Inside VBD. (Veterans’ Benefits Department) (Service to Veterans) (Column)

In 1992 we will attempt to familiarize you with the interworkings of the Veterans’ Benefits Department (VBD). We have experienced a new look and structure to better serve those who turn to PVA for help, and we think that it would be helpful for you to understand how this renaissance works and who it is that makes it all happen.

In the future, we will feature articles about the individuals and offices that encompass VBD. We will try to bring you closer to the people who are here to serve you. This month, the focus is on the overall structure of our department: How the VBD network really works.

Medical Services has joined VBD, prompting the internal realignment of our entire department. VBD is now made up of four interlocking sections that form the intricate network necessary for unparalleled representation to PVA members, other veterans, dependents, beneficiaries, and survivors nationwide–a total of more than 88,000 individuals.

Medical Services is responsible for monitoring the health care and treatment of veterans at VA medical facilities. To that end, Medical Services advises VBD personnel and PVA chapter personnel on medically related situations involving such care and treatment. On-site investigations, research, and information dissemination are tools utilized by Medical Services to resolve problems that arise in the health care of our veterans.

Field Services, which encompasses the network of 54 service offices nationwide, is responsible for on-site service to those who turn to PVA for assistance on the local level. Fully trained national service officers (NSOs) help veterans through every stage of their benefits, from initial claim through the Board of Veterans’ Appeals (BVA) level. Once an appeal has been filed, the primary responsibility shifts to the Appellate Services section for oversight and presentation of the veteran’s claim.

Appellate Services serves veterans who appeal to BVA for review and reconsideration of their application for VA benefits. In cases where VA denies benefits, PVA actively assists veterans in reaffirming their rights to such benefits through presentation of appeals to BVA. VBD boasts one of the highest allowance/win rates of all major veterans’ service organizations at this level and represents approximately 2,000 cases each year before BVA.

The new formed COVA Litigation section is responsible for those cases PVA elects to further represent to the US Court of Veterans’ Appeals (COVA). PVA reviews requests for COVA representation from veterans and determines if it will be able to assist at this level. In cases where BVA denies a veteran’s benefits and PVA believes it may be possible to overturn such decisions, the COVA Litigation section goes to work to see to it that the veteran is triumphant in his battle to receive benefits.

PVA has represented more than 45 cases since the activation of the court. As the court becomes more active with its caseload, this new section of VBD will prove particularly beneficial in our department’s mission to serve.

VBD is led by Richard L. Glotfelty, associate executive director for veterans’ benefits. He has worked as part of the VBD network since 1978, when he joined the staff as an NSO at our Pittsburgh service office.

In the coming months, we will introduce you to the other members of VBD who help to bring this intricate–but effective–network to life.

NON-VA HOSPITALIZATION AND

OUTPATIENT BENEFITS: PART III

What can be done if reimbursement is desired, but not authorized, for non-VA hospital or outpatient care?

VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services, must be filed within two years from the date the medical care or services were received. Claims for reimbursement of the expenses of care not previously authorized may be paid when care or services were rendered in a medical emergency in which delay would have been hazardous to life or health and where VA or other federal facilities were not feasibly available under the following circumstances:

* Veterans with adjudicated service-connected disabilities requiring treat ment for that disability

* Veterans requiring treatment for a non-service-connected disability associated with and aggravating an adjudicated service-connected disability

* Any disability of a veteran who is rated by VA as 100% service-connected (permanent and total)

* Veterans participating in a Vocational Rehabilitation Program under 38 USC, Chapter 31 and for whom there is a medical determination that care is needed to accomplish the goals of the rehabilitation program

This claim can be filed by a veteran who received medical services or the veteran’s appointed representative, the hospital or clinic or other community resource that provided the medical services, or a person, other than the veteran, who paid for the services from personal funds. A copy of the bill or statement of account should be attached to VA Form 10-583. Forms can be requested from the nearest VA facility, which can also provide the proper address for submission of the document.

When treatment of the veteran’s condition requires eyeglasses, hearing aids, or other prostheses, VA must be notified. These items, if approved, will be provided by VA. The agency may also authorize dental services and home-nursing services if the veteran meets eligibility criteria.

To obtain prior approval, the treating physician must contact the clinic director of the VA facility that has authorized the fee-basis medical care. When a fee-basis card can no longer be used, it should be returned to the VA facility that issued it.

RETROACTIVE GI BILL PAYMENT

If you are a Vietnam-era veteran who took courses in an associate-degree program any time between January 1, 1982, and December 31, 1984, you may be entitled to retroactive payment of VA educational benefits. Potentially eligible veterans are those who served during the Vietnam era, did not use all the months of Chapter 34 VA educational benefits, or were otherwise eligible for benefits and pursued courses in an approved associate degree program, predominantly vocational in content, between January 1, 1982, and December 31, 1984.

To process your claim, the Cleveland VA Regional Office must receive it no later than August 20, 1992. If you believe you are eligible, if you need assistance filing your claim, or if you have any questions, contact your local service office.

The retroactive GI Bill payment is the result of the settlement of the lawsuit, Pacheco v. VA (formerly known as Schunemann v. VA).

THE VETERAN ADVISOR

If you have a question you would like answered, send it to The Veteran Advisor, Veterans’ Benefits Department, 801 Eighteenth Street, NW, Washington, DC 20006. All inquiries will be answered, but only those of general interest to our readers will be published.

Q: I am a service-connected T8 paraplegic, 13 years postinjury. I found my health getting progressively worse as a result of my reduced level of activity. To improve my overall health and well-being, I began a rigorous course of physical therapy about two years ago. I went to VA as an outpatient at least three times a week. A significant portion of the therapy was devoted to hand-pedaling a specially designed stationary cycle.

I’ve slimmed down and feel great. I’ve started a new full-time job and can no longer receive this intense physical therapy. Both my therapist and SCI physician have recommended that I use a hand-operated cycle to maintain my current level of conditioning and health. The local VA prosthetics chief says VA can not provide hand cycles, as they are considered recreational equipment. Is this true even if the hand cycle is medically justified?

A: The Department of Veterans Affairs (VA) has long considered hand-operated cycles as recreational devices and, as such, has denied their issue to eligible VA beneficiaries, regardless of the reason the device is needed. However, two recent events have shown a possible change in the procedures governing the issuance of such devices.

* The first indication of the apparent change came when VA‘s marketing center in Hines, IL, granted a contract to a wheelchair-accessories manufacturer for a hand-operated device that attaches to a wheelchair. VA determined that this device is an accessory to a wheelchair and thus can be provided, as it simply improves the wheelchair’s speed and range and provides better physical conditioning for the user. When properly prescribed, the device can be furnished to eligible beneficiaries under this contract.

* The second change came when VA‘s general counsel determined VA has the authority, under current law, to provide disabled veterans with a device known as the Handbike. As its name implies, the device is a hand-operated bicycle designed by the VA Research and Development Center in Palo Alto, CA, in conjunction with Stanford University and the University of British Columbia.

In March 1991, after evaluating the Handbike, VA concluded it is safe and effective. Therefore, a recommendation was made to VA‘s Prosthetic Technology Evaluation Committee (PTEC) that furnishing the Handbike to VA beneficiaries be approved. Because of a 1984 VA general counsel opinion that VA lacks legal authority to furnish disabled veterans with recreational equipment, PTEC questioned whether the Handbike could be issued, as it may fall under the definition of “recreational equipment.” PTEC asked VA general counsel to determine whether Congress intended to provide disabled veterans with this type of equipment or a similar apparatus as a medical device.

After reviewing the question posed, VA general counsel decided that the Handbike may be issued to eligible veterans under its authority to provide wheelchairs. The test for providing the Handbike or similar equipment, according to VA general counsel, is medical necessity.

Although VA can provide the Handbike when medically necessary, don’t expect to see the device issued any time soon. It has only been evaluated as a VA prototype and is not in commercial production. VA, which holds the patents on the Handbike, has not found a manufacturer willing to produce the device.

One of the main obstacles in locating a manufacturer was VA‘s past position of not providing this type of device to disabled veterans. Now that this obstacle has been removed, a manufacturer for the Handbike may soon be found. In addition, current manufacturers of other types of hand-operated cycles may ask VA to evaluate their products through PTEC and its established procedures for possible issuance to eligible VA beneficiaries–when medically necessary.

A WORD TO THE WISE

Remember, when you pay VA for any services provided, retain your cancelled check or receipt as evidence of proof of payment. This is a safeguard in the event a VA error should occur.