VA Eligibility for Healthcare

26 Feb VA Eligibility for Healthcare

To be eligible for the Medical Benefits Package offered by the VA, a service member must have served in an active-duty capacity.

For members of the Air Force, Army, Coast Guard, Marine Corps, or Navy, eligibility is based on an active-duty service term of at least 24 months (for service after September of 1980).

For members of the National Guard or Reserve, eligibility is based on serving in an active-duty capacity during the full term of activation.

In both cases, eligibility is contingent upon an honorable discharge or release under honorable conditions.

Enhanced Eligibility

The minimum service requirements may not apply in the following circumstances:

• Veterans discharged for a service-connected or service-aggravated disability
• Veterans discharged for a hardship or “early out”
• Veterans whose active-duty service occurred before September 7, 1980

Also, the following classes of veterans may be given enhanced VA eligibility status:

• Veterans with a compensable service-connected disability of at least 10%
• Veterans receiving a VA pension
• Veterans whose annual household income is below the VA’s National Income or Geographical-Adjusted Thresholds
• Veterans determined by the VA to be Catastrophically Disabled
• Former Prisoners of War (POWs)
• Purple Heart Medal recipients
• Medal of Honor recipients
• Veterans having served in the Vietnam Conflict from January 9, 1962, to May 7, 1975, or on associated Navy or Coast Guard ships
• Veterans who were stationed at or resided at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987
• Veterans having served in the Persian Gulf from August 2, 1990, to November 11, 1998

Enhanced Eligibility for Combat Veterans

Veterans who have served in a theater of combat operations after November 11, 1998, and who have been discharged on or after January 28, 2003, will have enhanced VA benefits eligibility for 5 years after their discharge from service.

While these combat veterans will still be eligible for VA benefits after that time period, VA eligibility and level of covered care will be determined on more limiting factors like financial need, VA pension status, compensable service-connection rating, and the degree to which the veteran suffers from a catastrophic disability.

Determining VA eligibility and one’s priority rating after the 5-year mark using these considerations alone may result in the veteran being placed at a lower priority level than they would have been entitled to during the enhanced eligibility period.  It is therefore in a combat veteran’s best interest to apply for VA enrollment within 5 years of discharge, regardless of whether or not they are in need of coverage during that time.

Military Service Record Requirement for Enhanced Eligibility

To verify enhanced benefit eligibility for VA benefits, the VA will require a copy of the veteran’s DD Form 214, “Certificate of Release or Discharge from Active Duty.”  This form provides a complete record of military service, including the period of service, awards, honors, and combat service.

Members of the Air National Guard or the Army National Guard will receive an NGB Form 22, “National Guard Report of Separation and Record of Service,” that provides the same information.

To request a copy of your DD Form 214/NGB Form 22, visit https://www.archives.gov/veterans/military-service-records

Service-Connected Injury Or Disability

Any injury or disability incurred during military service or that was aggravated during military service will qualify as a service-connected injury or disability, unless the veteran was injured or disabled:

• During the commission of a crime, or
• While undertaking actions that demonstrate a reckless disregard for the veteran’s safety

Deployment Health Assessments

All deploying service members are required to fill out three deployment-related health assessments for each deployment:

• DD Form 2795, “Pre-Deployment Health Assessment”
• DD Form 2796, “Post-Deployment Health Assessment,” or “PDHA”
• DD Form 2900, “Post-Deployment Health Reassessment,” or “PDHRA” (focuses on psychological health, i.e., possible PTSD)

In addition to the DD Form 214, which will provide the VA with an overview of the veteran’s service record, the VA will also review these deployment health assessments to determine VA eligibility, particularly with regard to whether an injury or disability is service-connected or not.  A determination that an injury or disability is nonservice-connected will result in a lower priority rating for benefits.