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Glossary

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1151 Benefits: VA awarded monthly compensation benefits for disability or death incurred as the result of VA hospital care, medical or surgical treatment or examination, but only if the disability or death was proximately caused by negligence or an unforeseen event.

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Access: Access is the veteran’s ability to obtain medical care at his/her desired location. The ease of access is determined by components, such as availability of health care services, location of health care facilities, transportation, hours of operation, and cost-effective delivery of health care. Efforts to improve access often focus on improving efficiency of health care delivery processes.
Adjunct Condition: An adjunct condition, for medical treatment purposes, is a non service-connected condition that may be associated with and held to be aggravating an adjudicated service-connected condition. VA bills health insurance plans for treatment of an adjunct condition and as applicable, may charge a copay for treatment of the adjunct condition.
Adult Day Health Care: Adult Day Health Care is a therapeutic day care program, provides medical and rehabilitation services to disabled veterans in a congregate setting.
Aid and Attendance (A&A): A VA compensation or pension benefit awarded to a veteran determined to be in need of the regular aid and attendance of another person to perform basic functions of everyday life. A veteran may qualify for aid and attendance benefits if he or she:
Allowable Deductions: Allowable deductions are those payments made by veterans for certain nonreimbursed medical expenses, funeral and burial expenses and educational expenses. Veterans are able to exclude allowable deductions from their total gross household income in determining their eligibility for VA health care benefits.
Appeal: A process used to request VA reconsider a previous authorization or claim decision.
Applicant: A person who has submitted a formal request for VA health care benefits and/or for enrollment in the VA health care system.
Asset: Property or resource of an individual which includes: cash, stocks and bonds, individual retirement accounts, income producing property, etc.

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B

Bereavement Counseling: Bereavement counseling is assistance and support to people with emotional and psychological stress after the death of a loved one. Bereavement counseling includes a broad range of transition services, including outreach, counseling, and referral services to family members.

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C

Catastrophically Disabled: A veteran who has a permanent, severely disabling injury, disorder, or disease that compromises the ability to carry out the activities of daily living to such a degree that he/she requires personal or mechanical assistance to leave home or bed, or requires constant supervision to avoid physical harm to self or others.
Chronic Care: Long-term care of individuals with long-standing, persistent diseases or conditions. Chronic care includes care specific to the problem, as well as other measures to encourage self-care, promote health, and prevent loss of function.
Combat Service: A status applied for a veteran who served on active duty in a theater of combat operations during a period of war recognized by the VA.
Commonwealth Army Veterans: The term “Commonwealth Army veterans” refers to persons who served before July 1, 1946, in the organized military forces of the Government of the Philippines. These Filipino forces were made a part of the U.S. Armed Forces by a military order of the President dated July 26, 1941. Finally these veterans were discharged or released from this period of service under conditions other than dishonorable.
Community Residential Care: Community Residential Care provides health care supervision to eligible veterans not in need of hospital or nursing home care but who, because of medical and/or psychosocial health conditions as determined through a statement of needed care, are not able to live independently and have no suitable family or significant others to provide the needed supervision and supportive care. The veteran must be capable of self-preservation with minimal assistance and exhibit socially acceptable behavior.
Compensable Disabilities: A VA rated service-connected disability for which monetary compensation is authorized for payment. You might even be entitled to compensation when your disabilities are rated 0% disabling.; Here are the three situations that would be compensable.
Congressional Appropriation: The funding allocated by Congress to VA for providing benefits and medical services to eligible VA beneficiaries.
Consultation: Service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician.
Contract Provider: Any hospital, skilled nursing facility, extended care facility, individual, organization, or agency that has a contractual agreement with VA for providing medical services to veterans.
Copay: A specific monetary charge for either medical services or outpatient medications provided by VA to veterans whose financial assessment determines they are able to pay.
Covered Benefit: Medically necessary care and services included in the Medical Benefits Package as defined within 38 Code of Federal Regulation (CFR) 17.38.

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D

Diagnosis: The identity of a medical condition, cause or disease.
Deductible: An amount that a veteran must pay for covered services in a specified time period before VA benefits begin.
Dependent: Spouse or unmarried child (to include a biological, legally adopted, or step child under the age of 18, or between the ages of 18 and 23 and attending school, or a child who was permanently and totally disabled before the age of 18)
Disenrollment: The discontinuation of a veteran’s enrolled status. Disenrollment may result because the veteran requests not to participate in VA enrollment, or when VA determines that certain priority groups will no longer be provided services. Requests to disenroll must be in writing.
Domiciliary: A VA facility that provides care on an ambulatory self-care basis for veterans disabled by age or disease who are not in need of acute hospitalization and who do not need the skilled nursing services provided in a nursing home.
Durable Medical Equipment: Equipment intended for frequent use in the treatment of a medical condition or injury. Examples include wheelchairs, hospital beds, walkers, etc.

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E

Earned Income: Money you receive from working
Emergency: An emergency medical condition is a medical condition manifesting itself by acute symptoms of sufficient severity such that a prudent layperson, who possesses an average knowledge of heath and medicine, could reasonably expect the absence of immediate medical attention to result in 1) placing the health of the individual in serious jeopardy, 2) serious impairment to bodily functions, or 3) serious dysfunction of any bodily organ or part.
Enrollee: A veteran who has applied for VA medical services under 38 United States Code (U.S.C.) 1710 and 38 CFR 17.36, has been accepted for such care, and who has received confirmation of enrollment in the VA health care system.
Enrollment: The process for providing veterans access to VA health care benefits covered by the medical benefits package.
Enrollment Group Threshold (EGT): The enrollment priority group level, as determined by the Secretary Veterans Affairs, at which veterans will be accepted for enrollment into the VA health care system.
Environmental Contaminants / Gulf War Illness: Gulf War veterans were exposed to a wide variety of environmental hazards and potential harmful substances during their service in Southwest Asia. These include depleted uranium, pesticides, the anti-nerve gas pill pyridostigmine bromide, infectious diseases, chemical and biological warfare agents, and vaccinations (including anthrax and botulinum toxoid), and oil well free smoke and petroleum products. VA recognizes that there are other health risk factors encountered by Gulf War veterans. Veterans with service during the Gulf War are eligible to receive treatment for conditions related to this service .; If the treatment provided is for an illness or symptom that may possibly be associated with environmental contamination copay for medical care and medication copay will not be charged.; Conditions Associated with Environmental Contaminants:

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F

Formulary: A formulary is a list of medicines from which your VA provider can choose to treat your medical condition. This list of medicines has been looked at and approved by a group of highly trained VA physicians and clinical pharmacists. New medicines are usually added to the formulary based on a complete review of published medical studies as well as available patient safety data.; Medicines are grouped by VA as Formulary, Formulary-Restricted or Non-Formulary. Formulary-Restricted medicines usually can be used only by those providers with specific experience in how these medicines are prescribed and monitored. For example, oncologists usually are the only VA providers who can prescribe medicines used to treat cancer. Non-Formulary medicines are prescribed for those patients who either have failed or could not tolerate any of the VA Formulary medicines.
Financial Assessment: A means of collecting income and asset information used to determine a veteran's eligibility for health care benefits.

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G

Geographic Means Test (GMT) Threshold Copay Required: A copay status assigned to a veteran whose household income is above the VA means test income threshold but below the GMT income threshold. GMT copay for inpatient care is reduced by 80%, all other copay amounts remain the same. GMT income thresholds are based upon established geographic income thresholds.
GMT - Below the Means Test Threshold: Veterans whose household income and net worth are below the VA National income threshold such that they are unable to defray the expenses of care; therefore, they are not subject to copay charges for hospital and outpatient medical services.
GMT - Above the Means Test and GMT Threshold: Veterans whose household income and/or net worth are ABOVE the VA National income threshold and income ABOVE the geographically-based income threshold for their resident location who do not otherwise qualify for placement in a higher enrollment priority group. These veterans must agree to pay copays for hospital care and outpatient medical services.
GMT - Above the Means Test and Below the GMT Threshold: Veterans with household income and/or net worth are ABOVE the VA National income threshold and income BELOW the geographically-based income threshold for their resident location who do not otherwise qualify for placement in a higher enrollment priority group. These veterans must also agree to pay copays for hospital care and outpatient medical services, but their inpatient medical care copays are reduced 80 percent.
Geriatric Evaluation: Geriatric evaluation, which is part of the basic benefits package, is the comprehensive assessment of a veteran’s ability to care for him/herself, physical health, and social environment, which leads to a plan of care. The plan could include treatment, rehabilitation, health promotion, and social services.
Gross Household Income: Generally, gross income of the veteran, spouse and dependent children is counted for determining a veteran's eligibility for VA health care benefits. This includes earned and unearned income but excludes most need-based payments such as welfare, Supplemental Security Income (SSI).
Gross Income: Income before allowable expenses are subtracted

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H

Hardship: A “hardship” exist when there is a significant change in your family income and net worth from the previous calendar year to the present year.; You could have been working in the previous year and due to a recent disability are no longer able to work. Chances are this type of situation would create a significant change in your families income.
Head or Neck Cancer: Veterans with cancer of the head and neck and a history of receipt of Nasopharyngeal (NP) radium therapy are eligible for treatment. There are very specific dates and locations where this activity occurred. Eligibility for this special class needs to be verified. (Not all veterans receiving head and neck cancer treatment fall into this treatment category.); During the 1920s, nasopharyngeal (NP) radium therapy was developed to treat hearing loss caused by repeated ear infections. Radium-tipped rods were inserted into the nostrils and left in place for several minutes. Military physicians used NP radium to treat aerotitis media (barotrauma) in submariners, aviators, and divers. It is estimated that between 8,000 and 20,000 military personnel received NP radium treatments during World War II and until the 1960s. Veterans also included are those with documentation of NP radium treatment in active military, naval or air service; those who served as an aviator in the active military, naval or air service before the end of the Korean conflict; or underwent submarine training in active naval service before January 1, 1965. Veterans with exposure to NP radium treatments are eligible to receive treatment for conditions related to this exposure, including head and neck cancer.; If the veteran is being treated for any condition during this episode of care that is related to Head and Neck Cancer; the veteran does not have to pay a copay for the visit or the medication.
Health Insurance Portability and Accountability Act (HIPAA): HIPAA is a federal law enacted in 1996. It was designated to improve availability and portability of health coverage and the efficiency of the health care system by standardizing the electronic exchange of health information and protecting the security and privacy of member-identifiable health information.
Home Health Care: Skilled nursing and other therapeutic services provided by VA or a home health care agency in a home setting as an alternative to confinement in a hospital or skilled nursing facility.
Homemaker/ Home Health Aide Services: The Homemaker / Home Health Aide (H/HHA) Program provides services as an "alternative" to nursing home care. The H/HHA Coordinator along with the interdisciplinary team makes a clinical judgment that the veteran would, in the absence of H/HHA services, require nursing home equivalent care.
Hospice/Palliative Care: Hospice/Palliative Care programs offer pain management, symptom control, and other medical services to terminally ill veterans or veterans in the late stages of the chronic disease process.
Hostilities: “Hostilities” means any armed conflict in which the members pf the Armed Forces are subjected to combat conditions comparable to a period of war. The periods of armed conflict are determined by the Secretary of VA in consultation with the Secretary of Defense.
Housebound Benefit: The VA’s Housebound benefit is an additional amount available to eligible veterans and dependents who are entitled to VA pension or VA compensation. The housebound allowance may be paid to veterans, dependent spouses, or surviving spouses who because of their physical limitations, are unable to walk or travel beyond their home and are reasonably certain the disabilities or confinement will continue throughout his or her lifetime. Certain restrictions apply. For more information and eligibility criteria on this benefit call 800-827-1000 or go to http://www.vba.va.gov/bln/21/Benefits/.
Housing and Urban Development Geographic Index: Congress wanted to grant relief from making VA copay for some veterans with marginal incomes, recognizing that income alone is not always a fair measure of one's standard of living because of sometimes large differences in the cost of living in different areas of the country. Congress modified VA's system of determining veterans' ability to pay for health care by creating a geographically-based income limit and reducing inpatient copay for those veterans whose income falls below these new geographic income thresholds. The new geographic income thresholds are adjusted for all standard metropolitan statistical areas (SMSAs) and are updated periodically to reflect economic changes within the SMSAs. The geographic means test thresholds are based upon the geographically based low- income threshold set by the U.S. Department of Housing and Urban Development (HUD) for public housing benefits.

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I

Inpatient Care: Services received during a patient’s hospital stay.
Ionizing Radiation: Atomic veterans may have been exposed to ionizing radiation in a variety of ways at various locations. Veterans exposed at a nuclear device testing site (the Pacific Islands, e.g., Bikini, NM, NV, etc.) or in Hiroshima and/or Nagasaki, Japan, may be included. Atomic veterans with exposure to ionizing radiation are eligible to receive treatment for conditions related to this exposure. VA has recognized the following conditions by statute or regulation as being associated with radiation exposure:; Conditions Associated with Ionizing Radiation:

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L

Low-Income Threshold: Veterans with gross household income under the "low income threshold" are eligible to receive certain health related benefits at no cost to the veteran. The low income threshold is set by law and varies according to the veteran's family size and benefit applied for.

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M

Means Test

The formal financial assessment process used by VA to measure a veteran’s gross household income and assets. The means test determines veterans copay responsibilities and helps to determine enrollment priority.

Means Test Copay Exempt

Veterans not required to make copays for medical care provided by VA include:

Veterans with a compensable service-connected rating or
Veterans in receipt of VA pension benefits or whose income does not exceed the applicable VA means test income threshold;
Veterans requiring services/medications for treatment of a service-connected condition; or for conditions related to exposure to ionizing radiation, sexual trauma experienced while in the military; nose or throat radium treatments while in the military requiring services/medication for head or neck cancer; or for participation in Project 112/SHAD experiments,
Former POW's,
Veterans in receipt of a Purple Heart medal, WWI veterans and veterans who were discharged from the military for a disability that was incurred or aggravated in the line of duty. and
Combat veterans who were discharged after November, 11, 1998, who require services/medications for conditions that are potentially related to combat service, as follows:

If discharged on or after January 28, 2003 for five years post discharge.
If discharged from active duty before January 28, 2003, and if application for enrollment is made on or after January 28, 2008, until January 27, 2011.

Means Test Copay Required

A copay status assigned to a veteran who is required to make medical care copay based on financial status relative the applicable means test income threshold.

Medicaid

A jointly funded federal and state program that provides hospital expense and medical expense coverage to persons with low-income and certain aged and disabled individuals.

Medical Benefits Package

The term “Medical Benefits Package” refers to a group of health care services that are provided to all enrolled veterans.

Medical Need

The determination that care or service(s) are required to promote, preserve, or restore a veteran’s health as specified within 38 CFR 17.38(b). A treatment, procedure, supply, or service is considered medically necessary as determined by the patient’s care provider and in accordance with generally accepted standards of clinical practice.

Medicare

A federal program that provides health care coverage for people aged 65 and older, as well as some younger individuals with specific health problems. Medicare Part A covers hospitalization, extended care and nursing home care; Medicare Part B covers outpatient services, and is subject to a monthly premium.

Military Sexual Trauma (MST)

Sexual trauma experienced while on active duty in the military. Sexual trauma is defined as sexual harassment, sexual assault, rape and other acts of violence. Sexual harassment is further defined as repeated unsolicited, verbal or physical contact of a sexual nature, which is threatening in nature. If the veteran is being treated for any condition during this episode of care that the provider believes is related to MST; the veteran does not have to pay a copay for the visit or the medication. http://www.va.gov/womenvet/page.cfm?pg=23

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N

Nasopharyngeal Radium Therapy: Because it was effective in treating otitis media, military physicians used NP radium to treat aerotitis media (barotrauma) in submariners, aviators, and divers due to enlarged tissue in the throat combined with rapid pressure changes. It is estimated that between 8,000 and 20,000 military personnel received NP radium treatments during World War II and until the 1960s.
Net Worth: Simply put, “net worth” means the market value of everything you own, minus what you owe.; There are exclusions, not everything you own or owe is considered. VA has some very specific guidelines on how it computes net worth. The VA Means Test uses the same rules as VA pension to determine your net worth.
Noncompensable: Noncompensable refers awards of service-connection which VA determines do not warrant the award of monetary compensation.
Nonservice-Connected Pension: A monetary support benefit awarded to permanently and totally disabled, low-income veterans with 90 days or more of active military service, of which at least one day was during wartime. Veterans of a period of war who are age 65 or older and meet service and income requirements are also eligible to receive a pension, regardless of current physical condition. Payments are made to qualified veterans to bring their total income, including other retirement or social security income, to a level set by Congress. For more information, go to http://www.va.gov and click on Compensation and Pension Benefits.
Nonservice-Connected Veteran: An eligible veteran who has been discharged from active military duty, and does not have a VA adjudicated illness or injury incurred in or aggravated by military service.
Nursing Home: The term "nursing home care" means the accommodation of convalescents or other persons who are not acutely ill and not in need of hospital care, but who require nursing care and related medical services, if such nursing care and medical services are prescribed by, or are performed under the general direction of, persons duly licensed to provide such care. Such term includes services furnished in skilled nursing care facilities, in intermediate care facilities, and in combined facilities. It does not include domiciliary care.

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O

Open Enrollment: The process of accepting applications for enrollment at any time during the year.
Other than dishonorable conditions: All veterans are potentially eligible for most veterans' health care benefits are based solely on active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WWII), and discharged under other than dishonorable conditions
Outpatient Care: Refers to health care a patient receives without being admitted to a hospital. Examples include office visits, x-rays, lab tests and some surgical procedures.

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P

Palliative Care: Care provided primarily to relieve symptoms of a disease or condition rather than for curative purposes.
Pension Benefit: VA pension is a monetary award paid on a monthly basis to veterans with low income who are permanently and totally disabled, or are age 65 and older, may be eligible for monetary support if they have 90 days or more of active military service, at least one day of which was during a period or war. Payments are made to qualified veterans to bring their total income, including other retirement or social security income, to a level set by Congress annually. Veterans of a period of war who are age 65 or older and meet service and income requirements are also eligible to receive a pension, regardless of current physical condition.
Preferred Facility: The veteran identified VA health care location where the veteran prefers to receive care. A preferred facility may be any VA health care location, for example, VA health care facility, independent clinic, or community based outpatient clinic. If VA is unable to provide your needed health care, that facility will make arrangements to refer you to another VA health care facility or to one of VA’s private sector affiliates to provide the required care.
Preventive Care: Health Care that emphasizes prevention, early detection, and treatment.
Primary Care Provider: The clinician who is responsible for the supervision, coordination, and provision of the veteran’s medical care. This clinician provides routine health services and is the veteran’s first point of contact when the veteran becomes sick. The primary care provider can easily refer patients to a specialist (such as a surgeon) should they require care outside the scope of his or her expertise.
Project 112/SHAD: Project SHAD, an acronym for Shipboard Hazard and Defense, was part of a larger effort called Project 112, which was conducted during the 1960s. Project SHAD encompassed tests designed to identify US warships' vulnerabilities to attacks with chemical or biological warfare agents and to develop procedures to respond to such attacks while maintaining a war-fighting capability.
Prosthetic Devices: A device which replaces all or a portion of a part of the human body. A prosthetic device can be used when a part of the body is permanently damaged, is absent, or is malfunctioning.
Public Law (PL) 104-262: The public law passed by Congress in October 1996, also known as the Veteran’s Health Care Eligibility Reform Act of 1996. This law established national standards of access and equitable health care services to veterans and required that most veterans be enrolled to receive care.
Public Law (PL) 107-135: “ Department of Veterans Affairs Health Care Programs Enhancement Act of 2001” provides for chiropractic care and services for veterans through Department of Veterans Affairs medical centers and clinics.
Purple Heart: A “Purple Heart” is a medal given by the military to a service person injured as a direct result of combat.

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R

Radiation Risk Activity

On site participation in a test involving the atmospheric detonation of a nuclear device.
Participation in the occupation of Hiroshima or Nagasaki from August 6, 1945 through July 1, 1946.
Internment as a Prisoner of War in Japan (or service or active duty in Japan immediately following such internment.
Service at Department of Energy plants at Paducah, KY, Portsmouth, OH, or the K25 area at Oak Ridge, TN for at least 250 days before February 1, 1992.
Service at Longshot, Milrow, or Cannikin underground nuclear tests at Amchitka Island, AK prior to January 1, 1974.

Referral

The process of referring a veteran from one practitioner to another for health care services.

Regular Filipino Scouts

The Filipino Scouts were guerilla forces considered part of the Commonwealth Army of the Philippines. They were organized under commanders appointed, designated, or later recognized by the U.S. Army.

Respite care

Respite care gives the caregiver of a veteran a planned period of relief from the physical and emotional demands associated with providing care.

Restore Health

The process of improving a veteran’s quality of life or daily function level that has been lost due to illness or injury.

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S

Secondary Condition: A secondary condition, for medical treatment purposes, may be the result of an adjudicated service-connected condition. Veterans are encouraged to file compensation claims for non-rated secondary conditions. Non-rated secondary conditions are billable as a non service-connected condition.
Service-connected: Generally a service-connected disability is a disability that VA determines was incurred or aggravated while on active duty in the military and in the line of duty. A service-connected rating is an official ruling by VA that your illness/condition is directly related to your active military service. Service-connected ratings are established by VA Regional Offices located throughout the country.
Service-Connected Veteran: A veteran who has an illness or injury incurred in or aggravated by military service as determined by VA.
Sexual Trauma: Sexual Harassment, Sexual Assault, Rape and other acts of violence. Repeated unsolicited, verbal or physical contact of a sexual nature, which is threatening in nature.
Southwest Asia: An area of land located in the southwestern part of Asia to include the Persian Gulf, Red Sea, Gulf of Oman, Gulf of Aden, the portion of the Arabian Sea that lies north of 10 degrees North latitude and west of 68 degrees East longitude, as well as the total land areas of Iraq, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, and the United Arab Emirates.
Special (New) Philippine Scouts: The term "New Philippine Scouts" refers to non-commissioned Philippine Scouts who—
State Veterans Homes: The eligibility for State Veterans Homes varies from state to state. But typically veterans and sometimes their spouse, can be admitted to a State Veterans Home. The costs of living in a State Veterans Home are usually paid by Medicaid, long term care insurance, and private funds. VA pays a modest share of the cost for each veteran living in a State Veterans Home. You can find information on the State Veterans Home(s) for your state by looking in the state government pages of the telephone book. VA social workers at the VA medical center where you’re being treated can also provide information about State Veterans Homes.

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U

Urgent Care: Services received for an unexpected illness or injury that is not life threatening but requires immediate outpatient medical care that cannot be postponed. An urgent situation requires prompt medical attention to avoid complications and unnecessary suffering or severe pain, such as a high fever.

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V

VA Form 10-10EZ, Application for Health Benefits: The VA form completed by veterans to apply for VA health care benefits. The form includes demographic, military, insurance and financial information
VA Form 10-10EZR, Health Benefits Renewal: The VA Form used by veterans to submit their updated personal, insurance and financial information to VA.
Veteran: The term 'veteran' means a person who served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable.

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Federal Benefits for Veterans and Dependents
VA National Means Test Income Threshold | GMT Income Threshold
Viewers, Plug-Ins, & Readers | VA Health Care Eligibility & Enrollment Site Map

For questions about Health Care Eligibility, please visit the VA inquiry website.

Reviewed/Updated Date: July 28, 2008

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