The Department of Veterans Affairs has three separate branches: Veterans Health Administration (VHA), Veterans Benefits Administration (VBA) and the National Cemetery Administration. The VHA provides healthcare to eligible veterans, the VBA processes all benefit claims such as disability compensation, pension and education, among others, while the National Cemetery Administration provides burial and memorial benefits.
When veterans file claims for new service-connected disabilities or for increases in already held service-connected conditions, the VBA will schedule Compensation and Pension (C&P) exams at the nearest VA medical center or facility where C&P exams are performed.
These exams are not VA healthcare and are not meant to provide medical treatment. The exams are only for determining service-connection and if granted, what disability percentage will be awarded.
Healthcare provided by the VHA requires that veterans submit an application (VA Form 10-10EZ) and be deemed eligible based on service-connected disabilities, recent service in a combat theater or income. Once enrolled, veterans will be assigned primary care at a VA outpatient clinic or medical center and receive needed care, testing and treatment.
It’s important to know that VA primary care healthcare providers have nothing to do with granting service-connected disabilities; they simply provide needed healthcare as would any civilian doctor or hospital. VA healthcare records can help support a disability claim, but a veteran must always file the claim with the VBA.
Veterans are often upset after filing a claim and undergoing a C&P exam because they report the doctor did not do tests, give treatments or discuss various complaints. That’s because the examiner is giving a standard exam based on the veteran’s claim for a specific service-connected disability. The doctor can only address the claimed condition and nothing else. The exam is to verify the claimed disability exists and will help determine the percentage of disability awarded. In other words, the doctor is not there to treat the disability but to evaluate it and give a medical opinion.
Veterans enrolled in VA healthcare will have regular appointments with their primary care physician who can refer them to specialists such as cardiologists, psychiatrist or audiologists.
The only connection between the VBA and VHA is if a veteran has current medical evidence at a VA healthcare facility that will help support a disability claim. If that is the case, when he fills out the standard claims form, VA 21-526EZ, he will name the VA clinic or medical center where the evidence exists and the date range of treatment and the VBA, in working the claim, will get the medical evidence from the VA health care facility.
For example, a rating for a knee disability is usually based on range of motion and pain on motion, which is determined primarily by the C&P exam. For other disabilities, such as migraines, a rating is dependent upon medical evidence of “incapacitating episodes” over a certain period of time. This can’t be determined by a C&P exam alone, but by supporting medical evidence. Supporting medical evidence does not have to come from a VA healthcare facility. If a veteran has private treatment records he should submit those along with the VA 21-526EZ.
If you are unsure about how to file a claim or what evidence is needed to be successful, see an accredited veteran’s service officer for assistance.
Sandy Britt is a Montgomery County veteran’s service officer. If you have a general question or topic you’d like covered in a future column, email sjbritt@mcgtn.net. Questions about a specific claim can be addressed only by calling the MCVSO for an office appointment with a service officer.