Health Care Benefits for Veterans with Multiple Sclerosis
What benefits are available to Veterans?
The VA provides a Medical Benefits Package, a standard enhanced health benefits plan available to all enrolled Veterans. This plan emphasizes preventive and primary care, and offers a full range of outpatient and inpatient services within VA health care system. The medical benefits package provides the following health care services to all enrolled Veterans:
Eligibility for most Veterans health care benefits is based solely on active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WW II), and discharged under other than dishonorable conditions. Reservists and National Guard members who were called to active duty by a Federal Executive Order may qualify for VA health care benefits. Returning service members, including Reservists and National Guard members who served on active duty in a theater of combat operations have special eligibility for hospital care, medical services, and nursing home care for two years following discharge from active duty. Health Care eligibility is not just for those who served in combat. Other groups may be eligible for some health benefits. Veterans health care is not just for service-connected injuries or medical conditions, health care is available for nonservice connected Veterans. In addition, the VA offers full-service health care for women Veterans as well as men.
Previously the VA did not consider income in determining eligibility but this was changed in 2003 due to the increasing number of Veterans seeking services. The VA made the difficult decision to stop enrolling new Priority Group 8 (high income) Veterans whose household income exceded the VA Income Thresholds. The decision was made to ensure the availability of quality and timely health care to Veterans with service connected conditions, special authority based on military service, low income, and those with special health care needs.
Another change was made this year that affects the income eligibilty of all Veterans. The new regulations went into effect on June 15, 2009, and enables the Department of Veterans Affairs (VA) to relax income restrictions on enrollment for health benefits. While this new provision does not remove consideration of income, it does increase income thresholds. You may be eligible for enrollment under this new provision. Check here to see if you qualify for enrollment under new rules for VA health care:
If you are a Veteran with MS what benefits are you eligible for with the VA?
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 https://www.1010ez.med.va.gov/sec/vha/1010ez/
How did the presumptive rule come about for MS and what is it based upon?
In establishing presumptions for specific diseases, Congress has expressly indicated that the presumptive periods are based on the conclusion that diseases manifested within such periods may be presumed to have had their onset during service. When Congress established a seven-year presumptive period for multiple sclerosis, in what is now 38 U.S.C. § 1112(a)(3), the Senate Committee on Finance explained that the presumptive period was “based on information obtained from the National Institute of Health that it was the opinion of its scientific staff that 7 years was not an unreasonable period to recognize as the interval between onset and diagnosis in multiple sclerosis.”
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.
Are there supportive services for families of Veterans with MS?
Supporting the caregiver, as well as the patient, is an extremely important part of the care plan for persons with MS. There are counseling services for family members and respite care. Many VA's have a respite care program; however, the amount and scope of these services varies ranging bewteen 4 to 30 days of respite care per calendar year (January 1-December 31) depending upon each VA medical center.
Respite care can occur on an inpatient basis, either in a VA hospital or in the community in a skilled nursing facility, or on an outpatient basis, either in-home services provided by a home health aide or through attendance at an adult day health center in the community. Respite care should be arranged based on the unique needs of the caregiver and the person with MS.
Service connected Veterans do not have any co-pays for respite care. Non-SC Veterans may have a co-pay after 21 days of respite care. The co-pay amount, if any, is determined by completing an Application for Extended Care Services (VA form 1010-EC). To learn more about respite care options and for assistance in arranging respite care, contact the Social Work Service at your local VA.
What research is being done regarding chemical exposure during combat and under other military operations and the link to MS and/or other neurological diseases?
There are numerous studies about the effects of war on illnesses experienced by military personnel. Currently, there are several research studies that are examining whether there is a relationship and to what extent is the relationship between war and illnesses. A good resource is The War Related Illness and Injury Study Center based at the VAMC in Washington, DC. For more information on this project use the following link: http://www.warrelatedillness.va.gov/
In general, to determine whether an exposure causes a disease, it must be shown that those exposed have a higher incidence of the disease than those not exposed. For example, when Gulf War Veterans were evaluated for a number of neurological diseases, ALS stood out as being possibly increased compared to those not serving in the Gulf War. But, MS was not a disease that stood out as more common in Gulf War Veterans.
At this time, the ongoing research indicates that there is no known link between MS and Agent Orange, MS and radiation exposure, or MS and serving during the Gulf War. However, if you feel you might have been exposed to Agent Orange and are experiencing other health related symptoms we recommend you contact the Agent Orange hotline at 1-800-749-8387. There is also a VA Agent Orange website at http://www.publichealth.va.gov/exposures/agentorange/
For the last ten years, the VA has studied the effects of military exposure to depleted uranium and has found no association between this military exposure and Veterans developing neurological disorders.
There are a variety of resources available to Veterans that are interested in learning more about VA benefits. You can always speak with your local medical center benefits office, or with the patient advocate, and with a Veteran Service Organization (e.g. Paralyzed Veterans of America, Disabled American Vet, Veterans of Foreign Wars).There are several websites too. A quick way to begin the search is to use the links below:
Last updated: March 2011