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Confused --- what am I covered for?


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Hi, new to the forums. I wish I had know about this before I filed my claims.

Anyway, I have chronic shoulder and neck pains that are documented in my medical file. I got denied "service connected" on it and now I'm wondering if I can still get 'help' from the VA or do I need to go to a private medical insurance.

I'm a twice deployed OIF vet and I was told I had 5 years after discharge for coverage. The VA representative said that 5 years applies to ANY symptom -I- think is service related.

Also, I'm rated in 'Priority 1', does that mean I get coverage without co-pays for ANY condition or only conditions that are service connected?

Basically, ten years down the road, can I still go to the VA for my shoulder/neck pain as a priority 1 patient or am I out of luck? Do I still have a co-pay?

I plan to appeal the neck and shoulder pain. I'm actually quite shocked it was denied. The examining doctor acted like I was making it up but I was getting treatment for it for 6 years before I was 'involuntary separated' due to force reductions. So my plan was to go 20 years and I wasn't even aware I could get VA disability payments until the mandatory VA briefings I had to attend.

Thanks in advance.

 

 

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ok, did some more reading... the VA reps I spoke to probably were hesitant to answer my questions without knowing my rating, so I guess back to the VA to talk to someone.

Anyway, I guess because I have private medical insurance, they pay first? I'm now confused about why I would go to the VA? Do they pay the difference?

One VA rep I spoke with told me that a lot of vets don't fully understand their benefits. I can see why now...

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Just my opinion

but you can go to the VA rather or not you have private Insurance  they may ask you if you have private Insurance or not but you can still use the VA for medical treatment 

As for as your % it don't matter if your 10% or 100% the medical part it does not matter what your rated they do have a small co-pay if your less than 30% I believe.

However  only for Dental Treatment you need to be 100%

if you have a myhealthvet account you can go to ebenefit's and check on your current ratings.

Edited by Buck52
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You can choose whether to go to VAMC for medical care, or to get it privately with your insurance.  

There are advantages of both.  

With VAMC, depending on your income/disabilty percentages, you will have little or no copay.

With private care, you are likely to get better care, quicker, but may have to pay co pays and or deductables depending on your insurance.  

Now, if you apply for and are awarded VA benefits, then you could get compensated (pay per month) and you could get an increase if the disabilty gets worse down the road.  

Your best choice is probably to appeal your denial, which you do by filing a NOD on the VA's NOD form, that is, if you dispute their decision.  Most Vets are denied the first go around and have to appeal, often several appeals, to win their benefits.  A RO denial does not necessarily mean you dont deserve benefits, it often means VA employees are lazy and did not get your records, or shredded pertinent evidence.  

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