Yuku free message boards

Quote:

---

All they are there to do is to try and figure out what has happened and relay that info to you.

Unfortunately many veterans attempt to use the 800 number for things for which it was not originally intended. It was designed to be a means by which veterans could get information about VA benefits, how to file a claim, and to obtain the necessary forms and information. To a lesser extent it was there to assist with problem resolution. Please note that I said "assist". They don't have the authority to go around giving orders to other departments in the Regional Office or Medical Center.

Over time and with the development of the large backlog, veterans have started using this asset as a means of trying to track their claims through the claims process. This is very difficult without having the claims folder in hand as there is often more than one thing going on and even if there isn't, some individual aspects of the process, such as disability ratings, are so complex that usually the Rating Specialist or DRO can't tell you what is going to happen next until they have conducted a thorough review of the evidence.

That's why I tell folks that this isn't like tracking a package with UPS. While UPS can tell you exactly WHERE your package is and where it will go next, VA claims processing is much more complex and technical. They may be able to tell you where the file is at a particular point in time, but that's about all. They can't tell you with certainty what is going to happen to it or where it will go next until someone sits down with it and makes that decision based on the evidence.

Some folks get to be "regulars" to the phone people. They call on a regular basis to try and track their claim. While I can certainly sympathize with them having to wait so long because of the backlog, all this does is further burden and already overburdened claims process. This isn't the fault of the folks at the Regional Office. They are doing the best they can with what they are given.

Cruiser

---

VHA DIRECTIVE 2008-070, October 28, 2008
http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1789


4. ACTION


b. Facility Director. The facility Director is responsible for:

(1) Ensuring access to audiology and eye care services including preventive health (care) services and routine vision testing for all enrolled veterans and those veterans exempt from enrollment. Eyeglasses and hearing aids must be provided to the following veterans:

(a) Those with any compensable service-connected disability.

(b) Those who are former Prisoners of War (POWs).

(c) Those who were awarded a Purple Heart.

(d) Those in receipt of benefits under Title 38 United States Code (U.S.C.) 1151.

(e) Those in receipt of an increased pension based on being permanently housebound and in need of regular aid and attendance.

(f) Those with vision or hearing impairment resulting from diseases or the existence of another medical condition for which the veteran is receiving care or services from VHA, or which resulted from treatment of that medical condition, e.g., stroke, polytrauma, traumatic brain injury, diabetes, multiple sclerosis, vascular disease, geriatric chronic illnesses, toxicity from drugs, ocular photosensitivity from drugs, cataract surgery, and/or other surgeries performed on the eye, ear, or brain resulting in vision or hearing impairment.

(g) Those with significant functional or cognitive impairment evidenced by deficiencies in the ability to perform activities of daily living.

(h) Those who have vision and/or hearing impairment severe enough that it interferes with their ability to participate actively in their own medical treatment and to reduce the impact of dual sensory impairment (combined hearing and vision loss). NOTE: The term "severe" is to be interpreted as a vision and/or hearing loss that interferes with or restricts access to, involvement in, or active participation in health care services (e.g., communication or reading medication labels). The term is not to be interpreted to mean that a severe hearing or vision loss must exist to be eligible for hearing aids or eyeglasses.

(i) Those veterans who have service-connected vision disabilities rated zero percent or service-connected hearing disabilities rated zero percent if there is organic conductive, mixed, or sensory hearing impairment, and loss of pure tone hearing sensitivity in the low, mid, or high-frequency range or a combination of frequency ranges which contribute to a loss of communication ability; however, hearing aids are to be provided only as needed for the service-connected hearing disability.

(2) Ensuring that hearing aids are provided in accordance with the following policies:

(a) Hearing aids must be issued only to eligible veterans who are otherwise receiving VA care or services in accordance with 38 CFR §17.149 and this Directive.

(b) Veterans meeting the eligibility requirements to receive health care are eligible for diagnostic audiology services. Eligibility rules are the same for both inpatient and outpatient medical services. Veterans must not be denied access to audiology services covered by the Medical Benefits Package (38 CFR §17.38) because they do not meet the eligibility criteria for hearing aids.

(c) Audiologists must utilize the Remote Order Entry System (ROES) to review and request eligibility for hearing aids; by requesting the hearing aid in ROES, the audiologist stipulates that medical need exists based on the evaluation. Veterans in Priority Groups 1-5 are eligible for hearing aids.

(d) Non-service connected (NSC) veterans (Priority Groups 6, 7, and 8 ) must receive a hearing aid evaluation (HAE) prior to determining eligibility for hearing aids to establish medical justification for provision of these devices. These veterans must meet the following criteria for eligibility based on medical need:

1. Be enrolled or exempt from enrollment and receiving a vested level of care from a VA medical facility; and

2. Have hearing loss that interferes with or restricts communication to the extent that it affects their active participation in the provision of health care services as determined by the audiologist (see paragraph 4.c).

(e) Prosthetics must approve the ROES request when medical need is established. The cost of hearing aids is not a basis for denying these devices.

(f) In those instances where the veteran presents to the audiology clinic with a hearing aid provided from a non-VA source, the audiologist determines the effectiveness of the device in meeting the veteran's rehabilitative needs. If the device is sufficient for the veteran's needs, no device will be prescribed, but the audiologist may register the hearing aids through ROES for battery and repair services. If the device is not sufficient for the veteran's needs, the audiologist must apply the replacement provisions detailed in this Directive (see subpar. 4c(4)).

(3) Ensuring that eyeglasses are provided in accordance with the following policies:

(a) Eyeglasses are issued only to eligible veterans who are otherwise receiving VA care or services in accordance with 38 CFR §17.149 and this Directive.

(b) In accordance with 38 U.S.C .§1701 and enabling regulations (38 CFR §17.38), all enrolled veterans or those exempt from enrollment are entitled to optometric and ophthalmologic services as well as preventive health (care) services that include routine vision testing and eye care services.

(c) Veterans meeting the eligibility requirements to receive health care are eligible for eye care services. Eligibility rules are the same for both inpatient and outpatient medical services. Veterans must not be denied access to eye and vision care services covered under the Medical Benefits Package (38 CFR §17.38) because they do not meet the eligibility criteria for eyeglasses. Veterans in Priority Groups 1-5 are eligible for eyeglasses.

(d) NSC veterans (Priority Groups 6, 7, and 8 ) must receive an appropriate evaluation by an optometrist or ophthalmologist, prior to determining eligibility for eyeglasses, to establish medical justification for provision of these devices. In those instances where the veteran presents to the eye clinic with eyeglasses provided from a VA or non-VA source, the eye care practitioner or provider determines the effectiveness of the device in meeting the veteran's rehabilitative needs. If the device is sufficient for the veteran's needs, no device will be prescribed. If the device is not sufficient for the veteran's needs, the eye care practitioner or provider will apply the replacement provisions detailed in this Directive. These veterans must meet the following criteria for eligibility based on medical need:

1. Be enrolled or exempt from enrollment and receiving a vested level of care from a VA medical facility; and

2. Have vision loss that interferes with or restricts communication, quality of life or activities of daily living to the extent that it affects their active participation in the provision of health care services as determined by the eye care practitioner or provider (see subpar. 4d).

******************************

For additional information, please click on the site noted above to read the full document.

EXCERPTS FROM

VHA HANDBOOK 1130.01, December 24, 2008
http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=1817


10. ELIGIBILITY FOR DENTAL CARE

a. General

(1) VA Dental Services examine and treat eligible inpatient and outpatient beneficiaries. Eligibility for dental care is governed by statute and provided in accordance with the provisions of existing law and regulations as cited in United State Code., sections 1710(c) and 1712, and Title 38 Code of Federal Regulations (CFR) sections 17.160 through 17.166. Dental eligibility is determined in a different manner than medical eligibility. The Business Office, Health Eligibility Center, holds responsibility for verification of administrative aspects of dental eligibility. It is the responsibility of the Dental Service Chief to make determinations on all clinical aspects of dental eligibility.

(2) It is not the established mission of VA to provide dental care to all veterans or even to all those who are hospitalized. The extent of treatment is determined through an understanding of the patient's dental classification and the appropriate scope of dental care to be provided based on that classification.

b. Dental Classification. The laws and regulations mandate dental care as a benefit for defined veteran groups. Specific dental classifications have been established that further define patient groups and the appropriate scope of care based on that classification. The nuances of the classifications are addressed in the Inpatient, Outpatient and Long Term Care sections of this Handbook. Also see Appendix A for the Scope of Care Quick Reference Guide.

(1) The following patient groups are included in the defined dental classification scheme and are to be provided dental care in compliance with VHA regulations and Directives:

(a) Residents of VA Residential Rehabilitation Treatment Programs, including Domiciliaries.

(b) VA Community Living Center (formerly known as Nursing Home Care Unit) residents.

(c) Inpatients with compelling medical need for dental treatment.

(d) Patients having a compelling medical need that requires completion of dental care initiated while an inpatient.

(e) Outpatient Dental Class I through VI beneficiaries.

(f) Outpatients with dental emergencies.

(2) The following patient groups are included in the defined dental classification scheme and may be provided dental care if clinic capacity is available.

(a) Hospitalized veterans whose dental conditions are not considered to be adjunct to their medical problems.

(b) Inpatients without other dental entitlement who are active duty military personnel or military retirees.

(c) Specially designated inpatients and outpatients such as those provided for under approved sharing agreements.


11. OUTPATIENT DENTAL PROGRAM

a. Overview. The goal of VA Dental Services is to provide high quality, cost-effective dental treatment to eligible veterans. All VA dentists will be knowledgeable regarding the scope of care to be provided that is consistent with the patient's dental classification.

b. Persons Eligible for Outpatient Dental Care. Statutory eligibility for outpatient dental care is granted to veteran beneficiaries and is provided in accordance with existing law and regulations. Classes of eligible dental outpatients are as follows:

(1) Class I.

(a) Veterans having a compensable (10% or greater), service connected dental disability or condition (combat or non-combat related) rated under the 9900 series of the Schedule for Rating Disabilities (See Appendix B) are eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care.

(b) Appropriate dental authorization for outpatient dental care for veterans that have other rated, compensable service connected conditions of the head and neck area is sometimes confusing. Conditions such as loss of soft tissue, scarring or cranial nerve involvement may have significant impact on oral function even though there may be no physical trauma to the dental structures, per se. These non-dental conditions are not rated under the 9900 series, are considered medical conditions and are not eligible under Class I. The decision as to whether or not dental care will be authorized as adjunctive care (either as Class III or Class VI) will be determined by the Chief, Dental Service, or designee and based on the same criteria as for other medical conditions.

(2) Class II. Veterans having a noncompensable, service connected dental disability shown to have been in existence at the time of discharge or release from active duty may be provided any treatment as reasonably necessary for the one-time correction of the noncompensable, service connected dental disability if all of the following criteria are met:

(a) They are discharged or released from active duty under conditions other than dishonorable, from a period of active military service of not less than 180 days. In the case of Gulf War Era, Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans, they are discharged or released from active duty under conditions other than dishonorable from a period of active military service of not less than 90 days.

(b) Application for dental treatment is made within 180 days of discharge or release from active duty.

(c) The certificate of discharge or release certifies that the veteran was not provided, within the 90 day period immediately before discharge or release, a complete dental examination (including dental radiographs) and all appropriate dental treatment indicated by the examination was completed. This certification is found on the DD214, line 17.

(d) Scope of care for Class II.

1. One Episode of Class II Care. When Class II eligibility for a one-time episode of dental care has been exhausted by satisfactory completion of the authorized treatment, no further care will be provided. Class II dental beneficiaries who (through no fault of the VA) have not completed authorized treatment within 3 years after filing the application shall be presumed to have abandoned the claim for dental treatment.

2. Dental Prostheses and Implants Provided by VA. Class II dental beneficiaries are not entitled to long term maintenance of fixed or removable dental prostheses or dental implants. Once adjustments are satisfactory, the episode of prosthetic care is considered to be complete and subsequent treatment is the responsibility of the patient.

3. Periodontal Conditions. Specific treatment authorized for periodontal conditions of Class II beneficiaries is expected to provide maximum benefit by the time that episode of care is completed. When that treatment is satisfactorily completed as authorized, VA will not furnish any further treatment or follow-up for the periodontal condition.

4. Impacted Teeth. Impacted teeth are a developmental condition. Consideration for surgical extraction should be based on sound professional judgment to resolve existing disease or symptoms.

5. Malposed Teeth. Malposed teeth are considered a developmental abnormality and a pre-existing condition. VA will not provide orthodontic care in this circumstance. For cases in which trauma incurred in the line of duty resulted in malalignment of the teeth or when restorative procedures for which the patient is eligible require orthodontic intervention, orthodontic care may be provided.

6. Veterans with Orthodontic Appliances. When veterans arrive at VA facilities with orthodontic appliances for the purpose of correcting developmental malocclusion and have not had their treatment completed by the military prior to discharge, they need to be instructed to contact the dental clinic at their last active duty military assignment to arrange for completion of the care. If the military does not complete the orthodontic treatment, VA is not obligated to assume the responsibility of any phase of the orthodontic care unless directly related to rehabilitation of combat trauma to the maxillofacial region.

7. Service Connection of Dental Conditions for Treatment Purposes. Veterans Benefits Administration (VBA) may, upon request, provide documentation to the Dental Service defining service connection of specific teeth for dental treatment purposes. (38 CFR 3.381). The regulation provides for identification of teeth treated during military service, and applies only to Class II beneficiaries who have met the criteria as specified in Para. 11 b.(2)(a-c). The Chief or designee can use the document to assist in development of appropriate treatment recommendations.

(3) Class IIA. Those veterans having a noncompensable, service connected dental disability adjudicated as resulting from combat wounds or service trauma are eligible for repeat care and maintenance or replacement of the involved tooth/teeth. A Dental Trauma Rating (VA Form 10-564-D) or VA Regional Office Rating Decision letter (VA Form 10-7131) identifies the tooth/teeth eligible for care. Public Law 83, 84th Congress, Chapter 52, H.R. 5100, Approved June 16, 1955 invalidates old dental ratings and eligibility letters dated before 1955. Prior to 1955, teeth that received routine dental care while the veteran was on active duty were listed as "service connected". Patients with these dental ratings are not eligible for repeat care for the listed "service connected" teeth.

(4) Class IIC. Veterans who were Prisoners of War (POWs) are eligible for any needed dental care, including repeat care.

(5) Class III. Veterans with a dental condition professionally determined by VA to be aggravating or complicating the management of a service connected medical condition under active treatment are eligible for care to treat the dental condition. The goal is to provide focused care to treat only the oral conditions that directly impact the management of the service-connected medical condition. Eligibility for each episode of dental care must be predicated on referral (consult), followed by a new dental evaluation.

(6) Class IV. Veterans whose service connected disabilities have been rated at 100 percent (total) or who are receiving the 100 percent rate by reason of individual unemployability are eligible for any needed dental care, including repeat care, with the following exception: a veteran awarded a temporary total disability rating by the Veterans Benefits Administration is not eligible for comprehensive outpatient dental services based on an opinion by VA General Counsel (023) to the Under Secretary for Health (16), February 24, 2006, VAOPGCADV 2-2006. Determination of temporary status is the responsibility of the eligibility section of the Business Office.

(7) Class V

(a) A veteran who is actively engaged in a Chapter 31 vocational rehabilitation program is entitled to dental care to the extent needed to meet any of the following goals listed:

1. make possible his or her entrance into a rehabilitation program,

2. achieve the goals of the veteran's vocational rehabilitation program,

3. prevent interruption of a rehabilitation program,

4. hasten the return to a rehabilitation program of a veteran in interrupted or leave status,

5. hasten the return to a rehabilitation program of a veteran placed in discontinued status because of a dental condition,

6. secure and adjust to employment during the period of employment assistance, or

7. enable the veteran to achieve maximum independence in daily living.

(b) Requests for dental care will be forwarded to the Dental Service by the Chapter 31 Vocational Rehabilitation Program on VA Form 28-8861. This form needs to be provided for each episode of care requested. Dental care should not be provided beyond the anticipated rehabilitation date as specified on the form.

(8 ) Class VI

(a) Any veteran scheduled for admission or who is receiving outpatient care under 38 U.S.C. may receive dental care if the dental condition is clinically determined to be complicating the non-service connected medical condition currently under VA treatment. Eligibility for each episode of dental care will be predicated on referral and consultation, followed by a decision based upon clinical judgment. The goal is to provide focused care to treat only the oral conditions that directly impact the management of the non-service connected medical condition.

(b) Certain homeless and other enrolled veterans also are eligible for a one-time course of dental care per VHA policy, Public Law 107-95 and Title 38 United States Code (U.S.C.) § 2062. Dental workload for veterans participating in this program is recorded under the Class VI dental outpatient classification.

(9) Other Beneficiaries. Other beneficiaries who may be eligible for dental care in VA dental clinics on an outpatient basis, subject to and consistent with the provision of existing laws, VA regulations, and the availability of VA resources are:

(a) Armed Forces Personnel on Active Duty. Authority from the Commanding Officer of the military installation should accompany the request for dental treatment. However, if extenuating circumstances are present, treatment of the emergent dental condition may be accomplished prior to the receipt of authority. Emergency dental treatment for members of the Armed Forces on active duty will be limited to such treatment as is found necessary for the relief of pain and control of acute infection, trauma or hemorrhage.

(b) Armed Forces Personnel in VA Polytrauma Centers. Active duty military personnel with spinal cord injury, traumatic brain injury or blindness who are receiving treatment in a VA polytrauma center are eligible to receive dental care under a direct resource sharing agreement in accordance with Department of Veterans Affairs and Department of Defense Memorandum of Agreement regarding referral of active duty military personnel with effective date January 1, 2007. Dental services will be billed at the interagency rate, where one exists, or at actual cost as appropriate.

(c) VA Employees. VA employees may be provided emergency dental treatment only to the extent necessary to permit the employee to remain on duty. Provision of care is predicated on referral from the employee health program. Employees with emergent conditions that may require follow-up care will be advised to seek private care at their expense. Injuries incurred in the performance of duty may receive necessary emergency treatment.

(d) Beneficiaries of Sharing Agreements. Treatment provided will be dependent on the specific language of the agreement.

(10) Disability Evaluation Examinations for Compensation and Pension Rating Purposes. Requests for an oral examination are submitted to the Dental Service at the request of the Regional Office. Examination findings must be accurately and comprehensively reported and the patient coded as a Category 20. Examinations must be completed within the timeframe required by VBA.


***********************
For additional information, please click on the site noted above to read the full document.