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2006 VA HEALTH,
INCOME AND OTHER BENEFITS
By
Thomas McCormack 12/04/05
Many fans of movie musicals can
recall Joan Blondell belting out “Remember My Forgotten Man” against a
moving tableau of World War I doughboys in Busby Berkeley’s film,
Golddiggers of 1933. In one of Hollywood’s rare early forays into
social issues, the song and dance number called for better treatment of
the World War I veterans who’d just been spurned by President Hoover,
the lame-duck GOP Congress and even future World War II hero General
Douglas MacArthur, who used tanks to disperse thousands of unemployed
and disabled veterans demonstrating peacefully for benefits in
Washington the year before.
But over 70 years later,
Blondell’s torch-song lament still rings true: Most of us aren’t aware
of benefits which are available to all veterans – and especially
disabled veterans -- and they and the benefits due them too often
remain “forgotten.” (For just one example, in 2000 Lawrence Deyton, MD,
the VA’s national coordinator of HIV care, estimated that only 18,000
of an estimated 85,000 to 130,000 eligible HIV-positive veterans had
signed up for the VA health care to which they’re entitled.) Here’s a
brief survey of income and health coverage programs for veterans of
active duty with general or honorable discharges.
VA Disability “Pensions”
For Needy “Wartime” Veterans
Veterans who are permanently
and totally disabled or over age 65 and have
served at least 90 days active duty, including at least one day
during what the VA defines as “ wartime”--- even if they never
actually entered the war zone---can receive pensions for non-service-connected
disabilities (that is, disabilities not arising from the
time in service) if their incomes and assets are below certain levels.
In 2006, the pension level for a single veteran without dependents is
$881.58
+ monthly and
additional amounts are paid for invalids and those with dependents. But
see the sidebars below for more details about pension income levels, for
the officially-recognized “wartime” dates and for details about, and
exceptions to, the extra two-years-of-service minimum rule for those who
first enlisted after September 7, 1980 .
Income and Asset Rules For VA Pensions
In spite of its name, the VA
pension is, in fact, a welfare program: those with low
enough assets, and countable income below the pension amount,
receive payments to bring them up to the pension level. Thus, all other
countable income -- except welfare, needs-based payments such as
Supplemental Security Income (SSI)*, Temporary Aid to Needy Families (TANF,
formerly AFDC), state Temporary Disability Assistance, General
Assistance and Home Relief -- reduces the pension payment
dollar-for-dollar, and if the other income is high enough, it prevents
any pension eligibility at all. (Veterans’ spouses’ and even their minor
children’s assets and income are counted. But, in 2006, the first
$8,450 a year in a child’s earnings are disregarded.) Allowable
assets include one lived-in home of any value, one vehicle of any value
and $80,000 net worth in savings, other real estate, other vehicles,
boats, property or investments. VA pensions cannot be garnished for
private debt, except for child support and alimony orders (for details,
see 8/5/98 testimony of VA General Counsel before House Veterans’
Affairs Committee, searchable at www.VA.gov
)
Disability Standards For VA Pensions
To qualify for a pension, a
“wartime “ veteran need not show that his or her
disability arose from time on active service. But he or she
nevertheless must be considered permanently and totally disabled (which
generally means being “rated” 100 percent presently
disabled) by the VA under its disability regulations.---even if
from a malady that started after discharge. (But
financially eligible veterans over 65 don’t have to be
found medically disabled to get pensions; their age alone
qualifies them.) The VA disability rules are similar to, but somewhat
more liberal than, those of Social Security. Unlike Social Security,
however, the VA will consider such purely “social” factors as chronic
unemployability. And, by law, it must resolve all borderline or
doubtful questions in favor of the veteran. For an example, see the
quote in the sidebar below from the VA’s disability regulations on HIV
disease. Disability is determined by VA review of veterans’ submitted
military and even non-military medical records, physician
statements, etc.---and, almost always, “ratings examinations” which the
VA orders to be performed by VA physicians at VA medical centers.
Pensions For Surviving Spouses and Disabled Grown Children of Wartime
Veterans
Surviving spouses of wartime
veterans can also collect VA pensions if they are poor enough. Unlike
veterans, they need not show that they’re disabled themselves
or even that the wartime veterans they survive were disabled or
received VA pensions when they were still alive. Even grown disabled
children of wartime veterans -- again, if they’re poor enough -- can
receive VA pensions, although in these cases the grown child (called a
“helpless adult child” by the VA bureaucracy) must satisfy VA
disability standards by submitting his or her own medical records,
appearing for a VA “ratings examination” and proving that his or her
own disability started before age 18. (However, such grown
disabled children need not have been found disabled by
Social Security, either as minors or adults.) See the chart below for
pension levels that apply to surviving spouses, their dependents and
surviving “helpless adult children”. (The last surviving widow of a
Union Civil War soldier---who wed the veteran, who was by then in his
80s, as a much younger bride in the 1920s--received a VA pension until
her own death in 2002, according to news stories. In May, 2003, VA
Secretary Principi stated on C-SPAN that about 10 long-grown-up,
now-quite-old “helpless adult children” of Union Civil War soldiers were
then still receiving VA pensions! )
Pension Add-ons If You Need “Aid & Attendance” or Are “Housebound”
Pension levels of veterans,
surviving spouses and surviving disabled grown children are increased if
the VA finds they need “Aid and Attendance.” This broad class covers
almost anyone who can medically document that he needs help
because of limits with mobility, housekeeping, dressing, grooming,
bathing, toileting, meal preparation, errand, communication, social
interaction, mental acuity, chore capabilities and other Activities of
Daily Living (ADLs). Those who receive extra “Aid and Attendance”
payments---while they’re intended for the costs of medically necessary,
disability--related personal care---are not required to prove
they actually spend the add-ons on such care. A similar increment is
added to pensions of those who the VA determines are physically
“House-bound.” by their conditions This category defines itself, but is
far less widely used ---and pays far less---than the “Aid and
Attendance” add-on. Pensioners cannot receive both add-ons at the same
time. Authorizations for “Aid and Attendance” and “Housebound” pension
increments for veterans and their surviving spouses and “helpless adult
children” require the submission of medical documentation of that need
and, almost always, appearance for a VA “ratings examination”. See
“Improved Pension” Rate Tables at
www.VA.gov
VA Pensions, Supplemental Security Income (SSI) and Medicaid
VA pensions
count all family members’ income to reduce (and, if the other income is
high enough, even to eliminate) the pension payment: wages, private
pensions, regular earned Social Security benefits, bank
interest, investment income, etc. (Again, though, in 2006 up to $8,450
yearly of a child’s earnings are disregarded.) But
welfare-type payments, such as Supplemental Security Income (SSI),
Temporary Aid to Needy Families (TANF), General Assistance, state
Temporary Disability Assistance, Home Relief, food stamps, the value of
Medicaid-purchased medical care , energy assistance and housing aid
don’t count as income for VA pension purposes.
But the
reverse is not true: SSI, TANF, welfare, food stamps, Medicaid
and housing programs do count that basic portion of VA pension
income meant for the support of the pensioner veteran himself---but
not necessarily any additional amounts meant to support spouses
and dependents-- even though it is a welfare-type
payment. However, SSI, Medicaid and welfare will attribute, or “deem”,
only the pension’s dependent increment itself (and not
the veteran’s own basic portion of the pension allowance)
only to spouses and children themselves
when they themselves are the SSI, Medicaid or welfare
applicants. But these other assistance programs shouldn’t ever count the
“Aid and Attendance” and “Housebound” add-ons to pensions as anyone’s
income , since they’re exempted as being medical care purchases rather
than welfare per se. But where this issue comes up, it almost
always requires one to painstakingly explain (possibly even with written
materials or notes from the VA) the “A & A” and “Housebound” payments
and their purpose to get SSI, Medicaid and other welfare programs exempt
them from being counted as income.
What all this
means is that someone who is on SSI, Medicaid or welfare will not
have their simultaneous receipt of these benefits counted as income by
the VA, but SSI, Medicaid and other welfare programs
may well count the VA pension or some portion of it in
determining welfare eligibility for a veteran or his dependents Since
this sort of situation can get quite complex with families in which both
the VA pension and SSI, welfare and/or Medicaid are received or
are being applied for, expert advice from legal aid attorneys or other
experienced advocates is a must.
The
VA Pension Doesn’t Count Income Spent on Unreimbursed Medical Expenses (UME)
As already mentioned, in counting income, the VA
disregards (that is, it does not count toward eligibility or how much a
pension payment will be) a child’s earnings up to $8,450 yearly in
2006. In addition, income above 5% of the prior year’s
basic pension amount for a family of that size --
not inclusive of any add-ons to the pension level for “Aid and
Attendance” or “Housebound” status -- is not considered (i.e., it
is disregarded) in calculating eligibility for, and the amount of,
pension payments if it is to be spent on medical care and related
expenses.
These expenses can include costs not covered by
one’s health insurance, such as co-payments and deductibles;
transportation to medical care (busses, subways, taxis, tolls, car gas
and mileage); premiums for Medicare and any other health insurance;
services or drugs not provided by the VA, other health coverages or
Medicaid; and even in some circumstances medical expenses
of non-veteran family members.
For a single veteran in 2006, this means
that other, ordinarily countable, income over $42.33 monthly, which is
5% of 2005’s $846.33 monthly single veteran pension rate--- if
it’s to be spent on medical care--- won’t be deducted from his or her
pension amount. This feature is called the “unreimbursed medical
expense” or “UME” deduction, and is a way of shielding income meant for
medical care from being counted as income in the VA pension eligibility
budgeting steps. To adjust one’s pension to take account of income spent
on medical care, use VA Form 21-8416. See the example in the sidebar
below.
VA
Medical Care Eligibility and Enrollment
All veterans with honorable or general discharges
who have served at least 180 days of active duty can receive care at VA
medical centers -- even if they aren’t disabled under VA or Social
Security rules or have not served in a war zone or during wartime.
High-priority, free care with no co-payments is guaranteed to
those with service-connected disabilities above 50%, former prisoners of
war and any veteran (whether or not he or she has a
service-connected disability) for at least two years after he serves in
a combat zone. (But see the sidebar below for details about, and
exceptions to, the two year service minimum for those who first enlisted
after September 7, 1980.) Care available through the VA includes
inpatient hospital stays, outpatient hospital services, clinic and
physician services, surgery, complete laboratory and radiological
services and outpatient prescription drugs. According to a 2002-2003
GAO study, nearly one third of VA medical centers fail to offer home
health services (as they’re required to do) and some improperly deny
them to eligible, but non-service-connected, veterans; in response, the
VA promised in 2003 to begin making home health care more widely and
equally available (for details, see http://www.gao.gov/cgi-bin/getrpt?GAO-03-487
). Besides hospitals, there are also hundreds of freestanding VA
outpatient clinics; www.VA.gov
lists locations within each state.
Veterans typically
begin the enrollment process with interviews at VA medical facilities,
bringing discharge papers (DD214s)*,
documentation of any private health insurance and, for those of
limited income seeking Priority Group 5 or 7 care (see below), proof of
dependents, income and “net worth” (assets other than lived-in homes and
one car). Enrollment is completed once veterans are assigned to a
Primary Care Team (often denoted by colors: “red’, “green”, etc.) and
are scheduled for Team intake examinations---after which referral to
specific departments and clinics for ongoing care is arranged. Either
after the enrollment interview or the intake examination, they’re issued
plastic VA patient identity cards (those with purple triangles indicate
the coveted, priority status of “service connected”).
But, anytime, those
presenting themselves at the emergency room for genuine
emergencies---even those who haven’t yet applied for or
completed the regular enrollment process!--- are seen with the same
medical triaging, waiting and processing used at any hospital
emergency room. In practice, a not-yet-completely-enrolled veteran
arriving at a VA emergency room without any documentation
(proof of discharge, income and assets, health insurance papers), who
verbally alleges he’s a qualified veteran will be treated for emergent
care and, if medically essential for life or limb, even admitted to
inpatient care. But if he doesn’t medically require
inpatient admission or anything more than outpatient emergent care in
the ER, he won’t be given VA-issued prescriptions on-site
(although he would be given VA-issued prescriptions which he
could pay for himself at commercial pharmacies). Those
not-yet-fully-enrolled patients arriving at ERs with
documentation of discharge, income and assets and insurance are handled
the same. But, if they’re not admitted, they will also
be given, then and there at the VA’s in-house pharmacy, any
prescriptions that the VA physician orders.
Assume a veteran moves from one area of the country
to another---and, in particular, if he or she (perhaps only nominally
and temporarily) moves from one area to another to avoid long queues in
his or her own home area (for example, to take advantage of shorter
waits for the initial intake examination and primary care team
assignment in a less-crowded area) for Priority 5 or 7
non-service-connected veterans' health care. Does the move to the new
area mean that he has to re-enroll all over again and still again
go through a long wait for his initial intake examination and assignment
to a "primary care team"? No. When an already-enrolled,
already-examination-intaked Priority 5 or 7 non-service-connected
veteran moves to a new area, he need only appear at the nearest VA
hospital or clinic for care or the routine scheduling of care,
without the need to wait for a new intake examination.
Showing his VA ID card (issued at first enrollment)
and mentioning his Social Security number calls up his record on the
VA's nationwide computer. In such cases, the veteran would, of course,
be assigned by clerical intake staff to a "new" primary care team at the
new hospital or clinic (a necessity, of course, because of the move!).
There would then be only the same waits for primary care appointments or
specialty care referrals as are faced any other local, already-enrolled,
already-intake-examined veteran. (But, of course, those "routine" waits
can be, and often are, weeks and sometimes months even in the least
busy VA hospitals and clinics.)
In recent years, more
and more older World War II, Korea, Vietnam and Cold War veterans who
don’t have prescription coverage have learned that they can get
prescriptions from the VA and have begun crowding into VA hospitals.
Since 1996, the VA patient caseload has grown from 2 million to well
above 6 million. In areas with many retirees---like Florida, Nevada,
North Carolina, Southern California, Arizona, Texas and Hawaii ---this
has caused delays of many weeks, or even months, in scheduling
newly-enrolling veterans for their intake examination appointments.
By late 2002, 260,000
veterans were awaiting their intake examinations. To cope with this, in
September, 2002, the VA issued interim final regulations to give first
priority in scheduling these intake examinations to those veterans who
have service-connected, VA-recognized disabilities; others,
including those whose disabilities are non-service-connected
(e.g., only recognized by Social Security), have a secondary scheduling
priority for intake examinations. Nevertheless, until the Bush
Administration proposed putting on some brakes in its fiscal 2006
budget, in every recent year Congress has appropriated massive increases
for the VA health budget and will continue to do so to handle the
crowding. Higher VA health budgets are popular with Congress:
Conservatives almost always favor any sort of “military” expense; while
liberals know that the VA cares for the poor, the disabled and the
elderly.
VA Health Care
Priority Groups, Service-Connected Veterans and Co-Payment Rules
Except for genuine
emergencies, the VA prioritizes access, waiting times and medical
service availability for elective and other non-emergency care, using
eight priority groups:
1.
50% or more service-connected disabled veterans
2.
30% and 40% service-connected disabled veterans
3.
10% and 20% service-connected disabled veterans; former prisoners
of war; Purple Heart recipients
4.
Veterans, no matter how rich, whom the VA finds to be
“catastrophically disabled”, even if from a non-service-connected
cause, (see sidebar below for a list of qualifying conditions); or
who get pension or compensation payments for Aid and Attendance or as
Housebound; those who served in war zones within the last two years,
even if otherwise ineligible in another Priority Group.
5.
Non-service-connected veterans considered “poor” under VA
income/asset rules (see below)
6.
Vietnam War (1962-75) Agent Orange victims and those with other
designated conditions; First Gulf War (1990-91) and Iraq War (1998- )
veterans with Gulf War Syndrome and other designated conditions.
7.
Non-service-connected veterans considered “near poor” under VA
income/asset rules (see below)
8.
Non-service-connected veterans not considered poor
under VA income/asset rules (see below)
Service-connected
veterans always get free care, without even the $8
prescription co-payment, for their service-connected
conditions---no matter how high their income or assets. If they have
private health insurance it is never billed for treatment
of service-connected conditions. But service-connected and other
Priority 1 through 4 veterans must pay the co-payments of the Priority
5, 7 or 8 Groups that their incomes and assets would otherwise assign
them to for treatment of non-service-connected
conditions except that those rated 30% or more service-connected
disabled are exempt from paying the (Priority Group 5, 7 or 8) non-prescription
co-payments (even for non-service connected conditions’
care) that their incomes and assets would otherwise require of them. In
other words, a service-connected veteran, no matter how high his income
or assets, is exempted even from paying the applicable
income/asset-based Priority 5, 7 or 8 co-payments (except for
prescription co-payments) that he “deserves”, for care of a non-service-connected
condition, if he’s rated 30% or more service-connected disabled.
So, as a result, even service-connected and other Priority 1 through 4
veterans---especially those rated 30% or below---still do need to have
their income and assets evaluated in order to be assigned the applicable
Priority Group 5, 7 or 8 co-payment schedule (plus, if they’re
very poor, the extra prescription co-payment exemptions
mentioned below) for treatment of non service-connected
conditions. Debts owed the VA for any co-payments dues can be waived on
grounds of “equity and good conscience” by hospital fiscal officers (see
amendment to 38CFR17.05 in the April 20, 2004 Federal Register).
Upgrading Bad
Conduct, Dishonorable, Less-Than-Honorable & Undesirable Discharges;
Having Discharges Reclassified To Being For Disability or Hardship
Bad conduct,
dishonorable, less-than-honorable or undesirable military
discharges---and “too-early” discharges that need to be rewritten to
more clearly reflect that they were actually for hardship or disability
reasons---which may now prevent eligibility for VA medical care,
pensions, compensation or other benefits--- can be changed by applying
to appropriate military services’ discharge review boards. The website
www.usmilitary.about.com offers clear, concise explanations
and instructions for doing so, with relevant forms and addresses. For
attorneys and other professional-level advocates who need more
exhaustive information, the National Veterans Legal Services Program (www.nvlsp.org)
sells a comprehensive manual for about $100.
What About Those
Veterans Who Seek Only VA Prescription Drugs But Want To Retain Their
Own Civilian Doctors?
Some veterans may argue
that enrolling in VA medical care (for example, to gain valuable
prescription drug coverage) might require their giving up their own
civilian doctors (whom they see through Medicare or as patients in
various low income clinic programs). Actually, this isn’t so. There’s
no rule denying VA eligibles the right to also see civilian
doctors---and, in fact, a surprising number do so. As mentioned in the
previous paragraphs, VA facilities are very crowded now precisely
because many older veterans use their Medicare to see civilian
doctors but then use their VA eligibility to (redundantly) see VA
doctors to have the prescriptions they need ordered and written on VA
prescriptions forms which they then fill at the VA for $8!
The VA’s rules still
require that its prescription drugs are only available for prescriptions
written by VA doctors for patients they actually see. So, to get
VA-covered drugs, many, many older patients go through the motions of
seeing a VA doctor to get him to write the very same prescriptions that
their civilian doctors have already ordered for them---but now on VA
prescription forms. VA doctors know this and are quite used to it---they
quickly assess the patient’s state of health and what prescriptions the
civilian doctor ordered. If everything seems reasonable, proper and
necessary they quickly counter-issue the desired prescriptions on VA
forms, send such patients on their way and rapidly move on to other
tasks.
Of course, even
abbreviated, “pro forma” VA patient visits like these are
wasteful of VA resources (and the time of patients, who resent having to
be seen by a second doctor just to get VA drugs). But under its current
rules, the VA requires that its own doctors be responsible for decisions
to issue prescriptions. Some veterans, members of the public,
Congressmen and the General Accounting Office have called for
considering abandoning the “see a VA doctor first” prescription rule and
the VA has begun to study doing so.
The VA will allow some eligible veterans
with already-issued prescriptions from private, non-VA
doctors---those who've signed up for VA care but still awaiting their
post-enrollment "intake" exams for at least 30 days as of 7/25/03---to
fill them via its mail-order system to ease the current backlog of
veterans waiting to be in-processed to the VA system.
Only those privately-prescribed drugs that are
otherwise VA-covered, that are non-narcotic, that don't have to be
injected and that can be mailed out can be offered by this temporary
stop-gap for those veterans now queued-up in the current
backlog. Those who only become "backlogged" in the future aren't
eligible for this temporary, stopgap coverage unless VA rules are again
changed.
The VA still maintains its requirement that, in
general, VA-issued drugs can only be written by VA physicians for those
veterans they actually see as patients. Nevertheless, the GAO, many
Members of Congress and some veterans' organizations still want
regular, ongoing access to VA-issued drugs for those who remain in
treatment with private doctors---and the VA has said it is considering
such a permanent change in policy.
A press release on the temporary new policy is at
http://www.va.gov/opa/pressrel/PressArtInternet.cfm?id=639
The text of the temporary interim is printed in the
7/25/03 Federal Register at
http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/03-19011.htm
More On VA
Prescriptions
VA prescriptions are
issued by the prescribing doctor on a VA prescription form, which
usually indicates how many refills are to be allowed. Patients then drop
them off at in-house VA pharmacies---where, typically, dozens of
patients are waiting at any given time. With waits that usually exceed
those at commercial pharmacies, patients are given their prescriptions
(they’re usually later billed by mail for their $8 co-payments). Those
non-service-connected veterans claiming exemption from co-payments
because they can’t afford them (see below) at this point can encounter
time-consuming red tape that might well require an hour or two more
of processing (and only then if the finance and pharmacy offices are
open for such business). Service-connected veterans are not
charged co-payments for care related to their disabilities. And, yes, in
practice the difficulties VA staff face in distinguishing, Solomon-like,
between care for service-connected conditions and other conditions can,
and often does, result in some service-connected veterans getting
co-payment exemptions for care for what may really be non-service-connected
conditions.
Patients can---and,
where it’s medically possible, many do---choose not to wait
on-site for the prescription to be filled: They can instead opt for mail
delivery service to their homes (most prescriptions not picked up on the
day of submission are mailed out the next afternoon). But this can, and
often does, take several days or even a week; shipments are often late
or lost in the mail; and medications that are narcotics or are heat- or
refrigeration-sensitive can’t be mailed in any case. Patients pay their
billed co-payments by mailed checks or money orders. But those who
become seriously delinquent may well then be required to make on-site,
up-front cash co-payments for future prescriptions.
The VA, as federal
agency, is not subject to applicable state medication prescribing and
dispensing laws. Hence, patients generally must accept what the VA
physician orders; for example, they can’t (without convincing the
prescribing doctor) ask for a brand name instead of a medically
equivalent generic or invoke other substitution options that might be
available under state law at commercial pharmacies. On the other hand,
the VA permits even registered nurses and physician assistants to
prescribe in many cases---even where state law might not permit this.
Moreover, the VA can,
and often does, allow prescriptions to be refilled more times than is
allowed at ”civilian” pharmacies. Patents can request this when first
given prescriptions and as they drop them off at the VA’s on-site
pharmacies. Refills can be scheduled/diaried for “automatic” mail refill
or can be specifically re-ordered via telephoned- in computerized
systems. Those who don’t wish to wait at the VA for their
prescriptions---if they’re willing and able to pay cash--- can fill
those signed by a state-licensed physician at commercial
pharmacies.
One nice advantage of
the VA system is that it issues “prescriptions” (and at the
often-attractive “bargain price” of only an $8 co-pay!) for a wide
variety of “over-the-counter” items---bandages, dressings, braces,
lotions, salves, cough medicines, digestive remedies, patent medicines,
crutches, canes, walkers, wheelchairs, adult diapers and other first aid
supplies---that civilians must pay full cash prices for even though they
may not need physician prescriptions to buy them.
Transportation
To Distant VA Hospitals and VA Medical Travel Payments
In metropolitan areas with good, economical public
transit, getting to VA medical care via buses or subways is reasonably
cheap and service is reasonably frequent and accessible. But many
patients living in rural or far-out suburban areas lack a family
automobile, have little or no income to pay for their gas or reimburse
others for rides or live in areas that aren’t served by any
reliable or frequent-enough public transit or even long distance bus
service (e. g., Greyhound).
For travel to medical care and compensation and
pension ratings exams, the VA pays or reimburses up to an $18 monthly
maximum, subject to a deductible of $3 per one way trip, at a rate of 11
cents per mile, or 17 cents for those scheduled for repeat
ratings exams---if veterans are 30%-or-more service-connected disabled;
getting care for any service-connected condition; VA pensioners
or those with incomes under the applicable family-sized pension level;
traveling to VA compensation or pension ratings exams; and, with advance
authorization (unless it’s for genuine emergency care), traveling to VA
medical care or ratings exams and medically require ambulance, ambulette
or special handicapped van service and can’t pay the cost. But trips to
ratings exams and by medically necessary ambulance, ambulette and
handicapped vans aren’t subject to the $3 deductible. Submission of
appropriate records and receipts is necessary; see VA hospital and
clinic travel and/or finance offices for details and arrangements.
The Disabled American Veterans (www.DAV.org),
a nationwide non-profit organization, provides daily, free door-to-door
van transport service to disabled and indigent veterans who otherwise
can’t get to VA medical appointments. In many areas, only one morning
“inbound” and one late afternoon “outbound” trip is offered---meaning
that, even for brief appointments, whole days are consumed. On its
website, the key terms “transportation network”, “hospital coordinator”
and “volunteer services” refer one to a hospital-by-hospital listing of,
and telephone numbers for, those DAV workers who supervise the van
transport system serving each hospital. They have details about local
van service, scheduling, reservations and priorities. The drivers are
usually volunteers—as are many of the transport coordinators. Private
donations fund the system.
Case Management
and Patient Advocacy for VA Patients
Because the VA is a classical large,
often-impersonal bureaucracy patients’ needs can sometimes be overlooked
or forgotten: Mail-ordered prescriptions may not come on time or at all;
mail-order and other prescriptions may expire, their expiration perhaps
overlooked by busy physicians; and more vulnerable, less self-proactive
patients may not get the detailed case management and treatment/drug
regimen training that they need.
While the VA benefits system does offer appeals and
hearings for those who are aggrieved, it is attuned almost exclusively
to the needs of those seeking money Pension and Compensation payments
rather than quality medical care and related supportive services.
Veterans have one year after the denial of a benefit, or being given a
substandard service, to appeal in writing to their servicing VA Regional
Office, using VA forms available at
www.VA.gov or even by simply writing a letter. Appeals are
backlogged by many hundreds of thousands and typically take two years or
more to be resolved. Hence, the VA appeals system isn’t timely enough to
help with medical care quality complaints.
More vulnerable
veterans—those who are frail, are intellectually-challenged, have
limited education, are confused or intimidated by the massive, complex
VA system, or need detailed case management, guidance and assistance
with appointment schedules, treatment orders or drug therapy regimens---
can seek help from, or be referred to: the “service representatives”
(middle-aged and older veteran volunteers from groups like the American
Legion, the Veterans of Foreign Wars, etc. who work from offices in VA
hospitals—although what skills they have are more often focused on
Pensions and Compensation questions); Patient Advocates and Ombudsmen
are on staff in VA hospitals just as they are in civilian hospitals and
handle patient complaints about treatment and quality of care;
and---above all !—VA hospitals’ own medical Social Work departments
offer treatment-related supportive counseling and services to all
VA patients, including even those treated by outpatient clinical
departments.
The VA medical care
system, at least theoretically, requires one to secure unscheduled or
between-appointments medical care through the Emergency Room. But that
can take many hours’ wait, only to be seen by a generalist physician
unfamiliar with the patient’s individual care. He can (at most) offer
temporary care solutions and impermanent, stopgap prescriptions for
expired, lost-in-the-mail or about-to-expire medications. Some more
proactive patients successfully deal with this inevitable eventuality by
chatting up acquaintance-ships with their main treating clinical
department’s receptionists, clerks, nurses and social workers. These
contacts can then squeeze them in for last-minute appointments or
arrange to have a physician renew an expiring prescription or write a
stopgap prescription for one that’s lost or delayed in the mail.
Special Rules For
VA-Paid Care at Non-VA Facilities
Note that (except for
rare, arranged-in-advance purchases of specialty care at non-VA
hospitals) the VA does not pay for care at non-VA facilities,
with three exceptions:
First, with advance
permission, some veterans—usually, only those who get
service-connected compensation benefits (see below)--- can be
treated by selected non-VA medical staff or facilities in Colorado,
Wyoming, Utah, Montana, Idaho and parts of central Florida under
special, limited pilot programs.
Secondly,
service-connected compensationers--but not other
veterans—can with advance permission be treated by approved foreign
medical providers and foreign US military medical facilities for
emergencies when overseas. Contact the VA Foreign Medical program
office, P.O> Box 65021, Denver, CO 80206-9021 (303) 331-7590 (call [877]
345-8179 if living or traveling in Australia, Britain, Costa Rica,
Germany, Italy, Japan, Mexico, Panama or Spain). There are numerous
authorization and billing forms which are required. Request a copy of
the pamphlet “Department of Veterans Affairs Foreign Medical Services
Program”. Nevertheless, in spite of the restriction of care at overseas
US military medical facilities only to service-connected compensationers
who have secured advance permission, there are anecdotal reports that
other veterans who have VA patient identity cards have
secured emergency care at overseas U.S. military medical facilities.
This is because non-VA-employed military hospital clerks there
understandably have trouble mastering the VA’s complex (and, to them,
alien) rules. Hence, they often fail to distinguish between the classes
of eligible and ineligible VA patient identity cardholders.
Lastly, any
otherwise-eligible veterans----but only if (1) they
have already enrolled for VA health benefits; (2) have actually
already received some VA treatment within the last 24 months;
and (3) are not covered by private health insurance, Medicare
or Medicaid----can receive emergency care paid for by the VA at a
non-VA hospital in the US when 1) such a hospital is nearer than a VA
one and 2) delaying care to reach a more distant VA facility (under a
“prudent person” standard) would seriously endanger life or health.
Ambulance and related emergency medical services which appear necessary
(also under a “prudent layperson” standard) can likewise be covered. In
cases of inpatient admission or emergency room treatment, the veteran,
his family, his legal representative or the non-VA facility itself must
get authorization from the veteran’s regular VA clinical staff within 48
hours. That VA staff also decides when the patient is medically ready
for discharge or transfer to a VA facility---after which VA liability to
pay for care at a non-VA facility ends.
Coverage of
Eyeglasses, Hearing Aids & Related Exams and Dental Services
The VA not only covers eye examinations and
audiology tests and writes eyeglass and hearing aid prescriptions for
its eligible patients. In many cases it also actually provides
eyeglasses and hearing aids---even for some
non-service-connected Priority 4, 5, 6, 7 and 8 patients. Veterans'
Health Administration Directive 2002-039 of July 5, 2002 [paragraph
4.a.(1)] authorizes eyeglasses and hearing aids for:
* those getting service-connected compensation for
any reason or at any percentage;
* former prisoners of war;
* those getting Housebound or Aid and Attendance
increments to needs-based disability Pensions;
* those needing eyeglasses or hearing aids due to
any other (even non-service-connected) significant
medical cause, such as those that limit Activities of Daily Living (ADLs)
; and
* those with any other functional or
cognitive impairment-- as shown by ADL deficiency(ies) --who need
eyeglasses or hearing aids to participate in their own care.
Replacements are allowed in cases of loss and
breakage and for new or changed prescriptions. Hearing aids, without a
prescription change or loss, must last 4 years. Issuance of spares is
determined by the audiiologist or eye care specialist. Yet in spite of
this directive, the VA website www.VA.gov
(accessed 1/9/04) states that eyeglasses and hearing aids are provided
only to service-connected veterans, to former prisoners of
war and to some other more limited categories.
[Middle class persons only recently plunged into
poverty by disability or illness often continue to think that eyeglasses
for reading and driving can only be prescribed and purchased through
professional optometrists and opticians (eyeglass stores). Yet, as the
long-term poor already know well, such outlets as Sears, Target, WalMart,
CVS, Wahgreen’s, Dollar Stores, Rexall, Rite-Aid and Eckard’s actually
sell off-the-rack, ready-to-wear glasses, in a wide variety of differing
strengths, for reading and driving at far better prices ($10 to $20 (or
even much less) a pair vs. $120 and up at optician stores). In fact, the
American Academy of Ophthalmology finds that “Ready-to-wear reading
glasses are effective, safe and economical. Self-selection and
over-the-counter purchase of these glasses appears to be medically
acceptable, cost-effective and in the best overall interest of the
public.” But while these glasses work well for those with simple
prescriptions---or who only seek “spares” for contact lenses they
usually wear---they are not adequate for those with
astigmatism; those who need different strength prescriptions in each
eye; or those whose eyes are very close together or far apart. Since
ready-to-wear glasses are usually labeled with their strengths, wise
shoppers can and should seek strengths that match prescriptions written
for them by physician-ophthalmologists. Optometrists can also
prescribe---but they’ll likely try to sell one their own higher-priced
“professional” glasses.]
Dental services ordinarily are offered by the VA
only to 100% disabled , service-connected veterans, those
whose service-connected conditions include dental problems and those
held as prisoners of war for at least 90 days; but other, non-service-connected
veterans may apply, only within 90 days of discharge from
active duty, to get dental treatment that wasn’t completed while on
active duty. Often, the VA then authorizes care with selected private
dentists.
Those not eligible for VA eye care might contact
the Seniors’ Eyecare Program (
www.eyecareamerica.org ; 800-222-3937) if they’re limited
income citizens or legal aliens over 65; it offers some limited eye
care---although not eyeglasses or eyeglass prescriptions. Local
Lions’ Clubs www.lionsclubs.org
, United Way affiliates www.unitedway.org
, Salvation Army chapters
www.salvationarmyusa.org and, above all, the Lenscrafters’
Gift of Sight Program (
www.lenscrafters.com/gos.html; 800-541-5367) sometimes offer
help with eye exams, eyeglass prescriptions and/or eyeglasses.
The American Academy of Otolaryngology (www.entnet.org/healthinfo/hearing)
lists some resources for free or discounted hearing exams and hearing
aid resources---as do some Easter Seal Society (www.EasterSeals.org)
groups. The Starkey Hearing Foundation (www.starkey.com;
800-328-8602) provides over 10,000 hearing aids a year to the needy
using its own privately-set eligibility rules.
Most state Medicaid programs deny dental care
(other than extractions to relieve pain), dentures, eyeglasses and
hearing aids to adults. Go to
www.kff.org/medicaidbenefits for states’ Medicaid
coverage of these services. In addition, the report “State of Decay” at
www.oralhealthamerica.org
surveys whether, and to what extent, each state Medicaid program covers
adult dental services. However, the National Association of Dentistry
for the Handicapped (www.nadh.org;
303-573-0264) organizes dentist volunteers to give free dental care to
poor disabled persons in at least 32 states. Almost all dental schools
offer heavily discounted dental care by student dentists whose work is
supervised by dental professors; the American Dental Association (www.ADA.org;
312-440-2500) has a list of all American dental colleges. The ADA (www.ADA.org
; 312-440-2500) enlists dentist volunteers to give free care to the
needy aged in its Access to Oral Health Care for Older Americans
program.
Medical Care Rules For Priority Group 5 Income, Assets and
Co-Payments
In 2006, single veterans with annual incomes below
$25,841.13, or $2,153.34 monthly ----known as Priority Group 5----
are eligible for free care without any co-payments (except for $8 per
prescription), after those with service-connected and “catastrophic”
disabilities, former prisoners of war, those who served in combat zones
within the past two years and certain other priority classes are served.
($430.92 more monthly is allowed for one dependent, $173.40
more for a second and $144.50 more monthly for each
additional one; here, too, in 2006 the first $8,450 of a child’s
earnings is not counted.) Allowable assets per family include a lived-in
home of any value, one vehicle of any value and $80,000 of “net worth”
in other vehicles, boats, bank accounts, other property, investments,
etc.. If a veteran does happen to have private health insurance, the VA
will bill the plan for what it can, but it will not bill the veteran if
he or she has income below this level, except for the $8 prescription
co-payment.
Suspending All Prescription
Co-pays for the Very Neediest Veterans
Priority Group
2 through 6 veterans’ prescription co-payments can be suspended for the
rest of the year once they incur $960 of such charges in 2006—as is also
true for any applicable prescription co-payments that might otherwise be
required of 40%-or-less service-connected disabled veterans or for
treatment of a service-connected disabled veteran’s non-service-connected
condition. In addition, all veterans with incomes
under the prior year’s applicable basic pension level
(e.g., in 2006, $846.83 monthly for a single veteran) are exempt from
any prescription co-payments. When first
enrolling for VA care, those under this income level should be sure to
insist that their enrollment file specifies that they’re designated as
co-payment-exempt and those who originally enrolled at higher income
levels---but whose income later falls to within the co-payment
exemption income range---should re-visit the VA hospital or clinic’s
enrollment/eligibility office with revised, current proofs of income to
request that their records be corrected to now exempt them from drug
co-payments.
In early
February, 2004, VA Secretary Principi asked Congress for authority to
raise the prescription co-payment exemption income level
by an amount equal to the prior year’s pension Aid and
Attendance incremental payment (which would have been $566.08 more
monthly in 2006), although this proposal could be
withdrawn by his more conservative successor, James Nicholson. Observers
say this is the only eligibility- or co-pay-related
Administration proposal likely to pass Congress. The Administration
also proposed legislation in both its fiscal 2005 and 2006
budgets to raise drug co-pays for Priority Groups 7 and 8, and for
treatment of non-service-connected conditions of
service-connected disabled veterans, from $8 to $15 and to charge a
yearly “enrollment fee” of $250 to Priority 7 and 8 veterans. These
plans are opposed by the major veterans groups and by some GOP and all
Democratic members of Congress---but the White House and Congressional
GOP leaders replaced House Veterans Chairman Christopher Smith (NJ) and
Senate Veterans Chairman Arlen Spector (PA) with the more reliably
conservative Rep. Steve Buyer (IN) and Sen. Larry Craig (ID) .
Debts owed to the VA for any co-payments can be
waived on grounds of “equity and good conscience” by hospital fiscal
officers (see amendment to 38CFR17.05 in the April 20, 2004 Federal
Register).
“Space Available” Care With Added, Small Co-Pays For “Wealthier”
Priority Group 7 Veterans
After higher-priority cases such as
service-connected disabled veterans, former prisoners of war and lower
income Priority Group 5 veterans are served, VA medical centers may
at their option also give care to Priority Group 7 veterans----those
non-service-connected veterans whose incomes exceed the Priority 5
eligibility levels but are below Priority 8 levels. Priority 7 “net
worth” asset levels are the same as for Priority 5, however---namely,
$80,000, not counting household goods, a lived-in home of any value and
one vehicle of any value.. (The special limits for those who first
enlisted after 9/7/80 apply here too; see the accompanying sidebar.) In
Priority 7 cases, some other co-payments are charged---$0 for preventive
care outpatient appointments, $15 per primary care outpatient encounter,
$50 per specialty care outpatient encounter and $2 per night plus
$190.80 for the first inpatient hospital admission in 2006 (and $95.40
plus $2 per night for most subsequent admissions within 2006)---but this
is still far, far cheaper than it would be for those who’d otherwise
need to pay full costs in cash or do without. And if these “near-poor”
veterans do happen to have some private health insurance, the payments
from the insurance to the VA for the care are counted off the amount the
veteran must pay in co-payments. See the accompanying chart of VA
medical care co-payments for Priority Group 7 veterans.
“Space Available” Care with Even Bigger
Co-pays for Even Wealthier Priority Group 8 Veterans
On October 1, 2002, the VA created a new Priority
Group 8 for health care eligibility to implement the VA Health Care
Programs Enhancement Act, which was enacted in January, 2002. Priority 8
patients are those non-service-connected veterans with a “net worth” in
assets over $80,000 (not counting household goods, a
lived-in home of any value and one vehicle of any value) and/or
income over the levels used by HUD as the upper limits for lower
income housing assistance eligibility. The HUD levels vary
state-by-state, by Standard Metropolitan Statistical Areas (SMSAs)
within states and by family size, depending upon regional
costs-of-living (for one person, they generally range from about $29,000
yearly to about $37,000, with still higher incomes allowed for each
dependent). See the sidebar below about how to calculate a local area’s
Priority 8 income level.
The family-sized upper income limit for lower
income housing assistance in a locality is now the maximum income
allowed for Priority 7. Non-service-connected veterans’ with income
ABOVE this income level are now in Priority Group 8 !
(Those uncomfortable with the complex calculations set forth in the
sidebar below can call 1-800-245-2691 and at least attempt
to get the low-paid, clerical-level contractor telephone bank employees
answering to provide locality-specific [and family-sized] upper
income limits for federal lower income housing assistance.)
Priority 8 patients must make co-payments of $8 per
prescription, $15 to $50 per outpatient encounter, $952 plus $10 per
night for the first inpatient hospital stay in 2006 and $476 plus $10
per night for most subsequent hospitalizations within 2006.
Here, too, any private health insurance which a veteran has is
billed---and any payments the VA receives from the insurance are counted
off what he owes for co-payments.
Moreover, on January 17, 2003, the VA published
Interim Final Regulations in the Federal Register (Vol.
68, No. 12, pp.2669-2673) immediately suspending further
enrollment of Priority 8 veterans. But those veterans now
classified as Priority 8 who are already enrolled ---plus those
who already and originally qualified for Priority Groups 4, 5, 6 or 7
but whose income or assets only later rise into the Priority
Group 8 range---are "grandfathered-in".
“Compensation” For Veterans with “Service-Connected” Full or Partial
Disabilities
The VA pays “compensation” to veterans whose
disabilities arose from their time in active service -- even if
off-base, off-duty or on leave and whether or not overseas or
during wartime. These “service-connected” disabilities can
include disease or injury that a veteran proves
was contracted during service, even if disabling
symptoms only appear after discharge. (Conditions for which
treatment is sought and documented within one year of discharge can be
presumed to be service-connected too, even in the absence of
contemporaneous medical records from the actual calendar periods
of active duty.) Military medical records—and even evidence from
non-military sources---can be used to demonstrate this. Here too,
appearing for VA “ratings examinations” is almost always required as
well. It’s usually a long, legalistic process. But veterans who can
demonstrate any percent of service-connected disability are
entitled to basic lifetime tax-free monthly payments.
In 2006, veterans can get monthly service-connected
compensation awards for disabilities that cause partial
incapacity in increments of 10% ($112), 20% ($218), 30% ($337), 40%
($485), 50% ($690), 60% ($873), 70% ($1,099), 80% ($1277) or 90%
($1436)---and, of course, at a full 100% ($2393). Rules in force
since early 2003 provide that in-country Vietnam veterans who now have
diabetes are presumed automatically to be service-connected
disabled if rated at least10% (20% if also on regular medication for
diabetes), with higher ratings possible for serious diabetic
complications (amputations, serious and recurrent healing deficiencies,
peripheral neuropathy, poor circulation, cardiovascular and kidney
problems, etc.). Current tracheal, laryngeal, bronchial and lung cancers
and chronic lymphocytic leukemia of in-country Vietnam War veterans can
be presumed to be service-connected due to exposure to Agent Orange.
Veterans of the First Gulf War (1990-91) who now have ALS (Lou Gehrig’s
Disease) are automatically presumed to have a service-connected
disability. In 2004, the VA also began automatically presuming multiple
sclerosis in Vietnam and post-Vietnam war zone veterans as being
service-connected. The more elusive, difficult-to-diagnose-and-document
“Gulf War Syndrome” conditions of those who served in or near the First
Gulf War’s or the Iraq or Afghanistan Wars’ combat zones in many cases
can also merit compensation awards---as can some cirrhosis cases.
Those rated at 30% or more service-connected
disabled can have dependent allowances added to their
compensation payments, and, if they medically qualify for it, the
compensation program’s own Aid and Attendance enhancement (a
benefit with similar qualification rules, but distinct from, that for
pensioners) of $603 (2001 figure) for the veteran, and $37 to $122 in
2006 for an A & A-qualified invalid spouse (both of which require
submission of medical documentation and a VA ratings examination). In
addition to basic dependent increments for each child under age 18 for
veterans rated 30% or more, the compensation program also pays an
additional $19 to $207 monthly in 2005 (and slightly more in 2006)
for each child over 18 attending school, college or trade school,
with rates rising with the percentage of disability. See the Rate Tables
under “Compensation and Benefits” at
www.VA..gov
for details. Compensation is not a needs-based program like
pensions, so compensationers can have any amount in other income,
earnings or assets. Compensation benefits, like pensions, are rounded
down to the next whole dollar in making actual payments.
Post-Traumatic Stress Disorder (PTSD),
Alcoholism, Drug Addiction, HIV/AIDS and “Illegal” Activities
VA compensation claims
for post traumatic stress disorder (PTSD, which are continuing and
seemingly permanent psychological and behavioral incapacities resulting
from events---often, but not always, in combat---while in military
service) are well-known as part of the Vietnam veterans’ story, but PTSD
also afflicts other veterans too. Resources and suggestions for
assembling and documenting PTSD claims appear at
www.VA.gov ,
www.vva.org ,
www.ncptsd.org and at other
websites by entering “PTSD” and “DSM-IV” into search engines.
By law, the VA does
not recognize alcoholism or drug addiction as compensable
disabilities themselves (nor does it for pensions either).
However, underlying psychological disabilities that might give rise to
alcoholism or drug addiction as symptoms are
compensable---and, in those cases, alcoholism or drug addiction
histories can even serve as symptom evidence to buttress such claims.
Injuries or illnesses
resulting from illegal activities can never, under the
law, be compensable. But, in practice, only those illegal activities
which are facially quite obvious---or are (foolishly) voluntarily
admitted to by a service person while still on active duty (and so
officially recorded) , or by a veteran in the unlikely event that VA
staff directly question him on this point during claim processing---are
actually considered (or, much less, are formally adjudicated as)
illegal. For at least a decade the military services have pre-screened
new recruits for the HIV virus and they’ve also conducted periodic re-testings
of those on duty as well. As a result, few of more recent veterans ever
submit qualifying evidence (e.g., positive tests for the HIV virus
contemporaneous with military service time) that demonstrates a
seroconversion before discharge.
But more veterans who are HIV-positive and who
served before the adoption of comprehensive military HIV blood
tests (before 1990 or so) can get compensation now if they submit
qualifying, contemporaneous medical evidence of being positive, having
recognized HIV symptoms or seroconverting while on active duty. For
example, the VA estimates that approximately 2,800 veterans have
contracted HIV through blood transfusions while on active duty,
according to the St. Paul Pioneer Press (3/10/04). And this can
be so in spite of the apparent roadblock that the ban on illegal
activity (e.g., homosexual activity; sharing needles while using illegal
drugs, etc.) seems to impose because, as mentioned above, only
facially obvious, officially adjudicated or voluntarily admitted-to
events, in practice, come under the “illegal activities” ban..
(For example, an active
duty serviceman paralyzed by a gunshot during a shootout with police as
he robbed a bank would probably be denied compensation; but a serviceman
who became HIV-positive while on active duty would not be
denied compensation, absent any obvious, compelling, dramatic or
voluntary evidence or admission to particular “illegal” activities. Even
if directly asked, there are other believable explanations—“I was in
some bar fights with a lot of biting and blood”; “I think I once got a
transfusion after I was in a car accident, but it was so long ago that I
forget exactly where and when”; “ I used to see lots of (female)
prostitutes”; “I just knew sitting on those dirty public rest
room toilet seats could give me something”, etc.)
Service-Connected Veterans’ Dependents & Survivors & Their
Medical Coverage
The compensation payments go up for those with
dependents and include not only priority VA medical care for the veteran
himself, but also---only for 100% service-connected
disabled veterans or those who die on active service--- medical
coverage for dependents and survivors in the VA’s CHAMPVA medical
insurance plan. The CHAMPVA medical plan is premium-free for
those who are eligible, is not medically-underwritten
(there are no “pre-existing condition” restrictions and no medical
history questionnaires, blood tests or exams are needed to qualify) and
it offers coverage similar to major medical plans of large employers,
including some deductibles and co-payments.
It can even continue to cover now-grown, but
first-disabled-as-minors (“helpless adult”) children, including
even after the death of the veteran and even after that
of his or her surviving spouse! Where families with such grown disabled
children only tardily discover the existence of this lifetime coverage,
they can enroll late but only for prospective coverage
(past medical coverage is lost). But, again, note that
CHAMPVA is only for dependents and survivors of
100% service-connected disabled compensationers:
Even though those still-living veterans with just 30%
service-connected disability ratings can get dependent payment
allowances added to their compensation checks, they cannot
thereby qualify those dependents for CHAMPVA. And it’s also important to
note that disabled wartime pensioners’ (as opposed to
compensationsers’) dependents and survivors are not
eligible for CHAMPVA or any other VA care
either---although they can often get some medical expenses met by
the Pension system’s Unreimbursed Medical Expenses (UME) provisions if
they can’t get Medicaid or other coverage.
DIC Payments For Surviving Spouses and Children
of 100% Service-Connected Disabled Veterans
Surviving spouses of deceased service-connected
100% disabled veterans---or those who die on active duty--
get payments called Dependency and Indemnity Compensation (DIC), as well
as premium-free, lifetime continued CHAMPVA health coverage,
even if they themselves aren’t disabled at all. (See the CHAMPVA
pages at
www.VA.gov.) For a single surviving spouse widowed after
1993, the monthly payment is $993 in 2005; $247 more is paid for
each dependent child. An additional increment of $213 more was
paid in 2005 to the surviving spouse if a married veteran lived with her
at least 10 years before his death while, or as a result of being, 100%
disabled; or at least 5 years before his death after he became so
disabled; or at least one year before his death if he was a prisoner of
war.
Surviving DIC spouses, if medically qualified
themselves (by submission of medical records and through a VA
“ratings” examination), can also get added DIC allowances of $247 for
their own Aid and Attendance or $118 if Housebound themselves (2005). In
addition to the above amounts, the Veterans Benefits Improvement Act of
2004, HR 3936, adds still another $250 extra DIC payment where
surviving spouses have one or more dependent children. Here too, as with
Pensions, a “helpless adult child” DIC payment is made to grown, 100%
disabled children first incapacitated as minors (which requires
submission of medical records and VA ratings exams). See the
Compensation and DIC Rate Tables at
www.VA.gov.
DIC benefits, like pensions and compensation, are rounded down
to the next whole dollar in making actual payments.
Compensation & DIC Are Tax-Free, Non-Garnishable, Non-Welfare Benefits
Compensation and DIC benefits are tax-free, and are
not needs-based like “pensions”. One can have additional income without
affecting the payment. Compensation and DIC are tax-free and are not
themselves welfare-type payments, so need-based programs such as SSI,
Medicaid, housing and other welfare programs can and do count them as
income. VA compensation and DIC benefits can’t be garnished for any
private debt---except for child support and alimony orders and also
except for private debt garnishments ordered in those rare, unusual
cases where a portion of compensation is being received in lieu
of career military retired pay (because a portion of military active and
retired pay is garnishable for private debt). For details, see
8/5/98 testimony of VA General Counsel before House Veterans’ Affairs
Committee, which is searchable at
www.VA.gov
.
Servicemembers’ Group Life Insurance (SGLI),
Veterans’ Group Life Insurance (VGLI), Service-Disabled Veterans’ Life
Insurance (SDVLI) and Other Active Duty Death Benefits for Survivors
Veterans being discharged have the right to retain
life insurance policies of up to $400,000 in 2006, with some of that
coverage premium-free for those in combat zones (with the premium-free
combat zone portion of up to $400,000 retroactive to 2001). These
policies are issued in those amounts by the Servicemembers Group Life
Insurance (SGLI) plan to almost all active duty service persons,
including activated Reservists and Guardsmen, and they can be converted
later without medical underwriting (such as pre-existing condition
restrictions, blood tests or health questionnaires) within 120 days of
discharge into Veterans Group Life Insurance (VGLI) or private
individual policies through the Office of Servicemen’s Group Life
Insurance, at 213 Washington Street, Newark, NJ 07102. Those who are
totally disabled at the time of discharge have up to one year to
convert. SGLI and VGLI have small, economical premiums---which one can
have automatically deducted from active military pay, VA pension, VA
compensation and military retirement (although one must pay individual
conversion policy premiums directly oneself).
SGLI- and VGLI- insured service members and
veterans can also purchase---often without medical underwriting (medical
exams, medical history questions, etc.), if they enroll at the
first opportunity---life insurance for their spouses in $10,000
increments up to $100,000 and smaller amounts for their children.
Both SGLI and VGLI policies on service members and
veterans can be “accelerated” to pay out, before death, up to 50%
of the death benefit, to those who submit physicians’ statements
certifying a life expectancy of 9 months or less. (Unless they’re
totally unreasonable-seeming facially, physicians’ statements are
accepted without further inquiry; there’s no penalty if the insured
person actually lives longer; and the remaining insurance death benefit
amount stays in force for later payment to beneficiaries or--if the
policyholder so desires-- for conversion of the remainder death benefit
amount to a private, individual whole life insurance policy.) SGLI
policies (at, or shortly after, discharge) and VGLI policies (at any
time) can be converted without any medical underwriting, through
participating insurers, into individual whole life
policies---albeit with the typically somewhat higher private policy
premium rates--- that are then suitable for “viatication” (i.e.,
the “sale” of life insurance benefits, at a discounted price below the
full face death benefit amount, to investors by policy-holders who are
terminally ill, need nursing or home health care or are simply over age
62). To accelerate or convert a SGLI or VGLI policy, contact the SGLI/VGLI
office in Newark, which can also provide lists of participating insurers
for conversion.
Those found to be at
least partially disabled for service-connected compensation
purposes (but not just for pensions) can get $10,000 in Service Disabled
Veterans Life Insurance (SDVLI)--- separate and apart from, and in
addition to, whatever SGLI or VGLI insurance they might or might not
have-- by applying for it within two years of their service-connected
disability compensation award. And if the SGLI/VGLI office finds that
they are now totally disabled and unable to
work-----whether from a service-connected, compensable cause or, indeed,
any other cause---- they may purchase $20,000 more of
SDVLI. (This insurance is partially medically underwritten in
that it is designed to ignore the service-connected
medical disability of the veteran—but not other medical
conditions—in determining if, and for how much in premiums, the
veteran can get this life insurance.) Unlike SGLI and VGLI, SDVLI
policies can not be converted, accelerated or viaticated—although, of
course, they can provide well for loved ones after death.
Yet it may also be
possible for still-living, seriously ill veterans with SDVLI (or other
policies which can’t readily or completely be sold or accelerated) to
secure private loans, from better-off relatives or acquaintances with
whom they have long-standing, trusted relationships, in exchange for
naming that person the life insurance beneficiary. While such
arrangements would not always be ironclad-enforceable under the law,
they can work out where the insured person has the full trust of a
relative, friend, former employer or other person with cash to advance
for such a loan or with the ability to raise that cash (e.g., through a
reverse home mortgage, in the case of a cash-poor older, but
home-owning, relative).
The premiums for SDVLI
are very, very low (for example, only about $32 monthly for a male aged
55 for the additional $20,000), and the first $10,000 is free for
those rated 100-percent disabled. The SGLI/VGLI office in Newark has
further details.
In addition to the life
insurance, all military branches pay tax-free “death gratuities” of
$12,420---raised in 2005 to $100,000, but only for those dying in
the actual line of duty, with the raise retroactive to 2001---
who die while on active duty (which therefore can cover non-war
zone and non-combat deaths, but not if off-duty). Such survivors
also get up to 6 months of the service member’s housing allowances after
the death, full coverage of burial costs, an income tax reduction for at
least one year, tax breaks on survivors’ post-death home sales and child
care, generous veteran’s preferences for federal (and often state and
local) civil service jobs, VA educational benefits for both surviving
spouses and children, some military “space-available” travel and
premium-free Tricare health coverage (see
www.osd.Tricare.mil for details) of survivors for at least 3
years (and in any case they can alternatively get virtually identical,
premium free, lifetime CHAMPVA health coverage instead of Tricare
or in the very unlikely event that Tricare coverage ends), plus
many other applicable VA and even state veteran survivor
benefits. See the CHAMPVA pages at
www.VA.gov,
www.osd.Tricare.mil,
http://www.moaa.org/benefitdsinfo/default.asp, “Armed Forces
Tax Benefits” at
www.irs.gov and state veterans’ offices listed at
www.NASDVA.org for details.
Vocational
Rehabilitation, Education and Job Placement
In addition to the quite well-known VA educational
benefits for college, the VA also offers vocational rehabilitation and
related job training, education and placement services to those who
receive compensation for service-connected disabilities. Originally, only
those non-service-connected pensioners whose pensions started before
December 31, 1995 were eligible for these services . But a bill
enacted at the end of 2003 now also permits any qualified pensioner
under age 45 to receive vocational rehabilitation services during five
years after enactment. Vocational rehabilitation services can include
job readiness counseling, career evaluation, job placement, career
training, on-the-job training, and, in some instances, even college
courses.
Those in a full-time program received benefits of
up to about $474.27 monthly in 2004 (with an additional $114.03 for one
dependent, $104.95 more for a second dependent and $50.54
still more for each additional one; these rates may well have risen
by cost-of-living increases for 2005 and 2006), and the VA can also
cover books, fees, transportation, tutoring and other miscellaneous
costs. Generally, VA vocational rehabilitation programs must be
completed within 48 months; in exceptional cases, an additional 18
months are allowed. In some instances, living allowances over and above
compensation and pension levels may be authorized.
Once a veteran successfully completes a vocational
rehabilitation program and is successfully and gainfully engaged in
full-time work for one to 12 months, compensation and/or pension
benefits can be ended; priority medical care eligibility continues,
however.
Filing Applications for VA Benefits and
Appealing Denials
Application forms for VA pensions, compensation,
medical care and education benefits are available at VA hospitals,
clinics, outreach centers and Regional offices and at
www.VA.gov and can be downloaded and printed off that site.
(One can even fill out applications and apply on-line at
www.VA.gov.) To apply for medical care, visit the
“Eligibility Office” at any VA hospital (listed at
www.VA.gov ) in person, bringing one’s DD Form 214,
identification, birth and marriage certificates for all family members,
written proof of family income and assets and health insurance papers.
Applications for pensions, compensation and other benefits are
ordinarily made by mail to the VA Regional Office (locate the nearest
one at
www.VA.gov).
Help with applications and appeals is available
from state veterans’ agencies for free (see
www.NASDVA.com).
In addition, “service representatives”---sometimes professional staff,
but more often middle-aged and older veteran volunteer specialists, from
groups like the American Legion (www.legion.org
), the Veterans of Foreign Wars (www.VFW.org
), the Disabled American Veterans (www.DAV.org),
and the Vietnam Veterans of America (www.VVA.org
)---are given space to counsel veterans at many VA Regional Offices and
almost all VA hospitals. Ask for the “service representative”.
Some veteran advocates feel that the expertise of
state veterans’ advocates and service representatives isn’t sufficient
for more complex cases or those requiring assembly of detailed medical
data. More difficult applications and appeals might be handled---for
those who qualify as poor enough---by local legal aid offices skilled
with VA benefits. But sadly, few legal aid offices are skilled or
experienced with VA benefits.
Yet hiring a private or paid lawyer
or advocate for yourself during the application and the
administrative appeals process is almost impossible because of a
Civil War-era federal law which forbids lawyers or anyone else from
charging more than $10 to help with veterans’ benefit cases. (This
law was passed to prevent widespread, serious abuses in the late 19th
and early 20th centuries.) However, if you do lose your final
administrative appeal at the Board of Veterans’ Appeals, an amendment to
the law lets you then pay a lawyer regular (and higher) fees to
appeal further to the Court of Veterans’ Appeals and beyond. To locate
such paid lawyers specializing in VA court appeals, call the
National Organization of Veterans’ Advocates at (800) 810-8387 (see its
website at
www.vetadvocates.com) or the Court at (800) 869-8654. Even if
you have no money, it is sometimes possible to hire a lawyer on a
“contingency” basis (the lawyer gets a percentage, usually 20%, of your
back-due benefits if you win, and nothing if you lose).
To get detailed instructions yourself for how to
fill out a veterans benefits application and assemble medical evidence
(especially for compensation, pensions and DIC dependents’ payments) get
a copy of “The Vietnam Veterans of America’s Guide on VA Claims and
Appeals from http://www.vva.org
or by calling (301) 585-4000. Soldiers seriously wounded in combat can
get free, expert, special advocacy help with enrolling for all benefits
from the joint Army- and VA-sponsored Disabled Soldier Support System
(DS3), on the web at www.armyds3.org
; or by calling 800-833-6622.
In addition, to strengthen and/or raise the rating
percentage for a service-connected compensation claim, complete a
Veteran’s Application for Increased Compensation Based on
Unemployability, Form 21-8940; see
http://www.vba.va.gov/pubs/forms/21-8940.pdf; if the link
doesn't work, go to www.VA.gov,
then to Compensation, then to "Forms', then to "Forms series 21- " to
find it. This “Individual Uemployability” or “IU” provision is often
useful for raising disability ratings of only 60%, 70%, 80% or 90% to a
full, and much more lucrative, 100%---which can be above what they’d
otherwise be, on the medical evidence alone, for those who’ve been
largely unemployable because of, or after suffering, their
service-connected impairment. (By 2005, over 200,000 veterans had their
ratings artificially raised to 100% in this way, bringing them over $4
billion more in added, “extra” compensation payments. As a result, by
late 2005 both the VA and GOP-chaired Congressional veterans’ committees
began studying ways to limit such “extra”, possibly “undeserved”,
compensation amounts.) And while on its face Form 21-8940 isn’t
ordinarily used for wartime non-service-connected disability
pension claims too, submitting it with a pension claim that’s based
only on an otherwise insufficient, less-than-100% -ratable disability or
one that’s hard to prove or shaky certainly can’t hurt.
Generally, a denial of benefits or medical care
eligibility--- or complaints about medical care quality or the
timeliness or adequacy of medical specialty referrals--- must be
appealed within one year of the denial to the VA Regional Office (see
www.VA.gov for locations). But at
any given time, this VA appeals system is overwhelmed and backlogged
with hundreds of thousands compensation, pension and DIC income benefit
appeals which often take two or more years to decide. (This is because
medical care complaints are handled by the same overcrowded appeals
system as the income benefits cases.)
By law, veterans’ access to VA medical care is
ranked by statutorily-defined “Priorities” (1 through 8). Patients are
served only subject to the law’s prioritization and care
access, as a matter of basic reality, is constrained by the (limited)
funds appropriated by Congress. Priority 5, 7 and 8 patients have many
others who have priority before them---“service connected” disabled
veterans, former prisoners of war, Medal of Honor winners, the
“catastrophically disabled”, recent returnees from combat zones and so
on. This means that long waits for care, or specialty referrals, or lack
of wide provider choices-- and other medical “amenity” standards that
would ordinarily be applicable within a civilian entitlement
medical care program context-- simply don’t have traction in the
VA system. Again, VA care is prioritized, space-available care and
not an entitlement! Moreover, even valid legal claims
against the VA for substandard or negligent care are seriously limited
or prohibited by the legal doctrine of sovereign immunity. These
realities mean that appeal rights---while they do nominally apply
to medical care as well as other VA benefits---don’t always offer timely
or adequate redress.
VA’s Post-Vietnam Era Education Benefits for
Veterans and Survivors of Those Dying in/from Service
The VA full-time student education benefit was a
maximum $1,004 monthly for 2005 for those who served at least 3 years
and $816 for those who served less time. The Veterans Education and
Benefits Expansion Act of 2001 (P.L. 107-103), increased the underlying,
original “Montgomery GI Bill” program for post-Vietnam Era veterans and
raised the lifetime benefit total to $35,460 on October 1, 2003.
Under the GI Bill program, a military servicemember
who elects to participate in the program must pay $100 a month into the
program for 12 months while on active duty. Upon separation, a veteran
who served for three years would be eligible for 36 months (i.e., four
academic years) of educational assistance benefits at a qualified
education institution, including vocational and other post-secondary
professional training courses. The monthly benefit can be used to pay
for tuition, books, college fees, room and board, and other living
expenses while attending school. In many cases, children of 100%
service-connected disabled veterans who have also themselves been
declared “totally and permanently disabled” by the VA---and surviving
spouses and children of those who die on active duty or from
service-connected and combat-related causes-- can also receive these
benefits; see http://moaa.org/benefitsinfo/default.asp
and www.VA.gov for details.
VA Death and
Burial Benefits Other Than Income, Life Insurance, Education and
Health Coverage
The VA provides free burials and gravesites to any
honorably- or generally-discharged active duty veteran, his or her
spouse or widow(er) or minor child at several dozen national cemeteries
across the country and at dozens of state veterans’ cemeteries.
Burials are done on a space-available basis; gravesites are no longer
available at Arlington National Cemetery, except for high officials,
highly decorated veterans and certain other notables) and in much of
California. However, niches for cremated remains are available
everywhere. Free VA markers and (if permitted in that particular
cemetery) full-size headstones for veterans are provided, and
these can include not only the name and life dates, but also certain
military decorations. The VA pays to transport the remains to a
gravesite only if the veteran died in a VA hospital.
The VA pays about $128 toward non-government
headstones and up to about $300 for plots in private cemeteries, but
only for service-connected disability compensation recipients,
“wartime” veterans or any other veteran otherwise entitled to a burial
allowance. It pays about $300 for burial plots to survivors of
disability payment recipients or survivors of any veteran dying
in a VA hospital---and $2,000 for burial of 100% disabled
service-connected veterans.
The VA also drapes a deceased veteran’s casket with
an American flag (which is then ceremonially folded and presented to the
next of kin) and arranges for a military honor guard, a gun salute and
the blowing of Taps by a bugler at graveside. In the early 1990s,
the manpower-short military services tried to reduce the size of honor
guard contingents, substitute honor guards from Reservist or ROTC
squads for military units and even use tape-cassette recordings of
Taps rather than live buglers. An outcry from veterans groups and
Congress stamped out most of these “economies”. But such cutbacks can
and will return if military commitments reduce available manpower--as
was shown when the Army had to send even its elite Arlington Cemetery
ceremonial burial unit (widely seen in newsreels from President
Kennedy’s 1963 funeral and quite striking for its horses, flags,
caissons, funeral march music, buglers, dress uniforms and gun salutes)
as reinforcements to Iraq in late 2003.
Finally, the VA arranges for a letter signed by the
President thanking the deceased veteran’s next of kin, or a friend, for
his or her service to the nation. For benefits for those dying on active
duty, also see http://www.moaa.org/benefitdsinfo/default.asp
, www.VA.gov and “Armed Forces
Tax Benefits” at www.irs.gov.
Additional State Benefits For
Veterans, Dependents & Survivors
Surprisingly, almost all states
not only offer free advocacy help for federal VA benefits to their
residents; all of them also provide their own, separate
state veterans’ and veterans’ survivor benefits as well ! These
vary enormously from state to state---often depending upon whether a
veteran is service-connected disabled, the percentage of the disability,
wartime or combat service, or whether a veteran suffers from, or dies
of, war-, combat-, or service-connected causes, or was decorated.
They can include: free or reduced fee fishing,
hunting, camping, boating, drivers’ or professional licenses; free or
reduced fee state park, fair or museum admission; free, reduced fee
and/or specially-marked auto license plates; free cemetery interment or
burial allowances; exemption from, or reductions in, state income taxes
or even local real estate or personal property taxes; free or reduced
tuition in state colleges and vocational training courses; other loans,
grants or scholarships for veterans, children and spouses of disabled or
deceased veterans; rights to reside for free or at low rates in state
veterans’ homes; home mortgage, or home or car disability adaptation
assistance; extra state payments to disabled, blind, combat, wartime or
decorated veterans; waivers of some or all real estate transfer or
courthouse fees; and a host of other miscellaneous benefits.
To find out which states offer which of this wide
range of benefits (and, of course, most states offer far less than the
full potential range of them) contact staff at state veterans’ agencies,
which are listed with their telephone numbers and (where available)
websites at www.NASDVA.org or
www.NACVSO.org.
Other Benefits
for Veterans, War Zone Service Military and Activated Guardsmen and
Reservists
The commercial website
www.veteransadvantage.com , for an
annual membership fee of $19.95, offers a wide range of retail
discounts---including 15% or more off Amtrak fares. Call 1-866-838-7392
for Amtrak details. The Disabled American Veterans (www.DAV.org
), the Paralyzed Veterans of America (www.PVA.org
), the American Legion (www.legion.org
), the Veterans of Foreign Wars (www.VFW.org
) and the Vietnam Veterans of America (www.vva.org
) offer a wide range of benefits and various discounts to their members,
dependents and survivors.
Activated Reservists and Guardsmen have
return-to-work, fringe benefit, seniority and durational retirement
accrual rights with their civilian employers; see
http://www.abanet.org/legalservices/reservists/home.html
about legal rights---and many employers, including the US Postal
Service, at least 29 state governments, numerous local government bodies
and more than 500 private firms, supplement military pay up to civilian
pay levels (if higher) and even extend employer health coverage (see
www.esgr.org and its “Oustanding
Employers” listing). H.R. 1345, introduced in April, 2004, by Rep. Tom
Lantos (D-CA) and 83 bipartisan co-sponsors would mandate that
all civilian federal employees who are activated get pay
differential supplements.
Operation Hero Miles (www.heromiles.org
) transfers donated airline frequent flyer miles to combat-area,
overseas military personnel to fly them from U.S. military reception
airports (there are only 3) to their homes for family emergencies and
any R & R leave they otherwise might have to pay for themselves; its
donated miles are also available for needy family members’ travel to
visit hospitalized service persons; check the website for other, related
uses being developed. Non-profit Fisher Houses (www.Fisherhouse.org
) offer free lodging to relatives visiting wounded and ill service
persons at many military and VA hospitals across the nation. Regular
military, National Guard and Reserve persons sent to war zones or called
for active duty can get free (except for veterinary care) foster care
for their pet dogs, cats and birds through
www.NetPets.org . The USO (www.USO.org
; yes, the same organization that sponsored all those Bob Hope shows for
the troops over the years and was fictionalized in the Bette Midler film
For the Boys) promotes free telephone calling cards for overseas
troops; another group, Cell Phones For Soldiers (www.cellphonesforsoldiers.com
), does so too-- and also distributes cell phones themselves—for those
serving in Iraq.
Thomas McCormack
is a Vietnam Era veteran who has handled SSI and Medicaid eligibility
with the U.S. Dept. of Health and Human Services and done public
benefits advocacy for several disability organizations. He wrote
The AIDS Benefits Handbook (Yale
University Press). Email him at
tomxix@ix.netcom.com
Sidebar: VA and Related Information Numbers
VA Benefits…………………………800-827-1000
VA Life Insurance………………….800-669-8477
VA Educational Benefits & Loans…800-326-8276
CHAMPVA…………………………..800-733-8387
Tricare………………………………..800-538-9552
www.osd.Tricare.mil
Headstones & markers……………..800-697-6947
Persian Gulf Helpline……………...800-PGW-VETS
Summaries of State Benefits for
Veterans….
www.NASDVA.org
Support services for military families…..http://www.mfrc-dodqol.org
Military service personnel
locators……..http://www. mfrc-dodqol.org/wordfiles/Military_Personnel_Locator_Information.doc
VA’s Unique and
Different Income-Counting Principles and Methodology
In counting income for VA medical care and pension
eligibility, the VA---at least in theory---counts the last year’s
income (either the last full calendar year or the last full year
before the date of application, depending on factors that are far
from clear). This includes using 5% of the last year’s
basic family-sized pension level as the threshold amount in
determining what remaining expenses are allowable in the current
year’s UME income deduction. But conversely, the VA uses the
current year’s child earnings disregard in counting income for
this year’s medical care or pension eligibility.
VA pension and medical care income eligibility
levels---and pension payment levels---are expressed and calculated on
the last year’s annual income , rather than the
current, monthly basis that’s generally (with some exceptions)
used by other needs-based programs like welfare, SSI, Medicaid and food
stamps, and which are thus more familiar to benefit advocates and
ordinary citizen applicants. Notwithstanding this, in practice VA
enrollment and eligibility clerks quite often routinely accept and count
documentation of current earnings or Social Security benefits when poor
and working class veterans apply (the poor and many others do well just
to gather and submit written proof even of current income; proof
of last year’s finances is often beyond them).
Moreover, the VA has its own separate eligibility
terminology---not just in unique, but easily-understandable, terms such
as “service-connected”, concepts such as being disabled by only a
partial percentage of full capacity or referring to asset
eligibility levels as allowed “net worth”---but also in the non-use of
such workable, familiar terms as “income disregards”, “countable
income” or “income eligibility level” that make dealing with SSI,
Medicaid and welfare eligibility understandable.
Sidebar:
2006 Amounts: Wartime Needy Disabled Veterans’ & Survivors’ Pension
(The VA rounds benefit payments down to the next lower dollar in
making payments.]
Single Veteran:
$881.58 monthly
Veteran + 1
dependent: 273 more monthly
Each additional dependent: 150.50 more monthly
Aid and Attendance: 589.83 more
monthly
Housebound: 195.83
more monthly
Surviving spouse: $591.16 monthly
Spouse + 1 dependent: 182.75
more monthly
Each additional dependent: 150.50 more monthly
Aid and Attendance: 353.83 more
monthly
Housebound: 131.33
more monthl
“Net worth” ( assets) cannot exceed a lived-in
home of any value, and $80,000 in other property, savings and
investments.
In 2006, the first $8,450 in a child’s yearly
earnings are not counted.
Sidebar:
Calculating New Regional Priority Group 8
Minimum Income Levels
First, to see whether a particular locality is
in, or not in, a Standard Metropolitan Statistical Area (SMSA)
within a state, see http://huduser.org/datasets/il/fmr03
and consult the document entitled “Income Limit Area Definitions”.
Second, to calculate that locality's SMSA or non-SMSA family-sized
limits within a given state, consult relevant parts of the other
documents at that same site. Note the SMSA or non-SMSA family median
for the state, as applicable to your locality. Third, multiply that
median figure by .80, which gives median of the housing programs’
maximum “low income” limit for an “average” family. Fourth, to then
finally get the relevant different, varying levels for each
family size, multiply that sum by .70 for one person; .80 for
two; .90 for 3; 1.00 for 4; 1.08 for 5; 1.16 for 6; 1.24 for 7; and 1.32 |
