Health & Safety

Topics covered include health insurance, medical care & leave, and filing claims based on MST, PTSD, or TBI. 

A computer generated image of a series of papers layered on top of each other. The top paper is a check list with red check-marks on it.

Legal Needs Check-up Tool - Interactive Interview

Try our navigator to find legal information and where to get help with your legal issue.

Domestic Violence Overview/FAQ

Answers to Frequently Asked Questions (FAQs) about Domestic Violence.
black background with hot flames rising from the bottom

Frequently Asked Questions about the PACT Act

Answers to Frequently Asked Questions (FAQs) about the PACT Act. The Act provides eligibility and benefits to veterans exposed to burn pits and toxins during military service.

C & P Reports

Question:

How hard is it for me to get the doctor's opinion from my C&P exam?

 

Jim's Reply:

Many veterans want to see the results of their C & P exam and are frustrated when they can't access that paperwork. There are good reasons that you don't want or need to see that report.
 

The C & P exam doesn't produce a medical record and it won't be found in your VHA medical records. The C & P exam doesn't establish the doctor-patient relationship necessary for a medical record since there is no treatment offered and there is no whole body evaluation...the focus is entirely on your claimed condition and will be defined by the VBA rater who requested the exam.
 

The C & P exam is a part of the VBA process as your claim is adjudicated and you aren't allowed access to any of that as the VBA process is carried out.
 

Most veterans have second thoughts about all that occurred during the C & P exam and they want to see that report so they can object to anything they may think is wrong and get that corrected immediately!
 

Of course, that's a mistake. If you were allowed to see the report and try to correct any of the verbiage, the process would never complete...each time you would do that the process would start over and you would return to start.
 

What you must do is wait it out and if your claim is unfairly denied for any reason, then you must formally appeal that decision and then you get to see what is in the record that led to the denial. If you believe that the C & P exam report was wrong you can use that as the reason for your appeal and a new C & P examiner will do it again.
 

The VBA claims process is onerous and frustrating at best but we should always stick to the process and not deviate from how VBA wants it done. I often tell veterans that if that train leaves the track, it may be impossible to get it right again. 
 

Good luck sir.

 

A close up of a silver key, hanging from another key in lock.

Veterans Affairs Supported Housing (HUD-VASH)

Information on the Veterans Affairs Supported Housing program that helps homeless veterans find housing, pay rent, and get healthcare.

Tinnitus?

Question:

I have bad tinnutis, can't sleep but 4-5 hrs. I am 75 years old and served in Korea in 1967 & 1968. This problem continues to worsen. I am enrolled in VA health care but the co-pay cost me more than medicare. My retirement is $2500 per month and my wife has a teacher retirement, both incomes equal to less than 70k per year. What might I qualify for from veterans health services other than the Class 8 that I am now?

 

Jim's Reply:

When we are made eligible for VA health care services we are assigned to a priority group. Your tinnitus rating of 10% (the max for tinnitus) places you at 8 on the priority list and sets certain minimums for copays for health care other than that provided for the tinnitus. A vet with a disability rating of 100% is in priority group 1 with no copays for anything and the scale slides down from there.
 

From what you tell me I'd offer that you should consider filing a claim for the secondary conditions you associate with your tinnitus. Tinnitus is ringing in the ears and most people have a degree of tinnitus that they may or may not ever notice. In some people the ringing is distracting at times but not a real bother unless associated with profound hearing loss when the tinnitus may mask already dulled sounds. 
 

There are those folks who have such a loud tinnitus that they have serious issues with concentration, communication and sleep. VA doesn't compensate tinnitus at more than 10% disabling so to increase your benefits and get you into a better priority group so your copays don't cost as much, you need to file for a higher disability rating.
 

I'd first suggest that you have your hearing tested again and see if you don't suffer a degree of hearing loss. Then you'll need a medical record of the things that you believe are attributable to your tinnitus. Sleep loss is a condition as is depression, anxiety, mood swings, anger, etc. Again, these are secondary conditions to tinnitus that can be rated as such but you need a record of treatment to prove these are things bothering you.
 

As you are able to, take a while to get your records in order and file the claims.
 

Good luck!

 

CHAMPVA?

Question:

Hello. I am on Medicare and have an AARP supplemental plan that gives me full coverage. I recently qualified for CHAMPVA and I’m wondering if I can drop my expensive AARP coverage and/or my prescription part D plan. Will CHAMPVA cover expenses the same as a Medigap plan? Thank you.

 

Jim's Reply:

CHAMPVA is outstanding health insurance but it takes a little effort and patience to get used to. My wife uses her Medicare and her CHAMPVA together and it provides her with high quality care and prescriptions both by mail and at a local pharmacy. We're sure that her health benefits are better than mine!
 

There are intricacies and mysteries when you start using CHAMPVA. Yes, it should cover everything but some things need preapproval and that can get confusing. I've never been a believer in any sort of supplemental Medicare insurance as most of those receive terrible ratings in consumer reviews. Rather than a "Medigap" policy, we save the money we'd be paying for that policy and pay out of pocket expenses with no pain.
 

And again, I've viewed Part D as a terrible deal and unless you need some exotic and hugely expensive meds it makes more sense to pay out of pocket. However, your CHAMPVA should pay for all your meds although there are small deductibles on occasion.
 

The best I can tell you is that health insurance is a personal decision that you have to make based on your tolerance for risk and the economics you face in day to day life. A lot of folks are over-insured and they're happy knowing that they'll get care and not take chances with billing and debt. Others, like me, are el-cheapo by design and we look for cost savings at every step.
 

Before you drop your current insurance, get comfortable with CHAMPVA. Talk with your doctor's billing office and listen to what they say. Visit your favorite pharmacist and learn what their experience with all the insurances are. These people are all happy to talk to you about how they get paid because it's in their best interests! 
 

Go for it. Good luck!

 

Medicare

Question:

Hello Jim, I'm a 100% disabled Veteran and on Medicare part A. I stopped part B around 6 years ago because I never used it for medical reasons. I'm turning 65 soon and am getting correspondence from Medicare to pick up part B again but pay late penalties. What's your take on getting Medicare parts A and B? I appreciate your guidance and help with this matter. They want me to sign the notice card to opt out of Medicare part B by July. If I don't sign the card and mail it in they'll make the penalty adjustments and place me on Medicare A and B again.

 

Jim's Reply:

Medicare A is required when you begin taking your SSA retirement or SSDI, opting out is very difficult. Medicare B is optional but as you've learned, if you don't take it when first offered the penalty for that can be brutal depending on how many years you delayed.
 

Health insurance is a very personal decision. If you live within easy reach of a VA medical center, that's likely all you need. If you aren't within an easy drive to your clinic, you may want Part B so you can visit civilian physicians at very low cost.
 

I have it all...VA care, Medicare A & B because I'm 3 hours away from my VA hospital and I'm 1 1/2 hours away from my VA primary care clinic. My small community has a very nice and highly rated hospital and a bunch of doctors offices that are less than 10 minutes from my house.
 

You see where I'm going with this. It's a lot more convenient for me to use my Medicare even if it costs me a little more. I do stay connected to VA health care because I like my VA primary care guy a lot and I have all prescriptions filled through VA.
 

You'll have to decide for yourself how much money you want to spend protecting your health and how comfortable you are relying on VA if you do without the extra insurance. Good luck sir.

 

MEB

Question:

I’m a former active duty reservist. I currently have VA ratings but had a bad examiner during my MEB C&P exam and now my rating will go way down based on the exam. I also will not be eligible for medical retirement just a separation. Should I file for a new C&P exam either through an increase or appeal prior to the PEB’s review?

 

Jim's Reply:

The MEB process is incredibly complex and full of ambiguous processes, so much so that it's impossible to predict an outcome in almost any given case...like yours.
 

In very broad terms I usually offer that you should just get out as quickly as you can and then deal with the final ratings that VA awards you if you believe an increase is appropriate. This is the only time I'll find that VA is easier to deal with since you're dealing with DoD policy. That you may or may not be eligible for retirement adds to the complexity of your ordeal.
 

My expertise lies in working with the VA to ensure that you have the correct VA ratings and I have very limited PEB/MEB experience to offer you. I'll direct you to a site that I like https://militarydisabilitymadeeasy.com/mebprocess.html and I think you'll find your answers there.
 

Good luck!

 

Medicare B

Question:

Am I required by law to obtain Medicare Part B if I am 100% disabled Vietnam veteran? Agent Orange got me. Lung cancer, neuropathy, PTSD, etc. I was 16 and a VOLUNTEER! GOD BLESS you and your efforts.

 

Jim's Reply:

No, you are not required to take Medicare Part B. Many do take it and find it to be a convenient and not to costly addition to their health care but it is not required.