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Newsletter for Veterans and active military

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Newsletter for Veterans and active military

VA may have denied PTSD claims related to military sexual trauma:

A review of disability claims in 2017 for military sexual trauma determined that nearly 50 percent were incorrectly processed, according to a VA Office of Inspector General report.

Those incorrecctly denied were mostly due to: non-compelling evidence submitted; VA requesting adequate evidence from veterans; or insufficient medical opinions.

Veterans who submitted claims for PTSD related to military sexual trauma and feel their claims were improperly denied are encouraged to contact a veteran service organization.

Lawmakers want Cannabis research:

Members of the House and Senate VA committees sent VA Secretary Robert Wilkie a letter urging the VA to conduct medical research into the safety and efficacy of medicinal cannabis. The letter recommended that VA focus on veteran patients with post traumatic stress disorder and chronic pain so providers can better understand the potential benefits or dangers of medicinal cannabis.

VA pension program update - entitlement regulations amended:

The U.S. Department of Veterans Affairs (VA) recently amended its regulations governing entitlements to VA pension and Parents’ Dependency and Indemnity Compensation, which are need-based programs. “The amended regulations bring consistency to the pension process and ensure benefits are available for Veterans and survivors with financial need,” said VA Secretary Robert Wilkie. “They will help maintain the integrity of and provide clarity to our needs-based pension program.” VA’s pension program provides monthly benefit payments to eligible wartime Veterans and their survivors with financial need.

The pension regulations, which were updated Oct. 18, cover the following:

• Establish a clear net-worth limit for income and assets for Veterans to qualify for pension;

• Establish a 36-month look-back period to review asset transfers at less than fair market value that reduce net worth and create pension entitlement;

• Establish up to a five-year penalty period to be calculated based on the portion of the covered assets that would have made net worth excessive; and

• Updates medical expense definitions for consistency with VA internal guidelines.

The changes are intended to ensure VA only pays benefits to those Veterans with a genuine need. For more information on VA’s pension program, visit www.benefits.va.gov/PENSION.

Agent Orange | C-123 aircraft update - exposure presumption now official:

The Department of Veterans Affairs is adopting as final an interim final rule published on June 19, 2015, to amend its adjudication regulation governing individuals presumed to have been exposed to certain herbicides. Specifically, VA expanded the regulation to include an additional group consisting of individuals who performed service in the Air Force or Air Force Reserve under circumstances in which they had regular and repeated contact with C-123 aircraft known to have been used to spray an herbicide agent (“Agent Orange”) during the Vietnam era. In addition, the regulation established a presumption that members of this group who later develop an Agent Orange presumptive condition were disabled during the relevant period of service, thus establishing that service as “active military, naval, or air service.” The effect of this action is to presume herbicide exposure for these individuals and to create a presumption that the individuals who are presumed exposed to herbicides during reserve service also meet the statutory definition of “veteran” (hereinafter, “veteran status”) for VA purposes and eligibility for some VA benefits. This rule is effective Oct. 22, 2018. This final rule is applicable to any claim for service connection for an Agent Orange presumptive condition filed by a covered individual that was pending on or after June 19, 2015.

Adoption expense reimbursement - eligibility:

Veterans who lost their ability to reproduce due to a service-connected disability may be eligible for adoption expenses to be reimbursed through VA or to receive coverage for in vitro fertilization (IVF). VA also provides infertility evaluation, management, and treatment services to veterans enrolled in VA health care –– regardless of service connection.

GI Bill - SIT-REP bill could eliminate current payment problem/stalled in Senate:

Many student veterans have been waiting longer than normal for their GI Bill benefits this semester, as the Veterans Affairs Department works through a backlog of claims affecting thousands of students. Meanwhile, legislation that could have helped these students is stalled in the Senate, and veteran education advocates, along with some members of Congress, are calling for action. “There is significant concern about the delayed Forever GI Bill benefit payments,” said Ashlynne Haycock, deputy director of policy and legislation for the Tragedy Assistance Program for Survivors, one of the organizations that helped push the legislation through the House of Representatives last spring. “We all knew there would be a wait, but clearly this extended delay points to the fact that we must get the Senate to move on the SIT-REP Bill … to protect students and veterans.” The legislation (H.R.4830) which passed the House unanimously in May, would require schools to adopt a policy stating they will not deny access to classes or facilities, impose late fees, or make students pay out-of-pocket because of unpaid balances, as long as the student has provided a certificate of eligibility for VA benefits. This would ensure that no GI Bill users are punished by their schools because of VA processing delays. But since the legislation hasn’t passed, some organizations say their members are being charged late fees or barred from registering for next semester’s classes.

Tricare - benefit year changing to calendar year:

If you have Tricare or Tricare for Life you need to be aware of this change and of the following: Do you have a family member who gets supplemental services through the TRICARE Extended Care Health Option (ECHO) program? If so, you need to know that beginning on Jan. 1, 2019, the ECHO benefit cap will apply to covered costs during a calendar year and not a fiscal year October 1 - September 30. The calendar year runs from Jan. 1 to Dec. 31. Due to the shift to calendar year, TRICARE adjusted the benefit cap by $9,000 to cover the remaining quarter of this year. This includes the months of October through December. This will allow for a total amount of $45,000, from Oct. 1, 2017 to Dec. 31, 2018. The $36,000 limit for the costs of all ECHO benefits combined will reset on Jan. 1, 2019. This coverage limit doesn’t include ECHO Home Health Care. The benefit cap adjustment this year is for everyone who is in the ECHO program

Also, you have to register for ECHO with your regional contractor. If you need help with ECHO benefits or want to see if you qualify, call your regional contractor. You must get prior authorization from your regional contractor for all ECHO services. Also, a TRICARE authorized provider must provide these services. ECHO benefits include: durable equipment, rehabilitation, respite care, special education, training and transportation in some circumstances.

TRICARE - period to enroll in or change your health plan:

Open season is an annual period when you can enroll in or change your health care coverage plan for the following year. TRICARE beneficiaries will experience open season for the first time between Nov. 12 and Dec 10, 2018. TRICARE Open Season will happen each year from the Monday of the second full week in November to the Monday of the second full week in December. Enrollment choices made during this period will take effect on Jan. 1. During TRICARE Open Season, you may enroll in or change your TRICARE Prime or TRICARE Select health plan.

• TRICARE Prime — A managed care option available in the U.S. With it you have an assigned primary care manage who provides most of your care.

• TRICARE Select — A fee for service option in the U.S. (replaced TRICARE Standard & TRICARE Select in 2018) which allows you to get care from any TRICARE-authorized provider. Enrollment is required to participate. TRICARE Select is a self-managed, preferred provider network plan.

You have three ways to make an enrollment choice:

• Online: Go to the Beneficiary Web Enrollment website (stateside only);

• By phone: Call your regional contractor; or

• By mail: Mail your enrollment form to your regional contractor.

By Ronald S. Pandos

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