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Glossary
Glossary0-91151 BenefitsVA awarded monthly compensation benefits for disability or death incurred as the result of VA hospital care, medical or surgical treatment or examination. Benefits awarded only if the disability or death was proximately caused by negligence or an unforeseen event. AAccessAccess is the Veteran's ability to obtain medical care at his/her desired location. The ease of access is determined by things such as availability of health care services, location of health care facilities, transportation, hours of operation, and cost-effective delivery of health care. Efforts to improve access often focus on improving efficiency of health care delivery processes. Adjunct ConditionAn adjunct condition, for medical treatment purposes, is a non service-connected condition that may be associated with and held to be aggravating an adjudicated service-connected condition. VA bills health insurance plans for treatment of an adjunct condition and as applicable, may charge a copay for treatment of the adjunct condition. Adult Day Health CareAdult Day Health Care is a therapeutic day care program, providing medical and rehabilitation services to disabled Veterans in a group setting. Aid and Attendance (A&A)A VA compensation or pension benefit awarded to a Veteran determined to be in need of the regular assistance of another person to perform basic functions of everyday life. A veteran may qualify for aid and attendance benefits if he or she:
Allowable DeductionsAllowable deductions are those payments made by Veterans for certain non-reimbursed medical expenses, funeral and burial expenses, and educational expenses. Veterans are able to exclude allowable deductions from their total gross household income in determining their eligibility for VA health care benefits. AppealA process used to request VA reconsider a previous authorization or claim decision. ApplicantA person who has submitted a formal request for VA health care benefits and/or for enrollment in the VA health care system. AssetProperty or resource of an individual which includes: cash, stocks and bonds, individual retirement accounts, income producing property, etc. BBereavement CounselingAssistance and support to people with emotional and psychological stress after the death of a loved one. Bereavement counseling includes a broad range of transition services, including outreach, counseling, and referral services to family members. CCatastrophically DisabledA veteran who has a permanent, severely disabling injury, disorder, or disease that affects their ability to carry out the activities of daily living. The veteran is affected to such a degree that he/she requires personal or mechanical assistance to leave home or bed, or require constant supervision to avoid physical harm to self or others. Chronic CareLong-term care of individuals with long-standing, persistent diseases or conditions. Chronic care includes care specific to the problem, as well as other measures to encourage self-care, promote health, and prevent loss of function. Combat ServiceA status applied for a veteran who served on active duty in a theater of combat operations during a period of war recognized by the VA. Commonwealth Army VeteransThe term "Commonwealth Army Veterans" refers to persons who served before July 1, 1946, in the organized military forces of the Government of the Philippines. These Filipino forces were made a part of the U.S. Armed Forces by a military order of the President dated July 26, 1941. These Veterans were discharged or released from this period of service under conditions other than dishonorable. Community Residential CareHealth care supervision provided to eligible Veterans not in need of hospital or nursing home care but who, because of medical and/or psychosocial health conditions as determined through a statement of needed care, are not able to live independently. Veterans would not have suitable family or significant others to provide the needed supervision and supportive care. The veteran must be capable of self-preservation with minimal assistance and exhibit socially acceptable behavior. Compensable DisabilitiesA VA rated service-connected disability for which monetary compensation is authorized for payment. You might even be entitled to compensation when your disabilities are rated 0% disabling.
Congressional AppropriationThe funding allocated by Congress to VA for providing benefits and medical services to eligible VA beneficiaries. ConsultationService provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician. Contract ProviderAny hospital, skilled nursing facility, extended care facility, individual, organization, or agency that has a contractual agreement with VA for providing medical services to Veterans. CopayA specific monetary charge for either medical services or outpatient medications provided by VA to Veterans whose financial assessment determines they are able to pay. Covered BenefitMedically necessary care and services included in the Medical Benefits Package as defined within 38 Code of Federal Regulation (CFR) 17.38. DDiagnosisThe identification of a medical condition, cause or disease. DeductibleAn amount that a veteran must pay for covered services in a specified time period before VA benefits begin. DependentSpouse or unmarried child (to include a biological, legally adopted, or step child under the age of 18, or between the ages of 18 and 23 and attending school, or a child who was permanently and totally disabled before the age of 18) DisenrollmentThe discontinuation of a veteran's enrolled status. Disenrollment may result because the veteran requests not to participate in VA enrollment, or when VA determines that certain Priority Groups will no longer be provided services. Requests to disenroll must be in writing. DomiciliaryA VA facility that provides care on an ambulatory self-care basis for Veterans disabled by age or disease. Veterans are not in need of acute hospitalization and do not need the skilled nursing services provided in a nursing home. Durable Medical EquipmentEquipment intended for frequent use in the treatment of a medical condition or injury. Examples include wheelchairs, hospital beds, walkers, etc. EEarned IncomeMoney you receive from working EmergencyMedical condition displaying acute symptoms of sufficient severity such that a prudent layperson, possessing an average knowledge of heath care and medicine, could reasonably expect the absence of immediate medical attention to result in 1) placing the health of the individual in serious jeopardy, 2) serious impairment to bodily functions, or 3) serious dysfunction of any bodily organ or part. EnrolleeA veteran who has applied for VA medical services under 38 United States Code (U.S.C.) 1710 and 38 CFR 17.36, been accepted for such care, and received confirmation of enrollment in the VA health care system. EnrollmentThe process for providing Veterans access to VA health care services covered by the medical benefits package. Enrollment Group Thresholds (EGT)The enrollment Priority Group level, as determined by the Secretary Veterans Affairs, at which Veterans will be accepted for enrollment into the VA health care system. Environmental Contaminants / Gulf War IllnessGulf War Veterans were exposed to a wide variety of environmental hazards and potential harmful substances during their service in Southwest Asia. These include depleted uranium, pesticides, the anti-nerve gas pill pyridostigmine bromide, infectious diseases, chemical and biological warfare agents, and vaccinations (including anthrax and botulinum toxoid), and oil well free smoke and petroleum products. VA recognizes that there are other health risk factors encountered by Gulf War Veterans. Veterans with service during the Gulf War are eligible to receive treatment for conditions related to this service.
FFormularyA formulary is a list of medicines from which your VA provider can choose to treat your medical condition. This list of medicines has been looked at and approved by a group of highly trained VA physicians and clinical pharmacists. New medicines are usually added to the formulary based on a complete review of published medical studies as well as available patient safety data. Financial AssessmentA means of collecting income information used to determine a veteran's eligibility for health care benefits. GGeographic Means Test (GMT) Income Thresholds Copay RequiredA copay status assigned to a veteran whose household income is above the VA means test income thresholds but below the GMT income thresholds. GMT copay for inpatient care is reduced by 80%, but all other copay amounts remain the same. GMT income thresholds are based upon established geographic income thresholds. GMT - Below the Means Test Income ThresholdsVeterans whose household income is below the VA National income thresholds such that they are unable to defray the expenses of care. Therefore, they are not subject to copay charges for hospital and outpatient medical services. GMT - Above the Means Test and GMT Income ThresholdsVeterans whose household income is above the VA National income thresholds and income ABOVE the geographically-based income thresholds for their resident location. These Veterans do not otherwise qualify for placement in a higher enrollment Priority Group. These Veterans must agree to pay copays for hospital care and outpatient medical services. GMT - Above the Means Test and Below the GMT Income ThresholdsVeterans with household income ABOVE the VA National income thresholds and income BELOW the geographically-based income thresholds for their resident location. These Veterans do not otherwise qualify for placement in a higher enrollment Priority Group. These Veterans must also agree to pay copays for hospital care and outpatient medical services, but their inpatient medical care copays are reduced 80 percent. Geriatric EvaluationGeriatric evaluations part of the basic benefits package. It is a comprehensive assessment of a veteran's ability to care for him/herself, physical health, and social environment, which leads to a plan of care. The plan could include treatment, rehabilitation, health promotion, and social services. Gross Household IncomeGenerally, gross income of the veteran, spouse and dependent children is counted for determining a veteran's eligibility for VA health care benefits. This includes earned and unearned income but excludes most need-based payments such as welfare and Supplemental Security Income (SSI). Gross IncomeIncome before allowable expenses are subtracted HHardshipA "hardship" exists when there is a significant change in your family income and net worth from the previous calendar year to the present year. Head or Neck CancerVeterans with cancer of the head and neck, and a history of receipt of Nasopharyngeal (NP) radium therapy, are eligible for treatment. There are very specific dates and locations where this activity occurred. Eligibility for this special class needs to be verified. (Not all Veterans receiving head and neck cancer treatment fall into this treatment category.) Health Insurance Portability and Accountability Act (HIPAA)HIPAA is a federal law enacted in 1996. It was designated to improve availability and portability of health coverage and the efficiency of the health care system. It does this by standardizing the electronic exchange of health information, and protecting the security and privacy of member-identifiable health information. Home Health CareSkilled nursing and other therapeutic services provided by VA or a home health care agency in a home setting. Home health care is an alternative to confinement in a hospital or skilled nursing facility. Homemaker/Home Health Aide ServicesThe Homemaker / Home Health Aide (H/HHA) Program provides services as an "alternative" to nursing home care. The H/HHA Coordinator, along with the interdisciplinary team, makes a clinical judgment that the veteran would otherwise require nursing home equivalent care. Hospice/Palliative CareHospice/Palliative Care programs offer pain management, symptom control, and other medical services to terminally ill Veterans or Veterans in the late stages of the chronic disease process. Hostilities"Hostilities" means any armed conflict in which the members of the Armed Forces are subjected to combat conditions comparable to a period of war. The periods of armed conflict are determined by the Secretary of VA in consultation with the Secretary of Defense. Housebound BenefitThe VA's Housebound benefit is an additional amount available to eligible Veterans and dependents who are entitled to VA pension or VA compensation. The housebound allowance may be paid to Veterans, dependent spouses, or surviving spouses that, because of their physical limitations, are unable to walk or travel beyond their home. It is also reasonably certain the disabilities or confinement will continue throughout his or her lifetime. Certain restrictions apply. For more information and eligibility criteria on this benefit, call 800-827-1000 or go to http://www.vba.va.gov/bln/21/Benefits/. Housing and Urban Development Geographic IndexCongress wanted to grant relief from making VA copay for some Veterans with marginal incomes. They recognized that income alone is not always a fair measure of one's standard of living, due to sometimes large differences in the cost of living in different areas of the country. Congress modified VA's system of determining Veterans' ability to pay for health care by creating a geographically-based income limit, and reducing inpatient copay for those Veterans whose income falls below these new geographic income thresholds. The new geographic income thresholds are adjusted for all standard metropolitan statistical areas (SMSAs) and are updated periodically to reflect economic changes within the SMSAs. The geographic means test income thresholds are based upon the geographically based low- income thresholds set by the U.S. Department of Housing and Urban Development (HUD) for public housing benefits. IInpatient CareServices received during a patient's hospital stay. Ionizing RadiationAtomic Veterans may have been exposed to ionizing radiation in a variety of ways at various locations. Veterans exposed at a nuclear device testing site (the Pacific Islands, e.g., Bikini, NM, NV, etc.) or in Hiroshima and/or Nagasaki, Japan, may be included. Atomic Veterans with exposure to ionizing radiation are eligible to receive treatment for conditions related to this exposure. VA has recognized the following conditions by statute or regulation as being associated with radiation exposure:
LLow-Income ThresholdsVeterans with gross household income under the "low income thresholds" are eligible to receive certain health related benefits at no cost to the veteran. The low income thresholds are set by law and varies according to the veteran's family size and benefit applied for. MMeans TestThe formal financial assessment process used by VA to measure a veteran's gross household income. (Net worth determination is being eliminated.) The means test determines Veterans copay responsibilities and helps to determine enrollment priority. Means Test Copay ExemptVeterans not required to make copays for medical care provided by VA include:
Means Test Copay RequiredA copay status assigned to a veteran who is required to make medical care copay based on financial status relative to the applicable means test income thresholds. MedicaidA jointly funded federal and state program that provides hospital expense and medical expense coverage to persons with low-income and certain aged and disabled individuals. Medical Benefits PackageThe term "Medical Benefits Package" refers to a group of health care services that are provided to all enrolled Veterans. Medical NeedThe determination that care or service(s) are required to promote, preserve, or restore a veteran's health as specified within 38 CFR 17.38(b). A treatment, procedure, supply, or service is considered medically necessary as determined by the patient's care provider, and in accordance with generally accepted standards of clinical practice. MedicareA federal program that provides health care coverage for people aged 65 and older, as well as some younger individuals with specific health problems. Medicare Part A covers hospitalization, extended care and nursing home care. Medicare Part B covers outpatient services, and is subject to a monthly premium. Military Sexual Trauma (MST)Sexual trauma experienced while on active duty in the military. Sexual trauma is defined as sexual harassment, sexual assault, rape and other acts of violence. Sexual harassment is further defined as repeated unsolicited, verbal or physical contact of a sexual nature, which is threatening in nature. If the veteran is being treated for any condition during this episode of care that the provider believes is related to MST; the veteran does not have to pay a copay for the visit or the medication. http://www.publichealth.va.gov/womenshealth/trauma.asp NNasopharyngeal Radium TherapyBecause it was effective in treating otitis media, military physicians used NP radium to treat aerotitis media (barotrauma) in submariners, aviators, and divers due to enlarged tissue in the throat combined with rapid pressure changes. It is estimated that between 8,000 and 20,000 military personnel received NP radium treatments during World War II and until the 1960s. Net WorthSimply put, "net worth" means the market value of everything you own, minus what you owe. NoncompensableNoncompensable refers awards of service-connection which VA determines do not warrant the award of monetary compensation. Nonservice-Connected PensionA monetary support benefit awarded to permanently and totally disabled, low-income Veterans with 90 days or more of active military service, of which at least one day was during wartime. Veterans of a period of war who are age 65 or older and meet service and income requirements are also eligible to receive a pension, regardless of current physical condition. Payments are made to qualified Veterans to bring their total income, including other retirement or social security income, to a level set by Congress. For more information, go to http://www.va.gov and click on Compensation and Pension Benefits. Nonservice-Connected VeteranAn eligible veteran who has been discharged from active military duty, and does not have a VA adjudicated illness or injury incurred in or aggravated by military service. Nursing HomeThe term "nursing home care", (now community living center care), means the accommodation of convalescents or other persons who are not acutely ill and not in need of hospital care. However, nursing care and related medical services are required, if such nursing care and medical services are prescribed by, or are performed under the general direction of, persons duly licensed to provide such care. Such term includes services furnished in skilled nursing care facilities, in intermediate care facilities, and in combined facilities. It does not include domiciliary care. OOpen EnrollmentThe process of accepting applications for enrollment at any time during the year. Other than dishonorable conditionsAll Veterans are potentially eligible for most Veterans' health care benefits are based solely on active military service in the Army, Navy, Air Force, Marines, or Coast Guard, and discharged under other than dishonorable conditions Outpatient CareRefers to health care a patient receives without being admitted to a hospital. Examples include office visits, x-rays, lab tests and some surgical procedures. PPalliative CareCare provided primarily to relieve symptoms of a disease or condition rather than for curative purposes. Pension BenefitVA pension is a monetary award paid on a monthly basis to Veterans with low income who are permanently and totally disabled, or are age 65 and older. Veterans may be eligible for monetary support if they have 90 days or more of active military service, at least one day of which was during a period or war. Payments are made to qualified Veterans to bring their total income, including other retirement or social security income, to a level annually set by Congress. Veterans of a period of war who are age 65 or older, and meet service and income requirements, are also eligible to receive a pension, regardless of current physical condition. Preferred FacilityThe veteran identified VA health care location where the veteran prefers to receive care. A preferred facility may be any VA health care location, for example, VA health care facility, independent clinic, or community based outpatient clinic. If VA is unable to provide your needed health care, that facility will make arrangements to refer you to another VA health care facility or to one of VA's private sector affiliates to provide the required care. Preventive CareHealth Care that emphasizes prevention, early detection, and treatment. Primary Care ProviderThe clinician who is responsible for the supervision, coordination, and provision of the veteran's medical care. This clinician provides routine health services and is the veteran's first point of contact when the veteran becomes sick. The primary care provider can easily refer patients to a specialist (such as a surgeon) should they require care outside the scope of his or her expertise. Project 112/SHADProject SHAD, an acronym for Shipboard Hazard and Defense, was part of a larger effort called Project 112, which was conducted during the 1960s. Project SHAD encompassed tests designed to identify US warships' vulnerabilities to attacks with chemical or biological warfare agents, and to develop procedures to respond to such attacks while maintaining a war-fighting capability. Prosthetic DevicesA device which replaces all or a portion of a part of the human body. A prosthetic device can be used when a part of the body is permanently damaged, is absent, or is malfunctioning. Public Law (PL) 104-262The public law passed by Congress in October 1996, also known as the Veteran's Health Care Eligibility Reform Act of 1996. This law established national standards of access and equitable health care services to Veterans and required that most Veterans be enrolled to receive care. Public Law (PL) 107-135"Department of Veterans Affairs Health Care Programs Enhancement Act of 2001" provides for chiropractic care and services for Veterans through Department of Veterans Affairs medical centers and clinics. Public Law (PL) 110-329Also known as Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, passed by Congress September 30, 2008. This act provided VA additional funding to allow expanded enrollment opportunity for certain Priority 8 Veterans who may have been previously denied enrollment in VA's health care system because their income exceeded VA's means tests thresholds. Purple HeartA "Purple Heart" is a medal given by the military to a service person injured as a direct result of combat. RRadiation Risk Activity
ReferralThe process of referring a veteran from one practitioner to another for health care services. Regular Filipino ScoutsThe Filipino Scouts were guerilla forces considered part of the Commonwealth Army of the Philippines. They were organized under commanders appointed, designated, or later recognized by the U.S. Army. Respite careGives the caregiver of a veteran a planned period of relief from the physical and emotional demands associated with providing care. Restore HealthThe process of improving a veteran's quality of life or daily function level that has been lost due to illness or injury. SSecondary ConditionA secondary condition, for medical treatment purposes, may be the result of an adjudicated service-connected condition. Veterans are encouraged to file compensation claims for non-rated secondary conditions. Non-rated secondary conditions are billable as a non service-connected condition. If awarded service-connection for the secondary condition, VA may reimburse all copays related to such service-connection retroactive to the date of the original claim filing.
Service-connectedGenerally a service-connected disability is a disability that VA determines was incurred or aggravated while on active duty in the military and in the line of duty. A service-connected rating is an official ruling by VA that your illness/condition is directly related to your active military service. Service-connected ratings are established by VA Regional Offices located throughout the country. Service-Connected VeteranA veteran who has an illness or injury incurred in or aggravated by military service as determined by VA. Sexual TraumaSexual Harassment, Sexual Assault, Rape and other acts of violence. Repeated unsolicited, verbal or physical contact of a sexual nature, which is threatening in nature. Also see Military Sexual Trauma. Southwest AsiaAn area of land located in the southwestern part of Asia to include the Persian Gulf, Red Sea, Gulf of Oman, Gulf of Aden, the portion of the Arabian Sea that lies north of 10 degrees North latitude and west of 68 degrees East longitude. It also includes the total land areas of Iraq, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, and the United Arab Emirates. Special (New) Philippine ScoutsThe term "New Philippine Scouts" refers to non-commissioned Philippine Scouts who—
State Veterans HomesThe eligibility for State Veterans Homes varies from state to state. Typically, Veterans and sometimes their spouse can be admitted to a State Veterans Home. The costs of living in a State Veterans Home are usually paid by Medicaid, long term care insurance and private funds. VA pays a modest share of the cost for each veteran living in a State Veterans Home. You can find information on the State Veterans Home(s) for your state by looking in the state government pages of the telephone book. VA social workers at the VA medical center where you're being treated can also provide information about State Veterans Homes. UUrgent CareServices received for an unexpected illness or injury that is not life threatening but requires immediate outpatient medical care that cannot be postponed. An urgent situation requires prompt medical attention to avoid complications and unnecessary suffering or severe pain, such as a high fever. VVA Form 10-10EZ, Application for Health BenefitsThe VA form completed by Veterans to apply for VA health care benefits. The form includes demographic, military, insurance and financial information VA Form 10-10EZR, Health Benefits RenewalThe VA Form used by Veterans to submit their updated personal, insurance and financial information to VA. VeteranThis term means a person who served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable. Return to the Top of the Page
For information call1-877-222-VETS (8387) between the hours of 8:00 AM and 8:00 PM ET Monday - Friday
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