Presented by:
Leslie Arwin MD, MPH
Chief Medical Officer
Compensation and Pension
Exams Program (CPEP)
Lucile Burgo MD
National Co-Director
Post-Deployment
Integrated Care Initiative
Module Topics
1. Post-Deployment Care
2. Understanding Military Culture
3. Compensation & Pension / Benefits
4. Environmental Agents Exposures
2
Purpose
 Educate VA staff about the Compensation &
Pension (C&P) process and benefits
 Promote discussion to ensure Veterans have the
information, guidance and support needed to
access available benefits and resources
3
Learning Objectives
 Define “service connection” (SC)
 Define “presumptive” conditions
 Explain the role of the Primary Care Provider
(PCP) and other clinical staff relative to the
Compensation & Pension (C+P) process
 Acquire awareness of registry exams, follow-up
programs, and other benefits available for
Veterans from different eras
 Recognize that the C&P exam process is at the
heart of a Veteran-centric Veterans Affairs (VA)
4
History
2010: Department of
Veterans Affairs
 VHA role is to provide
medical exams &
healthcare
 VBA role is to administer
benefits
 Cemeteries
1592: Queen Elizabeth I
 Compensated injured
seaman
1776: Continental Army
 Pension program
1865: President Lincoln
 Promised to care for
him who shall have
borne the battle
5
VHA Organization
 Veterans Health Administration’s (VHA) role is to
provide healthcare services
 Veterans Benefit Administration’s (VBA) role is to
administer benefits
 Cemeteries
6
Veterans Benefits Administration
2008 Budget – Millions of Dollars
7
VA Compensation and Pension
 Of the 23.4 million living Veterans, nearly 3/4
served during a war period
 More than 1/4 of the nation’s population is
potentially eligible for VA benefits and services
based on status as Veterans, family members or
survivors of Veterans
8
VA Compensation and Pension
(cont’d)
 In 2008, VA provided $38.9 billion in disability
compensation, death benefits and pension to 3.7
million people
 About 3.2 million Veterans received disability
compensation or pension from VA in 2008
 In addition, 554,700 spouses, children, and
parents of deceased Veterans received VA
benefits
Source: VA Facts January 2009
9
Larry’s story; My ex-wife told
me to come to the VA…
 I was in Vietnam during the Tet Offensive.
 When I got home, things didn’t go so great.
 I married my high school sweetheart; it didn’t
work out. I tried a couple more times; it never
lasted.
 I tried college; I didn’t fit in. I quit college and
went to work In a gas station at night.
10
Larry’s story: My ex-wife told me
to come to the VA…(cont’d)
 I never talk to anyone. I keep to myself.
 I drank a lot. I smoked a lot. I couldn’t sleep.
 I’ve been jumpy ever since.
 My ex-wives say I have a short fuse.
 I got diabetes 5 years ago…now I’ve got that
“prostate” disease…
 I haven’t had regular work in a long time so I ran
out of my meds and I can’t pay for them. I hope
the VA can help me.
11
Why is Service Connection
Important?
 Compensation is financial
payment made to Veterans
for average loss of earning
capacity resulting from
service connected health
conditions
 Pension is paid to Veterans
who have impairments
arising from health
conditions unrelated to
military service
12
Why is Service Connection
Important? (cont’d)
C&P exam is to help determine service connection
 Not for diagnosis or treatment
 Describes physical or mental functional
limitations
Purpose of exam
 Provide medical evidence for VBA rating
specialists to assign benefits from 0% to 100%
for each claimed condition
13
C&P for Returning OEF/OIF
Veterans
 Enrolled returning
Veterans have 5 years
of priority access to
health services
 Service connected
conditions will ensure
continued care after the
initial 5-year period
14
Common Service Connection
Injuries and Illness
15
Principles of Service
Connection (1 of 3)
 Illness/injury incurred during time in active
service (or during an applicable period)
 Must be chronic in character (>6 months)
 If a condition was present prior to service,
service connection is possible; compensation is
based on the extent of aggravation
 No time limit on claiming service connection for
any potentially service connected condition
16
Principles of Service
Connection (2 of 3)
 The C&P clinician may be asked to opine
whether a Veteran’s condition is “at least as
likely as not” due to an in-service illness, injury,
or event
 Service connection is denied only when the
preponderance of the evidence is unfavorable
(against service connection)
 This rule resolves reasonable doubt in the
Veteran’s favor
17
Principles of Service
Connection (3 of 3)
Service connection may be:
 Direct
 Secondary
 Aggravation
 Presumptive
18
Direct
SC for injury or disease occurring during active
duty:
 Evidence of current impairment related to the condition
 Evidence in service treatment records (STR) of an
illness/injury/event
 Current impairment must be at least as likely as not
caused by a result of the documented in-service
illness/injury/event
19
Secondary
Diseases or conditions caused by or a result of a
SC condition
If SC for one condition, then possible SC for:
 Orthopedic -> right knee disability may result in
right hip disability
 HTN -> stroke
20
Aggravation
Benefits paid for the extent to which a non-serviceconnected condition was permanently aggravated
(beyond normal progression) during service or by
a service-connected condition
 Knee injury prior to service
permanently
aggravated during active duty
 Asthma worsened by environmental factors
 Mental health conditions
21
Presumptive
Certain categories of Veterans may have
conditions that are presumptively considered
service connected
 Agent Orange-exposed Veterans
 Gulf War Veterans with undiagnosed or unexplained
chronic illnesses
 Ionizing radiation-exposed Veterans
 Former Prisoners Of War (POW)
22
Ex-POW Presumptive
Conditions Include:
 Atherosclerotic heart






disease
Hypertensive vascular
disease
Stroke
Cirrhosis of the liver
Irritable bowel syndrome
Residuals of frostbite
Psychosis, anxiety states
(PTSD), depression
23
Argent Orange Exposure
Presumptive Conditions Include:
 Type 2 diabetes mellitus
 Soft-tissue sarcoma, Hodgkin’s
disease, non-Hodgkin’s
lymphoma
 Respiratory cancers
 Prostate cancer
 Spina bifida in children
Recently added presumptive
conditions
 Ischemic heart disease
 Parkinson’s disease
 Expanded to all B-cell leukemias
24
Ionizing Radiation Presumptive
Conditions Include:
 All forms of leukemia





(except for chronic
lymphocytic leukemia)
Solid tumors: thyroid,
pancreas, brain, ovary
Bronchoalveolar
carcinoma
Multiple myeloma
Non-Hodgkin’s
lymphomas
Primary liver cancer
25
Gulf War Presumptive
Conditions Include:
Included are medically unexplained chronic multisymptom illnesses defined by a cluster of signs or
symptoms that have existed for six months or more, such
as:
 Chronic fatigue syndrome
 Fibromyalgia
 Functional gastrointestinal disorders (including
irritable bowel syndrome)
 Any diagnosed or undiagnosed illness that the
Secretary of veterans affairs determines warrants
presumption of service condition
Signs or symptoms of an undiagnosed illness include
but are not limited to: fatigue, skin symptoms,
headaches, muscle pain, joint pain, neurological
symptoms, respiratory symptoms, sleep disturbance,
FI symptoms, cardiovascular symptoms, weight loss,
menstrual disorders
26
Cold Injury Sequelae
Many Veterans with cold injuries
served in the Battle of the Bulge
or in the Korean War
Long-term and delayed sequelae
of cold injuries include:
 Peripheral neuropathy
 Skin cancer in frostbite scars
 Post-traumatic arthritis in
involved limbs
 Raynaud’s phenomenon
27
Ratings and Benefits (1 of 3)
0%
 Designates service connection without impairment in
earning capacity
 Qualifies for free medical care for that condition
 No monetary compensation is paid at 0%
 Request an increase in compensation
10%
 Medical care at little or no cost for service connected
conditions
28
Ratings and Benefits (2 of 3)
20%
 Qualifies veteran for vocational rehabilitation,
including further education
30%
 Qualifies Veteran for additional benefits for
dependents
50%
 All medications are no cost; no co-pay for visits
29
Ratings and Benefits (3 of 3)
70%
 Free access to healthcare; free long-term care
100%
 Maximum benefits including full dental; severe
disabilities or special conditions may entitle Veteran
to special monthly compensation
30
Payments
 Monthly compensation (not disability) payments
vary according to degree of SC and number of
dependents
 VA benefits are not subject to federal or state
taxes
 Military retirement pay, disability severance pay,
and separation incentive payments can affect the
amount of compensation
31
Payments (cont’d)
2009 compensation



10% SC received $123/month
50% SC received $770/month
100% with no dependents received $2,673/month
If 30% SC or more, eligible for additional
allowance for each dependent
32
Encounter Form
33
Sign Orders
34
Initiating a C&P Claim
 Veterans fills out claim
request
 A service officer from
one of the Veterans
Service Organizations
can help
 A complete list of all the
services organization
will be included in our
resource guide
 Families may also
complete claim request
Veteran service representative
35
FAQs: What should we say to
our Veterans?
 “You should submit a claim for any conditions
you feel may be related to service so that you
receive support and care for those conditions”
 “Filing a claim is necessary to ensure you will
receive all the care and benefits for which you
are eligible”
 “These benefits may provide support not only for
you but for certain family members, too.”
36
FAQs: What should we say to
our Veterans? (cont’d)
 “Additional benefits may be available to you and
your family if you become unable to care for
yourself.”
 “The treatment and care you receive will become
part of the record and may be used in the claims
process.”
 “It is not your VA provider who determines
service connection or % of compensation; that is
done by the Regional Office using C&P exams
and other medical evidence.”
37
FAQs: What should we NOT
say to our Veterans?
The PCP should not direct the Veteran to the C&P
department
 The C&P department cannot provide an exam
until you submit a claim to the regional office
38
Other Benefits Considerations
 Good care means team-based care
 Social workers are an essential part of the team in
helping Veterans
 Social workers and Veterans Benefits Counselors
can help Veterans determine if he/she is eligible for
other benefits
 VHA can provide additional support for qualified
Veterans, including care management, homebased primary care, ancillary services, prosthetics,
etc.
39
Additional Benefits for NonService connected Veterans
Additional monetary benefits may be payable
when a Veteran:
 Needs the regular aid and attendance by another
person (including the Veteran’s spouse)
 Is permanently housebound
 These benefits may also be available to surviving
spouses
40
Special Monthly Compensation
 Veteran must be service-connected
 Enables provision of necessary care
 Example categories
 Amputations/loss of use
 Blindness
 Combinations of severe disabilities
 Aid and Attendance
41
Special Benefits for Surviving
Spouse
 Housebound or Aid and Attendance
 Considerations are:
 Housebound
 Inability to leave home
 Aid and Attendance
 Needs protection from hazards of daily living
42
Other Benefits
 Education, Training and Employment assistance
 VA educational benefits: GI Bill, Veterans
Employment Specialists, Transition assistance
Program (Hire Vets First), Small Business
Administration Patriot Express Loans
 Vocational rehabilitation
 VA home loan guaranties
 Life insurance
 Burial benefits and more
43
Health Registry Exams
 Specialized registry exam
 Non related to treatment
 Examples of registry exams include:
 Agent Orange
 Gulf War
 POW
 Ionizing radiation
 Depleted uranium
 Toxic embedded fragments
 Project shipboard Hazards and Defense (SHAD)
44
Resources
 A resource guide will be
included in this training
 Veterans’ Health
Initiative Books
 On-line and in facility
libraries
 For more information,
call Toll-Free 1-800-82100 or
 Visit our Web site at:
www.va.gov
45
Summary
 VA staff should understand the C&P process
 For many veterans, this exam is the gateway to
VA healthcare
 Many Veterans perceive this process as
validation of their service experience
46
Summary (cont’d)
VA staff should have a basic understanding of:
 The C&P process
 The Veteran’s SC status
 Benefits information to offer support to the
Veteran
 The role of the Veteran’s team includes helping
to ensure that the Veteran has the information
and access to all VA resources that will enhance
their health and medical care
47
Resources (cont’d)
 Information for Veterans and families
 Newsletter
 VA Web site (www.va.gov), ombudsman
assistance fore educational loans
 Department of Veterans Affairs Telephone
Assistance Service hotline number
1-888-827-1000
48