Code of Federal Regulations on IU Benefits in IU - Individual Unemployability Forum

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Code of Federal Regulations on IU Benefits

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theonlyway

Code of Federal Regulations on IU Benefits

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Posts: 256

Apr 12 12 10:21 AM

Can someone help me locate this? Its hard for me to decipher so much at once. I'm trying to find where it states in the Code Of Federal Regulations where it states a Veteran must be permanent and total to receive dental? The Chief of Admin called me and stated it is in the code of federal regulations that is a veteran is at 100% IU not P&T they are not entitled to dental. Apologies for being persistent as my tooth really hurts. Thanks

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"America will never be destroyed from the outside. If we falter and lose our freedoms, it will be because we destroyed ourselves." Abraham Lincoln

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Vet2112

#1

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Posts: 2259

Apr 12 12 10:28 AM

(Authority: 38 U.S.C. 1712 )

(g) Class III. Those having a dental condition professionally determined to be aggravating disability from an associated service-connected condition or disability may be authorized dental treatment for only those dental conditions which, in sound professional judgment, are having a direct and material detrimental effect upon the associated basic condition or disability.

(h) Class IV. Those whose service-connected disabilities are rated at 100% by schedular evaluation or who are entitled to the 100% rate by reason of individual unemployability may be authorized any needed dental treatment.

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theonlyway

#2

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Posts: 256

Apr 12 12 12:51 PM

Vet2112 wrote:
(Authority: 38 U.S.C. 1712 )

(g) Class III. Those having a dental condition professionally determined to be aggravating disability from an associated service-connected condition or disability may be authorized dental treatment for only those dental conditions which, in sound professional judgment, are having a direct and material detrimental effect upon the associated basic condition or disability.

(h) Class IV. Those whose service-connected disabilities are rated at 100% by schedular evaluation or who are entitled to the 100% rate by reason of individual unemployability may be authorized any needed dental treatment.

Thank you for posting this. So by this it states if you are rated !00% because of unemployability that we are in fact entitled to Dental, so why do they keep arguing? Or am I missing something?

__________________________________________________________________________________________

"America will never be destroyed from the outside. If we falter and lose our freedoms, it will be because we destroyed ourselves." Abraham Lincoln

Edited 1 time by theonlyway Apr 12 12 1:27 PM.

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Rotor Head

#3

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Posts: 8701

Apr 12 12 5:24 PM

You aren't missing anything, but the chief of admin is. You should help him with that. Feel better soon.

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Jeff82.czechpistols82792

#4

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Posts: 58

Apr 13 12 3:45 PM

From http://www.law.cornell.edu/uscode/text/38/1712:

Title 38 USC § 1712, (a)(1)(G)

(a)(1) Outpatient dental services and treatment, and related dental appliances, shall be furnished under this section only for a dental condition or disability—
[indent]
(G) from which a veteran who has a service-connected disability rated as total is suffering;
[/indent]

Tell him he can pound his CFR in his 4th point of contact.

Jeff
MOΛΩN ΛABE!

Edited 2 times by Jeff82 Apr 13 12 3:54 PM.

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Survivir

#5

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Posts: 10347

Apr 13 12 6:45 PM

theonlyway wrote:
Can someone help me locate this? Its hard for me to decipher so much at once. I'm trying to find where it states in the Code Of Federal Regulations where it states a Veteran must be permanent and total to receive dental? The Chief of Admin called me and stated it is in the code of federal regulations that is a veteran is at 100% IU not P&T they are not entitled to dental. Apologies for being persistent as my tooth really hurts. Thanks

The Veteran ONLY needs to be 100% Schedular or TDIU...and does NOT need to be rated "P&T".

The below link and information is from the VA.

http://www.va.gov/opa/publications/benefits_book/benefits_chap01.asp

Outpatient Dental Treatment

Dental benefits are provided by the Department of Veterans Affairs (VA) according to law. In some instances, VA is authorized to provide extensive dental care, while in other cases treatment may be limited by law. This Fact Sheet table describes dental eligibility criteria and contains information to assist Veterans in understanding their eligibility for VA dental care.

By law, the eligibility for Outpatient Dental Care is not the same as for most other VA medical benefits. It is categorized in classes. If you are eligible for VA dental care under Class I, IIC, or IV you are eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care. Other classes have time and/or service limitations.

If you:	You are eligible for:	Through
Have a service-connected compensable dental disability or condition.	Any needed dental care.	Class I
Are a former prisoner of war.	Any needed dental care.	Class IIC
Have service-connected disabilities rated 100% disabling, or are unemployable and paid at the 100% rate due to service-connected conditions.	Any needed dental care. [note: Veterans paid at the 100% rate based on a temporary rating, are not eligible for comprehensive outpatient dental services.	Class IV
Apply for dental care within 180 days of discharge or release from a period of active duty (under conditions other than dishonorable) of 90 days or more during the Persian Gulf War era.	One-time dental care if your DD214 certificate of discharge does not indicate that a complete dental examination and all appropriate dental treatment had been rendered prior to discharge.*	Class II
Have a service-connected noncompensable dental condition or disability resulting from combat wounds or service trauma.	Needed care for the service-connected condition(s). 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.	Class IIA
Have a dental condition clinically determined by VA to be associated with and aggravating a service-connected medical condition.	Dental care to treat the oral conditions that are determined by a VA dental professional to have a direct and material detrimental effect to your service connected medical condition.	Class III
Are actively engaged in a 38 USC Chapter 31 vocational rehabilitation program	Dental care to the extent necessary to: Make possible to enter, achieve goals, and prevent interruption of a rehabilitation program, or Hasten the return to a rehabilitation program for leave status, or placed in discontinued status because of a dental condition, or Secure and adjust to employment during employment assistance, or enable to achieve maximum independence in daily living	ClassV
Are receiving VA care or are scheduled for inpatient care and require dental care for a condition complicating a medical condition currently under treatment.	Dental care to treat the oral conditions that are determined by a VA dental professional to complicate your medical condition currently under treatment.	Class VI
Are an enrolled Veteran who may be homeless and receiving care under VHA Directive 2007-039..	A one-time course of dental care that is determined medically necessary to relieve pain, assist in gaining employment, or treat moderto severe gingival and periodontal conditions.	Class IIB

*Note: Public Law 83 enacted June 16, 1955, amended Veterans’ eligibility for outpatient dental services. As a result, any Veteran who received a dental award letter from VBA dated before 1955 in which VBA determined the dental conditions to be noncompensable are no longer eligible for Class II outpatient dental treatment. Veterans receiving hospital, nursing home, or domiciliary care will be provided dental services that are professionally determined by a VA dentist, in consultation with the referring physician, to be essential to the management of the patient’s medical condition under active treatment.

For more information about eligibility for VA medical and dental benefits, contact VA at 1-877-222-8387 or www.va.gov/healtheligibility

Survivir

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texasyank

#6

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Posts: 425

Apr 13 12 8:12 PM

Here is the paragraph from VHA Dental Handbook 1130.1 that addresses Class IV eligibility. 1130.1 is the "bible" for VA dental service chiefs, like me. A vet does not have to be P&T.

(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.

The position that you have to be P&T to be eligible for dental is completely illogical. Not only would it negate eligibility based on IU, it would negate eligibility for 100% schedular vets who are not rated permanent. In fact, restricting eligibility to vets who are P&T would eliminate about 90% of VA dental patients.

Edited 2 times by texasyank Apr 13 12 8:26 PM.

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Survivir

#7

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Posts: 10347

Apr 14 12 5:54 AM

texasyank wrote:
Here is the paragraph from VHA Dental Handbook 1130.1 that addresses Class IV eligibility. 1130.1 is the "bible" for VA dental service chiefs, like me. A vet does not have to be P&T.

(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.

The position that you have to be P&T to be eligible for dental is completely illogical. Not only would it negate eligibility based on IU, it would negate eligibility for 100% schedular vets who are not rated permanent. In fact, restricting eligibility to vets who are P&T would eliminate about 90% of VA dental patients.

I just want to clarify...that a Veteran CAN BE Rated TDIU and NOT be Rated "P&T".

A Veteran CAN BE Rated TDIU...and also BE Rated "P&T", too.

If I misunderstood...then I apologize.

I just don't want anyone to think that if a Veteran is rated TDIU...that the Veteran can not be Rated "P&T"...because they CAN BE.

Survivir

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LouF

#8

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Posts: 12981

Apr 14 12 7:44 AM

10,000 plus post...

I am IU P&T but the issue here is that you only need to be TOTAL or IU, there is nothing in CFR 38 about permanent only TOTAL which includes IU

Lou SSG
Santa Fe NM
4/21 11LIB Americal
1/69-8/70
50% PTSD
60% IHD
100% IU P&T

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texasyank

#9

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Posts: 425

Apr 14 12 9:07 AM

Lou: Exactly

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theonlyway

#10

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Posts: 256

Apr 14 12 4:58 PM

thanks for all the responses. I've tried and tried to tell the Chief of Admin and of Eligibility. They keep making smart ass comments and laughing at me, telling me to write my congressman and that they would gladly fight it (meaning they would fight against 100% IU qualifying for dental). Its really sad that I and probably many others are treated like this. He was telling me that some Norris vs West case made it into law that 100%IU wouldn't qualify for dental unless I was permanent and total....

__________________________________________________________________________________________

"America will never be destroyed from the outside. If we falter and lose our freedoms, it will be because we destroyed ourselves." Abraham Lincoln

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Jeff82.czechpistols82792

#11

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Posts: 58

Apr 17 12 12:02 PM

So if everyone at the hospital is wrong, who do you go to next?

Jeff
MOΛΩN ΛABE!

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jameschap

#12

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Posts: 1554

Apr 17 12 12:21 PM

Jeff82 wrote:
So if everyone at the hospital is wrong, who do you go to next?

If you can print off information show it to Patient advocate. If they still not convinced go to VARO get them to put it in writing or call them or fax something to your VAMC.
I had a SC dental condition class 1 (was rated less than 100% total) I still had to bicker with dental clinic took me couple weeks but got them squared away.

“Setting a good example is a far better way to spread ideals than through force of arms.” VETERAN

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