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I'm Rated At 100% For Ptsd Is My Spouse Elegible For Any Medical?


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About 5 years ago after I returned from Iraq, I filed a claim for compensation and was awarded 100% for PTSD, but not p&t. The award letter stated that there would be a future examination on my claim. Well, I thought by now I would have been reevaluated. My spouse and I recently moved to Texas, and she has not been able to find employment yet, and has no medical insurance. I understand she is not eligible for CHAMPVA because I'm not p&t. Is there something she does qualify for her medical? She is a diabetic and her medical expenses are piling up on us right now. Thanks in advance for any insight you might be able to provide.

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  • HadIt.com Elder

Down-load a VA Form #21-4138 from the VA website. Simply state on the form that you are requesting an increase in benefits to P&T rating due to the fact that it has been 5 years since you were rated 100% WITHOUT a P&T rating and that your disability has not improved (if it has worsened, then so state).

When you are then rated 100% P&T the CHAMPVA folks in Colorado will pay you back anything that she has been out as far as medical care/medication is concerned.

But, YOU MUST get that 21-4138 turned in, to establish your effective date of your claim for P&T.

When you were awarded yout 100% for PTSD, were you established at being Totally Disabled due to Individual Unemployability (was a form 21-8940 turned in by you?)?

If not, then get that one filled out and sent in, and forget about the form #21-4138.

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  • HadIt.com Elder

ChampVA is good but does not include Dental.

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  • HadIt.com Elder

Nope, no dental.

But, boy oh boy is CHAMPVA good. They pay off just like clockworks. And, I know that, by the time I finally got my P&T from the date that I applied was like a couple YEARS, and, my wife is also a diabetic and she'd been prescribed that Baetta(sp?) stuff (lizard-spit, seriously, made from Gila Monster saliva, and, if you've ever tried to squeez spit outta a Gila Monster then you know why that stuff is $400 a pop!, i guess).

Anyway, the FIRST check that she got for retro-payment on the FIRST year of her retro (I split it into two years for MY ease of filing, seeing as how I had the time to get it all together, while the wife worked), anyway the 1st check was well into 5 figures and so was the 2nd, and that was just to get her caught up to date.

Just make sure and send the CHAMPVA folks the stuff that they need (we use the druggist-supplied little script forms with the medical name of the drug, amount, cost, date, doctor, etc. The drugstore WILL send all that stuff off to CHAMPVA if you 'splain to them what CHAMPVA is and tell them to send it to the Colorado address and tell them to send a regular Medicare form for the billing, that CHAMPVA will work off the Medicare form. But, instead of having to explain that to each new person that our drugstore hires, and to keep B.S. to the minimum, I DO IT, simple as that.

Same info goes for any doctor's visits, labwork, etc, etc,

I am a firm believer that CHAMPVA is one of the best benefits that us veterans have.

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Have you applied for SSD? You will get medicare for your dependents if you are approved for SSD but you need to file a claim!

I would advise you do it as soon as possible.

Good Luck!

B6

I think a lot of Vets, myself included are afraid if they assert themselves they'll lose everything. I had a similar experience. I was awarded 70% TDIU 100% and it was about 4 years since my award and I went to my VFW DSO and filed a request for P&T award. Within 3 months I had another C&P and P&T, but the key for me was that I had to be the driving force duing the process. The only reason that I got it so fast is follow-up, follow-up, follow-up. It was taking forever for the contractor to send my C&P results to VA so I wrote a letter of compleint to VA that the contracted provider was dragging her feet. I talked to the provider's boss and kept things moving. Download and complete VA Form #21-4138. Make sure you attach supportive documentation indicating in support of P&T. The amount of time to become eligible to use Medicare I will tell you be longer than filing claim for P&T from my experience. Just saying. I even asked and received a note from my VA shrink stating that he "agreed with me, that given my current mental status blah, blah attemtping to return to work would cause my condition to worsten." Do the Medicare thing as well, but I think the first line of offense should be pursuing P&T.

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That is true about the Medicare, the only problema that I see is that, after you wait the requisite 5 months that SSD holds you back.........then it is two years before Medicare kicks in. In other words, IF everything goes RIGHT vis a vis the Medicare claim, it's two and one half years before Medicare.

Didn't know any of that Larry! Thanks for the heads up....good info!

B6

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