(Excerpts from) Federal Benefits Manual for Veterans and Dependents - 1999

Ionizing Radiation Registry Program (P.L. 97-72 1991)
In addition to special eligibility to enroll for VA health care for radiation-related conditions, atomic veterans are eligible to participate in VA's Ionizing Radiation Registry examination. Under the Ionizing Radiation Registry program, VA will perform a complete physical examination, including all necessary tests, for each veteran who requests it if the veteran was exposed to ionizing radiation while participating in the nuclear weapons testing program, or if he or she served with the U.S. occupation forces in Hiroshima or Nagasaki. Veterans need not be enrolled for general VA care to be eligible for the Ionizing Radiation Registry. (This is a "FREE EXAM at no charge. If experiencing any problems ask VA staff to refer to Veteran Health Administration Manual M-10 Part 11 for clarification.)
Veterans can reach their nearest VA office by calling 1-800-827-1000

VA Programs for Veterans Exposed to Radiation (P.L. 97-72)
VA provides special priority for enrollment for health-care services to any veteran exposed to ionizing radiation in connection with nuclear device tests or with the American occupation of Hiroshima and Nagasaki, Japan, during the period beginning Sept. 11, 1945, and ending July 1, 1946. In addition, these "atomic veterans" are eligible to participate in the VA ionizing radiation registry examination program. VA also pays compensation to veterans and their survivors if the veteran is determined to have a disability due to radiation exposure while in service.

The Defense Threat Reduction Agency's Nuclear Test Personnel Review program since 1978 has maintained a database of participants in atmospheric nuclear test activities. (Interesting)

Determination of Service-Connected Diseases VA may pay compensation for radiogenic diseases under two programs specific to radiation-exposed veterans and their survivors:

Statutory List. (Presumptive)(P.L. 100-321 & amendment P.L. 102-578) Veterans who participated in nuclear tests by the U.S. or its allies, who served with the U.S. occupation forces in Hiroshima or Nagasaki, Japan, between August 1945 and July 1946, or who were similarly exposed to ionizing radiation while a prisoner of war in Japan, are eligible for compensation for cancers specified in legislation. The 15 types of cancer covered by these laws are: all forms of leukemia except chronic lymphocytic leukemia; cancer of the thyroid, breast, pharynx, esophagus, stomach, small intestine, pancreas, bile ducts, gall bladder, salivary gland and urinary tract; lymphomas (except Hodgkin's disease); multiple myeloma; and primary liver cancer. (1999 amendment to S.4 passed the Senate and awaits the House and President's approval to become Law, would add lung cancer, colon cancer and tumors of the brain and central nervous system.)

Regulatory List. (Non-presumptive)(P.L. 98-542) Disability compensation claims of veterans who were exposed to radiation in service and who develop a disease within specified time periods not specified in the statutory list are governed by regulation. Under the regulations, various additional factors must be considered in determining service-connection, including amount of radiation exposure, duration of exposure, add elapsed time between exposure and onset of the disease. VA regulations identify all cancers as potentially radiogenic, as well as certain other non-malignant conditions: posterior subcapsular cataracts; non-malignant thyroid nodular disease; parathyroid adenoma and tumors of the brain and central nervous system.

A final rule that expanded the regulatory list from more than a dozen specific cancers to add "any other cancer" (any malignancy) was published Sept. 24, 1998. The rulemaking began following a 1995 review of the radiogenicity of cancer generally by the Veterans Advisory Committee on Environmental Hazards. It concluded that, on the basis of current scientific knowledge, exposure to ionizing radiation can be a contributing factor in the development of any malignancy. VA also will consider evidence that diseases other than those specified in regulation may be caused by radiation exposure.

Claims for compensation may be filed at the nearest VA regional office. Veterans or their survivors can reach the nearest regional office by calling 1-800-827-1000.

Rates of Disability Compensation

Rates of compensation depend upon the degree of disability and follow a payment schedule that is adjusted annually and applies to all veterans. Current rates at increments of 10 percent disability are listed in VA's handbook, Federal Benefits for Veterans and Dependents, available on the Web at http://www.va.gov/benefits.html. Additional amounts may be awarded for certain severe disabilities.

For deaths in 1993 and after, compensation to survivors is paid based on a flat rate to all eligible claimants. An additional amount may be paid if the veteran had been rated 100-percent disabled for service-connected disabilities, including individual unemployability, for at least eight years prior to death and had been married to the surviving spouse during the same period. Additional amounts also may be payable to the surviving spouse for dependent minor children.

Disability Compensation

The VA compensation program provides you monthly benefits if you are disabled because of an injury or disease incurred in or aggravated during your military service and for certain conditions which may develop after your release from active duty. Benefits are authorized based upon the severity of your claimed disability(ies). If your service-connected disabilities are evaluated as 30 percent or more, you are entitled to additional allowances for your dependents. Other Benefits/Payments May Affect Your VA Compensation

Military Retired Pay - By law, the payment of VA compensation benefits is affected by the receipt of military retired pay. If you receive military retirement, you may initiate a waiver of your retired pay to receive the full amount of VA compensation. Until the waiver takes effect, your compensation will be adjusted or withheld depending on the amount of military retired pay you are entitled to. The advantage of waiving military retired pay for VA compensation is that VA benefits are not taxable.

Disability Pension - Non Service-Connected Pension is a program that provides financial support to wartime veterans having limited income. The amount VA will pay you under this program depends on the type and amount of income you and your family members receive from other sources. Payments are made to you to bring your total annual income, including other retirement and Social Security income, to an established support level. Countable income may be reduced by unreimbursed medical expenses.
Eligibility:
Generally, you must have 90 days or more of service of which at least 1 day must have occurred during a period of war, and you must have been discharged under conditions other than dishonorable.
You must have a disability(ies) that VA evaluates as permanent and total. For VA pension purposes, permanent and total means it is not likely that you will be able to maintain a substantially gainful job. Unemployability and age are factors also considered in VA's eligibility decision.
How to Apply:
VA Form 21-526, Veteran's Application for Compensation or Pension. The following supporting evidence and/or documents should be submitted with your claim:

Medical Records - Medical records to provide a diagnosis and prognosis of your current medical condition and to substantiate any and all treatment by private doctors and hospitals.

Dependency Documents - Original or copies of birth and marriage certificates and copies of divorce/death record terminating your prior and those of your spouse.

Military Discharge/DD Form-214 - If you have a copy of your DD-214, please provide it with the application as this will expedite processing. Otherwise, VA will attempt to obtain verification of your military service from the service department.

VA Health Care
Veterans and their families have raised questions about new eligibility and enrollment rules for VA health care. Specifically, misinformation has led some veterans to wonder whether they will lose their eligibility for VA health-care services if they are not enrolled at VA by October 1, 1998. The answer is NO, they will not lose their eligibility, but in most cases, they do need to apply for enrollment by contacting their nearest VA medical center.
VA health-care eligibility reform was authorized by Congress and signed into law by the President in October 1996. The new law required VA to manage veterans' access to VA care by using a system of enrollment priorities. There are seven enrollment priority groups, and VA will enroll veterans from as many of the groups as possible.
Veterans can apply for enrollment AT ANY TIME that they come to a VA medical facility for care, even AFTER the trial enrollment period, which ended on October 1, 1998.
For details about the seven enrollment priority groups, and enrollment in general, please refer to the VA home page subject, "Benefits" and under the section "Benefits in Detail," go to the link "Eligibility Reform Page." (http://www.va.gov/health/elig)
To receive information about individual eligibility, a veteran should contact the nearest VA medical center. Its address and telephone number are listed on our home page under "Facilities" on the VA home page. (http://www.va.gov/facilities.html)
Washington, D.C. -- The Department of Veterans Affairs (VA) has announced that, in fiscal year 1999, it will enroll all veterans who apply for VA health care.
It is our desire to serve as many veterans as possible under this new law, and we've made it easier than ever before for veterans to obtain health care benefits," said Dr. Kenneth W. Kizer, VA Under Secretary for Health. "For the first time, enrolled veterans will have access to the full range of services they need, not just those medical needs resulting from military service."
March 11, 1998
Veterans who are classified as being service-disabled with a rating of 50 percent or greater will continue to be eligible for VA health-care services without making application for enrollment. While veterans in these categories do not have to be enrolled to be treated, they are encouraged to do so to help VA plan its services and allocate its resources.
Those who are enrolled will be eligible for inpatient and outpatient services, including preventive and primary care. Other services include: diagnosis and treatment; rehabilitation; mental health and substance abuse treatment; home health, respite and hospice care; and drugs and pharmaceuticals in conjunction with VA treatment. Veterans accepted for enrollment will be eligible to receive care at any of VA's more than 1,100 service sites. While enrollment must be renewed every year, a veteran's enrollment will automatically be renewed unless he or she chooses not to re-enroll, or unless VA resources limit the number of veterans the department can cover. Certain veterans will be asked to provide income information annually in order for VA to properly classify them within the enrollment system, as required by law.
To apply for enrollment, veterans should call, write or visit their nearest VA health-care facility. Most facilities have designated special enrollment coordinators to assist veterans and their families, and to answer any questions they may have.

  For other questions and e-mail contacts, go to the bottom of the VA home page and click on the icon "Putting Customers     First" to go to the "1-Stop Customer Service" page.
  (http://www.va.gov/customer/consumer.html)

  Application for Health Benefits VA Form 10-10 EZ
This file is a PDF file. If you need the Acrobat reader, you can download it from Adobe.

DIC (Dependents Disability Compensation)
July 24, 1998: VA ANNOUNCES RESTORATION OF BENEFITS FOR SPOUSES
Washington, D.C. - The spouses of deceased veterans who lost Department of Veterans Affairs (VA) survivor benefits when they remarried may be eligible for restored Dependency and Indemnity Compensation (DIC) benefits if they are no longer married. Legislation signed by the President June 9 repeals a 1990 law that permanently terminated eligibility for DIC for a veteran's surviving spouse who remarried after the death of the veteran. The pre-1990 policy, which will be renewed effective October 1, allows benefits to be restored if the marriage is terminated. The basic monthly rate for DIC is currently $850. Veterans' spouses should contact their local VA Regional Office or call VA toll-free at (800) 827-1000 for assistance. Information on DIC benefits may also be found on VA's Internet Home Page at http://www.va.gov.

Survivors' Benefits
Dependency and Indemnity Compensation (DIC)
DIC is a monetary benefit awarded to surviving spouses, unmarried children under 18 and certain helpless children and parents of service personnel of veteran who die because of service-connected causes. In certain cases, entitlement can be established if the veteran's death is nonservice-connected.
A basic DIC payment is made monthly to eligible persons with other allowances added under certain circumstances (e.g., for additional dependents or if a surviving spouse is so severely disabled as to be housebound or in need of regular aid and attendance). Income does not affect the DIC payments for surviving spouses and children. The monthly DIC rates for eligible parents depend on the amount of other income received by the parent.

Survivors Benefit Plan (SBP) -- DIC payments are affected by the receipt of SBP benefits. Consult with a VA counselor for more details.

How to Apply:
VA Form 21-534, Application for Dependency and Indemnity Compensation, Death Pension and Accrued benefits by a Surviving Spouse or Child including Death compensation, (if applicable), or VA Form 21-535, Application for Dependency and Indemnity Compensation by Parent(s).

The following supporting evidence and documents should be submitted with the application:

Dependency Documentation - Original or a copy of birth and marriage certificates and copies of divorce/death record terminating all prior marriages for veteran and spouse. Parents, applying for DIC, should furnish original or a copy of the veteran's birth certificate.

Military Discharge/DD Form 214 - Original or a certified copy. VA will attempt to obtain verification of military service from the service department if these documents are not available.
Certification of Death - Original or a copy of the veteran's death certificate.

Contact Your Local VA Regional Office for Additional Assistance, by dialing our toll-free number, 1-800-827-1000 for "The Facts About Enrollment for VA Health Care and Application Form:"

February 1999
VA Programs for Older Veterans

Currently, the median age of World War II veterans is estimated at 73.8 years. Today, nearly 9 million veterans are age 65 and older -- 34.8 percent of the overall veteran population. By 2000, the number of veterans age 65 and older will peak at 9.3 million and represent 38.2 percent of the total veteran population. On an average, the elderly have more chronic medical problems than younger persons. Their need for health-care services, especially long-term care, is much greater, creating a challenge to VA's healthcare system. That challenge is being met through a variety of programs directed toward the special, complex needs of the aging veteran population.

Nursing Home Care
VA's 132 nursing home care units, based at VA medical centers, provide skilled nursing care and related medical or psychosocial services. A comprehensive care management system is coordinated by an interdisciplinary team. In FY 1998, more than 47,000 veterans were treated in these facilities. Veterans who have been hospitalized in a VA facility for treatment, primarily for a service-connected condition, may be placed, at VA expense, in community facilities. In FY 1998, VA contracted with 3,500 community nursing homes to provide care to more than 28,900 veterans. Through the State Nursing Home Program, VA contributes to the construction costs of the nursing home and provides partial perdiem grant payments to the state for veterans placed in a state home. There are 90 state nursing homes in 43 states, with an average daily cencus of 12,600 patients.

Domiciliary Care
VA facilities and VA-supported state homes provide domiciliary care, or residential rehabilitation and health maintenance centers, for veterans who do not require hospital or nursing care but are unable to live independently because of medical or psychiatric disabilities. They receive necessary medical and psychiatric care, rehabilitative assistance, and other therapeutic interventions on an outpatient basis from the host hospital, while residing in the structured, therapeutic, homelike environment of the domiciliary. VA operates 40 domiciliaries with nearly 5,878 beds. An additional 5,841 beds for domiciliary care are available at 46 state homes.

Hospice and Respite Care
VA's hospice care program provides pain management, symptom control, and other medical services to terminally ill veterans, as well as bereavement counseling and respite care for their families. Each facility has a hospice consultation team consisting of a physician, nurse, social worker, and chaplain to plan, develop and implement a program of hospice services.Respite care is a program designed to relieve the spouse or other caregiver from the burden of caring for a chronically ill veteran at home. This is done by admitting the veteran to a VA hospital or nursing home for planned, brief periods of care, generally lasting 2-4 weeks. The long-range benefit of this program is that it enables the veteran to live at home with a higher quality of life than would be possible in an institution. It may also provide the veteran with needed treatments during the inpatient stay, maintaining or improving functional status and prolonging the veteran's capacity to remain in the home. There are respite care programs at 136 VA medical centers. While they vary in size, each typically provides care to approximately five veterans on any given day.

Geriatric Evaluation Management Programs
Geriatric Evaluation Management (GEM) programs provide comprehensive health-care assessments, therapeutic interventions, rehabilitative care and long-range term care plans for primarily older veterans with multiple medical, functional and/or psychosocial problems and those with particular geriatric problems, such as early-stage dementia, urinary incontinence or falls. GEMs are aimed at keeping frail elderly out of nursing homes. Programs are staffed by an interdisciplinary team composed of a physician, nurse, social worker, and other health professionals skilled in assessing and treating geriatric patients. The first GEM was opened in June 1976 by the Geriatric Research, Education and Clinical Center at the VA Medical Center in Little Rock, Ark. Today, there are 110 GEMs system wide.

Noninstitutional Long-Term Care
While VA provides care to veterans in nursing homes and domiciliaries, and pays for care for certain veterans in private community nursing homes and state veterans homes, VA also developed a number of long-term care programs in noninstitutional settings. These programs have grown out of the philosophy that a home or community setting is the desired location to deliver long-term care, and that nursing home placement is a last resort. Within VA, this type of care includes hospital-based primary care, adult day health care, homemaker/home health aide services and community residential care programs.

* Hospital-Based Primary Care -- provides primary medical care to chronically ill veterans in their own homes under the coordinated care of interdisciplinary treatment teams. In FY 1998, VA operated programs at 71 sites and served an average of 6,360 patients a day, for a yearly total 13,224 patients.

* Adult Day Health Care -- provides health maintenance and rehabilitative services to frail individuals in a group setting during daytime hours. Introduced in the late 1970s at five VA facilities, by 1998 VA operated 14 programs directly and provided contract services at 83 VA medical centers, providing care to approximately 1000 veterans daily.

* Homemaker/Home Health Aide Services -- In April 1993, VA initiated a pilot program of health-related services for service-connected veterans who would otherwise be in a nursing home. These services, provided in the community by public and private agencies, include such things as light housekeeping, meal preparation, bathing, dressing, feeding, medication management, and assistance with medical equipment. VA staff directly provides case management of these services. Homemaker/home health aide services were purchased for 118 VA medical centers, serving more than 2,300 veterans during 1998.

* Community Residential Care -- provides room, board, limited personal care and supervision to veterans who do not require hospital or nursing care but are not able to live independently because of medical or psychiatric infirmities, and have no family to provide needed care. In 1998, approximately 9,300 veterans were provided care in 2,100 homes.

Alzheimer's Disease and Other Dementias
Dementia is characterized by intellectual deterioration, including disturbances in memory as well as impulse control, language, spatial abilities, and judgment severe enough to interfere with social or occupational functions. Alzheimer's disease, the most common form of dementia, is characterized by a gradual onset of symptoms with progressive intellectual deterioration. VA's program for veterans with Alzheimer's disease and other dementias is decentralized throughout the medical-care system. Many medical centers have established specialized programs for the treatment of veterans with dementing illnesses. Veterans with dementia participate in all aspects of the health-care system, including outpatient, acute and extended-care programs. A number of educational resources have been developed by VA for training staff to provide care to dementia patients and to work with family care-givers. Many of these resources have been disseminated to the general public as well. In addition, VA investigators are actively involved in research on the causes and treatment of Alzheimer's disease and other dementias.

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