MSCoE - Life Issues FAQs
Frequently asked Questions and Answers relating to Life Issues in MS. To ask a question use one of the email addresses on the MSCoE Contact Page
Individual unemployability (IU) recognizes that the effects of certain service-connected conditions, while not meeting the VA's criteria for permanent and total disability, may interfere with a veteran's ability to work and support themselves. The criteria is rather complicated and takes into account a veteran's education and work history as well as Social Security Disability evaluation(s) and participation in vocational rehabilitation. Individuals who meet the criteria for IU receive benefits equivalent to veterans who are 100% SC. Since, by definition, a veteran with IU is unable to secure gainful employment due to the effects of their service connected condition(s), a veteran who successfully returns to the work force will have their benefits reduced to the corresponding level of compensation for their SC disability.
All the VSOs are active, but a high percentage (approximately 50%) of PVA members have MS, so they are particularly active in this area (as is United Spinal). If you want to start with the PVA their website is at http://www.pva.org
3. My husband was in the USMC and is 100% disabled (service connected). I was just recently diagnosed with MS, and want to know if there are any benefits for me? This has affected my job, and I am not sure where to go from here.
The VA provides limited spouse benefits. Your spouse should contact social work or an advocacy group, such as the Paralyzed Veterans of America (www.pva.org) to make sure his benefits are optimized. The National MS Society is a great organization to assist individuals who have MS in understanding their health care benefits and where to get the services they need. You can access the National Chapter through their website at http://www.nationalmssociety.org/ The national chapter will provide useful information and connect you to your local chapter. Call your local chapter and get connected. An MS specialist can put you in touch with psychologists, therapists, and vocational counselors who can work with you to address work related issues so that you can maintain your present job, modify your job, or find an alternative.
Left sided weakness and feeling faint are symptoms that can have many causes and require a thorough history & physical by a health care provider. Weakness on one side of the body could be related to multiple sclerosis, but also can be due to many other causes. Faintness is not a typical symptom of multiple sclerosis, but could occur in multiple sclerosis if a person is dehydrated. Faintness might be due to a side effect of one of the disease modifying therapy medications or a side effect of one of the symptom management medications. Again, both of these symptoms require evaluation by a health care provider to determine what is the cause and how to manage these symptoms.
5. My husband has been evaluated as having 100% SC MS. He has been in the hospital many times for lengthy periods of time. This last time I am told by a PVA rep that his benefits will be cut because he is being taken care of in the hospital. I am in the hospital every day feeding and caring for him. Is this correct?
If the Regional Office has determined the veteran requires Aid and Attendance (A&A) as the result of his service connected disability(ies) and the veteran is hospitalized at government expense for a lengthy period of time, the VA would be correct to reduce his monthly compensation. This would be effective the last day of the month following the month in which the veteran is admittted for hospitalization at government expense. For example, if the veteran was admitted October 2, 2006 and was still in-patient on November 30, 2006, then the veteran's comp would be reduced effective December 1, 2006. This is in accordance with 38 CFR 3.552(b)(1).
As an active duty service member that was just diagnosed with MS, you will be undergoing the Physical Evaluation Board (PEB) to determine your medical status. The PEB can determine one of two things, they could find you fit for duty and return you to full duty status or they could find you unfit for duty and either medically discharge you with disability severance or medically retire you with full retiree benefits which include Tricare. This is dependent on the evaluation assigned for your disability. If you are medically discharged, you can elect to continue your medical coverage through COBRA but you will be required to pay for the coverage. Or you can seek enrollment at the nearest VA Medical Center to continue treatment.
The MS Center of Excellence provides benefits in the way of support for veterans and their caregivers through educational programs, the website, and various outreach activities. At this time, the VA provides medical treatment for veterans and provides support services like counseling for family members. Support services focus on helping families cope with chronic illnesses and disabilities experienced by veterans and themselves. For more information about family services, use the following link: http://www.va.gov/healtheligibility/familymembers/
8. I served in the Marine Corps from 1982 to 1987. I had many problems in the mid 80's regarding weakness to my arms and had many tests completed to try and find the cause. I have undergone many surgeries since to try and rectify or at least treat the problems to no avail. I was diagnosed in 2006 with MS. I have received many of the same tests that were completed the last several years. Do I qualify as MS-Service Connected? What are the qualifications for IU in this case?
Whether you are currently in the military or are honorably discharged you are eligible for medical care, including medications and equipment, from the VA. Individuals who are diagnosed with MS while they are in the military or within seven years of their honorable discharge are eligible for a service-connected disability. In your case, it sounds like you will need to work with a Veterans Service Organization to help you fill out the proper paperwork to document the onset of MS-like symptoms you described in the FAQ and to file for SC. They will work with you in helping determine when your first symptoms of MS started. If your first symptoms can be documented while in the military (or by either a VA or private Physician within 7 years of your discharge), you may have a service connected disability. If MS symptoms can be documented within this time period, this information will be presented to the VA in your claim, and a VA physician/hearing officer will determine if your MS meets the VA criteria for service connection. If it is determined that you have a service connected disability, you will receive needed care as a service connected veteran. If you cannot document a MS diagnosis or MS symptoms within 7 years of discharge, you may still be eligible for care depending on your income level. The VA will generally provide any medically necessary care (as determined by a VA Provider), subject to income levels. Again, we recommend working with your local Veteran Service Officer to help with the required paperwork for MS documentation.
9. I am an active duty military member who has recently been diagnosed with MS which was triggered from a Hepatitus B vaccination. I will shortly be discharged from the service due to this condition. I have two questions: 1. How many people contract MS due to the Hepatitis B vaccination (On the vaccination fact sheet it lists MS under "Precautions" but says two clinical studies have been performed to prove there is no connection. What made them perform 2 studies and why not list all other diseases that are not connected in the "Precautions" section?) 2. I am close to being medically discharged from the service. Upon discharge, who would you recommend I contact at your organization to receive VA benefits representation? Any assistance in the matter will be greatly appreciated. Thank you.
We have a veteran's guidance document on immunization that may be of help at Managing MS: Vaccinations There are also numerous answered FAQs on benefits issues as well.
If you were honorably discharged from a branch of service, then you may be eligible for medical care, including medications and equipment, from the VA. The majority of veterans who apply for services are eligible. To determine your eligibility, go to the Enrollment Clinic at a VA and complete an Application for Health Benefits (e.g. Form 10-10EZ or Means Test). This form requires financial information. Previously the VA did not consider income in determining eligibility but this has changed in recent years due to the increasing number of veterans seeking services. Veterans whose income exceeds the VA's income guidelines (these vary by geographic area to reflect differences in cost of living, etc.) and are not service connected, fall into priority group 8. Delivery of services is not mandatory for these veterans. HOWEVER, veterans in this situation can apply for hardship based on financial or medical circumstances. The enrollment clerk can assist you in doing so. Veterans who are severely and permanently disabled may meet the criteria for Catastrophic Disability. This moves a veteran into a higher priority group (5) and makes delivery of services mandatory. If you had symptoms of MS in the military or within seven years after honorable discharge, you may be eligible for service-connected disability. If this is the case, complete the Veterans Application for Compensation and/or Pension (VA form 21-526) available online (http://www.va.gov) or at your Regional Office and return it to the Regional Office for processing. Veterans service organizations, such as the Paralyzed Veterans of America (http://www.pva.org/), United Spinal Association (http://www.unitedspinal.org/), and Disabled American Veterans (http://www.dav.org/) are good support resources. Remember to bring your DD214 with you to expedite the enrollment process. If you never received your DD214 or it has been lost, you can contact the National Personnel Records Center in St. Louis, MO, at 314-801-0880 to request a copy.
11. My husband was diganosed with ms in 1998. He was in the Army and was discharged in 1971. Are there any benefits for him? He is wheelchair bound and I am the only caregiver paying for his care. Let me know. Thanks.
Yes, there are benefits available for veterans that are honorably discharged from the military whether the disability is service connected or not. The first thing he needs to do is to apply for benefits, complete VA Form 10-10EZ, Application for Health Benefits, which may be obtained from any VA health care facility or regional benefits office, or on line at http://www.va.gov/1010ez.htm or by calling 1-877-222-VETS (8387). We recommend that veterans contact their local veteran service organization like Paralyzed Veterans of America http://www.pva.org to get help with the application process. If he is already enrolled, it is still a good idea to contact PVA for help with reviewing his eligibililty and benefit status and making an appointment with your local VA medical center. Again, if he is eligible for VA services, whether he is service connected or not, he can receive medical care for his MS. This care includes disease modifying therapies (prescription medications), physical therapy, occupational therapy and other health care services and medical equipment (like appropriate wheelchairs). The VA provides support services like counseling for family members. Support services focus on helping families cope with chronic illnesses and disabilities experienced by veterans. And the VA provides respite care. Again, a veterans service organization and your local VA medical center social work department can give you more information about what is available in your area. Thanks for your email.
12. I am an SC MS veteran diagnosed in 1992 at 70% (I required a cane or crutches). Now I'm almost totally wheelchair bound (90-95%). How do I go about getting re-rated? Should I check with my primary care physician or my neurologist? Thanks.
To re-open a claim simply submit a Statement in Support of Claim (VA form 21-4138) to the Regional Office. The Regional Office typically considers the primary care provider's and neurologist's documentation of the MS and related conditions in the medical record when evaluating a claim. Veterans may also wish to consider applying for Special Monthly Compensation (SMC), also known as Aid & Attendance, at the same time. These are additional funds granted to veterans who are 100% SC and require assistance with activities of daily living such as bathing, dressing, toileting, etc. These additional funds are intended to provide the means to hire someone to provide the necessary care. Aid & Attendance varies in amount depending on the degree of impairment of the individual veteran. To apply for Aid & Attendance, a VA physician must complete the Exam for Housebound Status or Permanent Need for Regular Aid & Attendance (VA form 21-2680). Even though you do not currently have a 100% SC rating, they can evaluate your request once the rating decision is made. Finally, it is often helpful to enlist the aid of a veteran's service organization (VSO) in submitting and monitoring your claim.
13. How can a member of a Veterans healthcare team assist in expediting the processing of my compensation claim that is most certainly going to be granted but for unknown reasons is now dragging on for months? I stand to lose everything I've managed to protect through a previous bankruptcy as the costs of fundamental requirements for trying to provide a normal quality of life for myself and family escalate. The fact that I am not a recent participant in Operation Iraqi Freedom in no way makes my disability any less serious nor my current situation any less critical. Who can I contact for immediate action? Thank You
The wait for a decision on a claim can definitely be long and frustrating for many veterans. Social Security and the Department of Veterans Affairs are separate benefit systems with separate processes for establishing disability. Even though they are both federal agencies, they do not work collaboratively. For an individual having difficulty supporting themselves and their family and potentially faced with financial ruin, the wait for a decision can seem interminable. One way to potentially speed up the process is for a member of the veteran's healthcare team to write a letter requesting expedition of the claim based on financial or medical hardship (in some cases, both may apply). Keep in mind that most veterans submitting claims want them to be processed as soon as possible and many ask for expedition of their claims. It may be helpful to specify the nature of the financial or medical hardship for which you are requesting expedition. Another option is to contact a VSO for assistance with the claim; they may be able to determine what is preventing the claim from moving forward and/or advocate on the veteran's behalf with the ratings team at the Regional Office. Finally, some veterans write to their local representatives and/or congress people for assistance. In the meantime, it may also be helpful to contact the social worker associated with your health care team. Social workers can assist veterans with a number of important issues including financial resources, housing, and advanced care planning as well as provide ongoing support. They can also work collaboratively with other community agencies, such as the National MS Society, to meet an individual's needs. The MSCoE is committed to providing quality care to ALL veterans, regardless of their period of service.
14. I have MS diagnosed while on active duty, making it service connected, and am retired now. I am waiting for the VA to rate me. I need to start treatment because my coordination and balance have worsened. I do not want to suffer the medical cost and put my family in financial hardship. I was employed part time but laid off along with others recently. How do I approach employment knowing my performance will be less than I am used to doing, and fear being fired or becoming a safety risk? Is there any way to speed up the VA? I served my country for 22 years and feel I should be compensated, I did not ask for this, nor did my family.
Return to work issues are best handled by a team skilled with vocational rehabilitation. You may find it useful to work with a Physiatrist, a Neurologist, a Vocational Rehabilitation Counselor, and other appropriate members of a therapy team. This group can identify your problems and help you develop solutions. They can assess whether you will be able to successfully return to the same job, the same job with altered hours, a similar job, or a different job all together. In rare instances, return to a paying job may not be your best strategy. If return to work is feasible, your Vocational Rehabilitation Team can help you decide what information is appropriate to release to your employer, facilitate any additional education or training, acquire medically necessary equipment to support your vocational needs and train you in proper use, assess the need for worksite modifications and help facilitate necessary modifications. Your Vocational Rehabilitation Team can help train and support you in your return to work efforts. For additional support in navigating the VA system it is best to work with a VA social worker who will advocate for your health care needs and services. For advocacy support, contact your local VA Social Work Department and your local veterans service organization.
Yes. For example, a veteran might have 30% for MS and 20% for diabetes, which combines to 40%. Notice that 30% and 20% do not add up to 50% in this case. The VA Schedule for Rating Disabilities "combines" the evaluations rather than "adds" the evaluations. It works this way: the first (largest) rating is 30%. That means you are 30% disabled and 70% able. If you have another disability, say 20%, then it is 20% of the remaining 70% of your abilities or 14%. 30% plus 14% equals 44% which rounds down to 40%.
Compensation & Pension Examiners base their decisions on several factors, including review of the medical record, an interview with the veteran, and exam findings or observations during the appointment. Documentation from a neurologist or physiatrist (a doctor specializing in Physical Medicine & Rehabilitation) describing the degree of mobility impairment certainly could be useful in establishing "loss of use." The physician could either write a detailed note in your medical record or write a letter submitted with a "Statement in Support of Claim" at the time a veteran requests that their claim be re-evaluated. It may also be helpful to enlist the assistance of a VSO in pursuing a claim.
If you had symptoms of MS in the military or within seven years after honorable discharge, you may be eligible for service-connected disability, including medical care, medications and equipment. However, eligibility for care at a VA facility is NOT contingent on a determination for service connected disability. Rather, the eligibility is based on processing of an application for medical benefits (VA Form 1010EZ). To determine your eligibility for service connected and nonservice connected benefits you need to apply for health benefits. There are several ways for you to enroll. You can enroll in person at any VA medical center or you can go online and complete an Application for Health Benefits (e.g. Form 10-10EZ or Means Test) to expedite the process at http://www.va.gov/healtheligibility/HECHome.htm This form requires financial information. Previously the VA did not consider income in determining eligibility but this has changed in recent years due to the increasing number of veterans seeking services. Veterans whose income exceeds the VA's income guidelines (these vary by geographic area to reflect differences in cost of living, etc.) and are not service connected, fall into priority group 8. Delivery of services is not mandatory for these veterans. HOWEVER, veterans in this situation can apply for hardship based on financial or medical circumstances. The enrollment clerk can assist you in doing so. Veterans who are severely and permanently disabled may meet the criteria for Catastrophic Disability. This moves a veteran into a higher priority group (4) and makes delivery of services mandatory. Remember to bring your DD214 with you to expedite the enrollment process. If you never received your DD214 or it has been lost, you can contact the National Personnel Records Center in St. Louis, MO, at 314-801-0880 to request a copy, or go online with the Military Personnel Records Center at http://www.archives.gov/facilities/mo/st_louis/military_personnel_records.html, which is part of the National Archives and Records Administration (NARA). The Internet address for NARA is: http://www.archives.gov. If you are eligible to receive services at the VA, disease modifying therapies (DMTs) for MS are routinely available to veterans whether or not they are service connected. Typically prescription co-pays in the VA are $8 per prescription per 30 days supply. For those who are unable to pay the medication co-pay, an application for co-pay waiver can be submitted (Financial Status Report, VA form 4-5655) to the office at your local VA medical facility.
18. I live in Baltimore and read in the newspaper about your center opening. My sister has MS and is having a difficult time getting proper care because there are few doctors who specialize in MS. My sister's husband was in the military (Air Force) in the 1960s. Do you think she would be eligible to see someone there?
Unfortunately, spouses of veterans are not eligible for care at the VA unless they, too, are veterans. For help locating qualified providers for MS care in your sister's area, contact the National Multiple Sclerosis Society (http://www.nmss.org) or the Consortium of Multiple Sclerosis Centers (http://www.mscare.org).
The VA does provide automobile grants for service connected disabilities. To be eligible for the Automobile grant, the veteran must have one of the following and it has to been determined to be service connected as defined by 38 CFR § 3.808(b): a) Loss or permanent loss of use of one of both feet; b) Loss or permanent loss of use of both hands; c) Permanent impairment of vision of both eyes: Central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye. d) For adaptive equipment eligibility only, ankylosis of one or both knees or one or both hips. Once the VA has determined the veteran has one of these disabilities, the Regional Office would establish entitlement to the Automobile grant. The veteran would also then be entitled to special monthly compensation at that time. If you feel you meet one of the following disabilities and are not rated for them by the VA, you should contact any veterans' service officer about filing a claim for increase and consideration for the automobile grant. If the VA has already determined you are eligible for this grant then you need to complete VAF 21-4502 and submit it to the Regional Office.