversible, extreme disabilities—known as catastrophically disabled conditions—that warrant personal or mechanical assistance to move from a bed or home, or consistent supervision. The veteran qualifies for this categorization even if the disability is not service-related.
- Group 5, veterans receiving pensions: Group 5 includes individuals who get a VA pension or those who are eligible to get a VA pension.
Veterans with little income or few properties that rate below the VA’s national income limit are included in Group 5 as well as those applicable for state Medicaid programs. Read more about this circumstance in the section “Addressing Financial Concerns.”
- Group 6, special periods of service: This category covers veterans who have participated in World War I. Also included are veterans who have served in a combat zone after November 11, 1998. The latter veterans’ qualifications are as follows:
- The veteran was discharged from active duty on or after January 28, 2003 and have been registered in the VA medical program as of January 28, 2008
- The veteran applied for enrollment after January 28, 2008 (these veterans can enroll to be categorized automatically in Group 6 for five years after discharge)
- The veteran was discharged from active duty before January 28, 2003 and applied for enrollment after January 28, 2008 until January 27, 2011
A veteran must have served at least one day of active-duty in a designated combat zone to be automatically entitled for categorization in Group 6.
As explained in Chapter 6, veterans with service-related medical conditions or disabilities rated by the VA as zero percent disabling are also entitled to Group 6.
Group 6 also includes veterans exposed to ionizing radiation resulting from testing development or employment of the atom bomb in World War II. Ionizing radiation may have effected some atomic veterans in some way in multiple locations. Any veterans exposed at a nuclear device testing site such as the Pacific Islands, Bikini, New Mexico, Nevada, or during the occupation of Hiroshima or Nagasaki are included as well.
Veterans having served during the Vietnamese War and were exposed to Agent Orange are also eligible for Group 6. These veterans are required to have served active-duty in Vietnam between January 9, 1962 and May 7, 1975, and have suffered from one of the following conditions that the National Academy of Sciences determined as evidence of a possible connection with herbicide exposure:
- Acute and subacute peripheral neuropathy
- Adult-onset diabetes (Type 2)
- Chronic lymphocytic leukemia (CLL)
- Hodgkin’s disease
- Multiple myeloma
- Non-Hodgkin’s lymphoma
- Porphyria cutanea tarda
- Primary amyloidosis
- Prostate cancer
- Respiratory cancers such as cancer of the lung, bronchus, larynx, or trachea
- Soft-tissue sarcoma (but not including osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma)
Group 6 also includes Gulf War veterans who served in Operations Desert Shield, Desert Storm, and Iraqi Freedom that might be effected by any of the many medical condition attributable to “Gulf War Illness”.
More information regarding the Gulf War Illness, visit the VA website at www.publichealth.va.gov/exposures/gulfwar/.
Group 6 also includes veterans who served in Project 112/SHAD.
Project SHAD, an acronym for Shipboard Hazard and Defense, was directed during the 1960’s as an effort in the larger Project 112. Project 112 consisted of the development of biological and chemical weapons and was organized by the United States Department of Defense. Project SHAD was designed to test the susceptibility of U.S. warships during chemical agent or biological warfare agent attacks and provide measures by which to operate in the event that such an attack occur. This project was also concerned with warships upholding war-fighting aptitude after being attacks with such agents. Many of the veterans involved in Project SHAD were exposed to multiple chemical and biological agents that may have caused averse medical conditions.
- Group 7, veterans with low incomes: Veterans not eligible for Groups 1 through 6 that have an annual income of net worth above the VA’s national income limit but their income is below the Department of Housing and Urban Development’s (HUB) income rating for the area in which they live qualify for Group 7. Read the section “Addressing Financial Concerns” for additional information concerning the VA’s national income limits and the geographical income threshold.
If a veteran has income limits below both the national income limits and the HUD’s geographic income threshold, they are categorized in Group 5.
If a veteran qualifies for Group 7 they are obligated to pay co-pays also addressed in “Addressing Financial Concerns.”
- Group 8, all others: Veterans in group 8 include those who don’t fit into Group 1 through 7. This generally includes those who have annual incomes or net worth above both the VA’s national income limit and HUD’s geographic income threshold. More on this is found in the section “Addressing Financial Concerns.”
Veterans in Group 8 are obligated to pay for a share of their medical care. Read more about this rule in “Addressing Financial Concerns.”
Since January 16, 2003, the VA no longer accepts new enrollments for Group 8. Those having enrolled before January 16, 2003, will remain enrolled and eligible for Group 8.
Making a case for VA medical care
To apply for VA healthcare, veterans must complete VA Form 10-10EZ, Application for Health Benefits. Veterans can obtain this form from any of the VA medical centers or in Appendix C or have a copy of the form mailed to them by contacting the VA’s Health Benefits Service Center by calling toll free at 877-222-8387 (877-222-VETS). The Service Center is open Monday through Friday from 7 a.m. to 8 p.m. eastern time.
The VA Form 10-10EZ is accessible in PDF form at https://www.vets.gov/health-care/apply/.
Veterans can mail the completed VA Form 10-10EZ to a VA medical center near them.
Applying for the VA Form 10-10EZ face-to-face is also possible by visiting a VA medical center. Visiting a VA medical center can be advantageous, as staff members can are obligated to help veterans fill out the form.
It is important to attach evidence of military service and discharge characterization if a veteran is not already enrolled in the VA system.
After receiving a request and enrolling and categorizing them in a priority group, the VA is required to notify the veteran by mail with this information. Read more about priority groups in “Making sure you enroll in the right group.”
Not everyone is required to enroll
Generally, veterans must be enrolled in the VA healthcare program in order to be granted medical benefits. However, a veteran doesn’t have to be enrolled if they:
- Have been categorized as 50 percent or more disabled from service-related conditions by the VA’s rating system explained in Chapter 6
- Need service for a VA-rated, service-related disability only
- Were discharged less than one year prior for a disability the military decided was caused or agitated by military service, unrated by the VA.
Making a first appointment
Individuals do not have to wait for confirmation of enrollment to make an appointment for medical care. If a veteran applies in person they are able to make their first appointment during their application. If applying outside of a VA medical center, the VA application form has a section in which a request for appointment can be scheduled.
However, there is a priority system used by the VA when making appointments. Those with service-related disabilities of 50 percent or more and veterans in need of care for service-related medical conditions are granted priority of appointment within 30 days. Other veterans are scheduled for a primary-care appointment at first availability.