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VietNamEraVet1969

Just Received letter in Priority Group 1

Question

I just received a letter, dated March 08/2018, stating the following word for word;

Our records indicate that the information used to establish your benefits for VA Health care have recently changed and that you are now enrolled in Priority Group 1 effective 02/21/2018. Your unique eligibility factors are:

  • 100% Service-connected
  • Determined to be a Vietnam-era herbacide-exposed Veteran

Your new copay, if applicable, and benefits information are provided on the reverse of this letter.

Basic Medical Benefits Package--Yes

Medications/Suplies--------------------Yes

Dental------------------------------------------Yes then a note that Veterans paid at 100% rate based on a temporary ratiing, etc etc, are not eligible for comprehensive outpatient dental services. (I have just completed a 6 month temporary rating for prostate cancer and protastectomy surgery completely removing my prostate). Thought this would be important to include.

VA Community Living Centers----Yes

Medically Related Travel Benefoits-Yes

Eyeglasses---------------------------------Yes

Automobile Adaptive Equipment-under certain conditions

Home Improvement------------------__under certain conditions

Clothing Allowance Benefit______under certain conditions

Emergency Care for non-service connected condition--under certain conditions

Foreign Medical Care------------------Yes for service connected disabilities

 

I should include that I just received my last payment for the 6 month temporary 100% disability for the prostate surgery on the 1st of the month. Then this letter showed up in today's mail.

Does this not sound like they have gone ahead and given me a permanent 100% Priority Group 1 disability? Or is this a standard letter showing only the record of the temporary 100% rating from October 2017?

I spent a year from December of 1968 to December of 1969, effectively all of 1969 in Camp Frenzell-Jones 199th LIB.

If I've left any info out that would help you help me make a determination please just let me know. And yes of course I will follow up by calling Comp & Pen next week.

Thank you for reading

 

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Priority Group 1

  • Veterans with service-connected disabilities rated 50% or more disabling, or
  • Veterans determined by VA to be unemployable due to service-connected conditions

 

Above is the criteria for Priority Group 1.  Not sure where you were before your latest adventure with the VA, but you are now in 1.  It has more to do with your rated disability, than being 100% temp or permanent.

FWIW,

Hamslice

 

 

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What are the Priority Groups?

Once you apply for enrollment, your eligibility will be verified. Based on your specific eligibility status, you will be assigned a priority group.

The priority groups are as follows, ranging from 1-8 with 1 being the highest priority for enrollment. Under the Medical Benefits Package, the same services are generally available to all enrolled veterans.

Priority Group 1

  • Veterans with service-connected disabilities rated 50% or more disabling, or
  • Veterans determined by VA to be unemployable due to service-connected conditions

Priority Group 2

  • Veterans with service-connected disabilities rated 30% or 40% disabling

Priority Group 3

  • Veterans who are Former Prisoners of War (POWs)
  • Veterans awarded a Purple Heart medal
  • Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty
  • Veterans with VA-rated service-connected disabilities 10% or 20% disabling
  • Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”
  • Veterans awarded the Medal Of Honor (MOH)

Priority Group 4

  • Veterans who are receiving aid and attendance or housebound benefits
  • Veterans who have been determined by VA to be catastrophically disabled

Back to Top

Priority Group 5

  • Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0% disabled by VA with annual income below the VA’s and geographically (based on your resident zip code) adjusted income limits.
  • Veterans receiving VA pension benefits
  • Veterans eligible for Medicaid programs

Priority Group 6

  • Compensable 0% service-connected Veterans
  • Veterans exposed to Ionizing Radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki
  • Project 112/SHAD participants
  • Veterans who served in the Republic of Vietnam between January 9,1962 and May 7,1975
  • Veterans of the Persian Gulf War who served between August 2, 1990 and November 11, 1998
  • *Veterans who served on active duty at Camp Lejeune for not fewer than 30 days beginning August 1, 1953 and ending December 31, 1987
  • Veterans who served in a theater of combat operations after November 11, 1998 as follows:
    • Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for 5 years post discharge.
    • Combat Veterans who were discharged between January 2009 and January 2011, and did not enroll in the VA health care during their 5 year period of eligibility have an additional one year to enroll and receive care. The additional one-year eligibility period began February 12, 2015 with the signing of the Clay Hunt Suicide Prevention for America Veterans Act.

Note: At the end of this enhanced enrollment priority group placement time period Veterans will be assigned to the highest Priority Group their unique eligibility status at that time qualifies for.

*Note: While eligible for Priority Group (PG) 6; until system changes are implemented you would be assigned to PG 7 or 8 depending on your income.

Priority Group 7

  • Veterans with gross household income below the geographically-adjusted income limits (GMT) for their resident location and who agree to pay copays

Back to Top

Priority Group 8

  • Veterans with gross household income above the VA and the geographically-adjusted income limits for their resident location and who agrees to pay copays

Veterans eligible for enrollment:

Noncompensable 0% service-connected:

  • Subpriority a: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status
  • Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or less

Nonservice-connected and:

  • Subpriority c: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status
  • Subpriority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or less

Veterans not eligible for enrollment:

Veterans not meeting the criteria above:

  • Subpriority e: Noncompensable 0% service-connected (eligible for care of their SC condition only)
  • Subpriority g: Nonservice-connected

 

Above is all the priority groups.  Posted for research, for others, when in Hadit looking, etc.,  From Military.com

Hamslice

 

Edited by Hamslice

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Good Answers Hamslice

I would think were all in this Health Care Together as we all served together. 

It don't seem fair in my opinion ,  were all veterans and it should not matter what S.C. % We are  & our health Care should be equal for all. 

(jmo)

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Prostate cancer ( AO) has a definitive criteria for ratings:

“The Veteran's prostate cancer is rated under Diagnostic Code 7528, which provides a 100 percent disability rating for malignant neoplasms of the genitourinary system.  Diagnostic Code 7528 provides that, following the cessation of surgical, x-ray, antineoplastic chemotherapy, or other therapeutic procedure, the 100 percent rating shall continue with a mandatory VA examination at the expiration of six months.  Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e).  If there has been no local reoccurrence or metastasis, the residuals are to be rated as voiding dysfunction or renal dysfunction, whichever is predominant.  38 C.F.R. § 4.115b, Diagnostic Code 7528.”

https://www.va.gov/vetapp17/files8/1752468.txt

I suggest that you read this entire case carefully-

This veteran got lucky because the RO made an error in his rating-

still after the initial temp 100% , VA rates on residuals.

 

"Does this not sound like they have gone ahead and given me a permanent 100% Priority Group 1 disability? Or is this a standard letter showing only the record of the temporary 100% rating from October 2017?"

I don't see anything to indicate 100% P & T.

The error the VA made is this:

"Here, the Veteran was not provided with the required VA examination at the end of the six-month period following cessation of medical treatment as required by Diagnostic Code 7528. Notably, the AOJ was able to determine the date of cessation of the Veteran's treatment for his malignant prostate cancer, which determined the minimum six-month period during which the 100 percent disability rating must continue, based on the Veteran's medical records. However, given that the AOJ failed to provide the Veteran with a mandatory examination following the six-month period, the AOJ could not practically determine that assignment of a rating was warranted, or rather, whether the Veteran experienced a local reoccurrence or metastasis, which would warrant a continued 100-percent disability rating. 38 C.F.R. § 4.115b, Diagnostic Code 7528. Accordingly, the Board concludes that the assignment of a staged rating of 60 percent for residuals of prostate cancer was incorrect without the mandatory examination. Therefore, the Veteran's initial rating should be reinstated to 100 percent as of November 1, 2013."

But you have to read the whole case to see how the BVA awarded on residuals.

Here is the BVA order:

"ORDER An initial 100 percent disability rating from March 1, 2013 to November 3, 2014 for service-connected status post robotic prostatectomy due to prostate cancer is granted. A 60 percent disability rating for service-connected status post robotic prostatectomy due to prostate cancer with residual urinary incontinence and frequency is restored, effective July 1, 2015. A disability rating in excess of 60 percent from November 3, 2014 for service-connected status post robotic prostatectomy due to prostate cancer with residual urinary incontinence and frequency is denied. Entitlement to an initial disability rating of 70 percent, but no higher, prior to February 14, 2017 for PTSD is granted. Entitlement to SMC at the (s) rate is granted from March 1, 2013 to November 3, 2014."

The Remand in part reads:

"In the July 2015 remand, the Board instructed the AOJ to afford the Veteran a VA examination regarding his sleep apnea, and asked the VA examiner to address the Veteran's contentions that his in-service sinus problems were early signs and symptoms of his current sleep apnea. Following a January 2017 examination, the VA examiner opined the Veteran's sleep apnea is not directly related to his active duty service, stating there is no correlation between sinusitis, hay fever, or any sinus disease and sleep apnea, as sleep apnea can only be diagnosed by sleep study. However, the VA examiner stated later in his opinion that sleep apnea tends to be multifactorial in nature, including sinus conditions and upper respiratory conditions. Further, the VA examiner did not address the April 2015 opinion from Dr. S.P. as requested by the Board. Accordingly, the Board finds the January 2017 VA examiner's opinion did not adequately respond to the Board's directives regarding the theory of direct service connection, and an addendum opinion is necessary."

The veteran was represnted by an attorney and this case shows a lot of errors the VARO in Atlanta, GA made.

 

Edited by Berta

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15 hours ago, VietNamEraVet1969 said:

 

11 hours ago, Hamslice said:

Thanks Hamslice,

So if I understand you correctly, if they were to have determined me to be 'permanently' disabled, they would have notated that somewhere in the letter?: 'Rated Temporary' vs 'Rated Permanent'

If that's the case all that is clear is that on 02/21/2018 I was placed in Priority Group 1 (PG1) and rated 100% Service Connected and Determined to be a Vietnam-era herbacide-exposed Veteran.

Then why wouldn't they have not indicated a duration of time for being placed in PG1? This rating is effective for X number of months?

I suppose I'll get answers when I call Monday morning, but just thought I'd ask, and thanks

 

 

Priority Group 1

  • Veterans with service-connected disabilities rated 50% or more disabling, or
  • Veterans determined by VA to be unemployable due to service-connected conditions

 

Above is the criteria for Priority Group 1.  Not sure where you were before your latest adventure with the VA, but you are now in 1.  It has more to do with your rated disability, than being 100% temp or permanent.

FWIW,

Hamslice

 

 

T

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