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This Knol is provided to you to describe general processes and procedures that occur during the application for disability compensation and pension and other benefits within the Department of Veterans Affairs System. Any author you find here is not providing you with legal advice. Any information provided by this Knol or any contributor to this Knol is not intended as and should not be construed as legal advice. You should always consult an attorney to help answer specific questions regarding how VA laws apply to you and/or your situation. The summaries provided here are incomplete, and the DVA laws and regulations are subject to change. We do not guarantee and we are not liable for the accuracy or completeness of any of the information provided, or any results or outcome as a result of the use of this information.Related or Secondary Benefits
SSDI and VA Compensation
Karl Kazmierczak, Esq. http://www.kazmierczaklaw.com/
Can you get VA disability benefits and Social Security Disability benefits?
I have noticed in my practice that many veterans do not know they can get both Social Security disability and VA compensation benefits. There is not an offset between these two programs. This means you can get your entire benefit under VA Compensation and your entire benefit under Social Security Disability at the same time. It gets a little more complex when we start to talk about VA pension.
VA pension is a needs-based program for disabled veterans of wartime service. Veterans under the pension program can receive money up to the total pension amount. The VA will look at a veteran’s assets and countable income and if this is below the pension amount they will receive money to bring them up to the pension total amount. Income that does not count against the pension is welfare and other needs-based payments. These include supplemental security income (SSI), state welfare, general systems and home relief. The VA does count all family members income which can reduce or eliminate the veteran's pension. Social Security disability payments will count to reduce or eliminate pension amounts. This is because Social Security Disability unlike SSI is not a needs-based program. Workers compensation benefits paid either to the veteran or their spouse will count as income in calculating VA pension. It is also important to note here that even though VA pension is not offset by SSI payments, welfare or Medicaid these programs can count VA pension in determining eligibility for these programs. So unlike Social Security disability and VA compensation benefits, your amounts you get for SSI, Medicaid or welfare can be reduced or eliminated due to the income you receive from VA pension. So as you can see even though VA pensions are not offset by SSI payments, SSI payments are offset by VA pension benefits. This is done on the dollar for dollar basis.
So how will working affect my benefits? Service connection VA compensation benefits are usually not affected by employment. However, if the veteran has what they consider substantial gainful employment it may prevent benefits based on employability. Veteran’s pension benefits will be eliminated if the veteran is engaged in substantial gainful activity. This is because in order to get VA pension one must be totally disabled.
Pharmacy Benefits
Formulary
A formulary is a listing of medicines allowed by a health insurer for use by its beneficiaries. Like most modern health care provider entities, the VHA uses a national formulary to accomplish cost controls while allowing providers and patients a choice of quality medications for the treatment of various conditions. Detailed information about the way this works and what drugs are on the VHA formulary may be found here.Almost all providers and payers of health care in America use a formulary. Formulary committees are usually made up of pharmacists, physicians and administrators and they spend a great deal of time ensuring that affordable medicines are available to their patients.
The concept of the formulary seems simple. To develop and administer a formulary is a complex task. Each organization will develop its own reasoning for what is allowed, what is prohibited, an appeals process and any associated fees or co-pays. An example of just how complex this can be may be found at The Fingertip Formulary.
The VA often approves medicines that aren't on the VHA formulary. The rationale for approving prescriber requests for non-formulary medications may be found here.
Generic Drugs
A generic drug is a less expensive version of a brand name medication.Pharmaceutical manufacturers spend a lot of money to develop a drug. If the drug is approved and if it becomes popular, the manufacturer may reap a large reward in terms of profits. Eventually the patent on the drug runs out and generic manufacturers are then allowed to duplicate the medication and sell it for far less cost.
The popularity of generic drugs continues to grow as our health care systems search for ways to control costs. The FDA maintains an Office of Generic Drugs with a specific focus on maintaining the quality of generics.
The Food and Drug Administration requires that a generic medicine is "therapeutically equivilant" to the original drug. packaging, the delivery (pill, capsule, etc.) and some inert ingredients may change but the basic part of the medication is required to be exactly the same as the original. A letter to prescribers that explains how FDA views therapeutic equivilance may be found here.
Copays and Pharmacy Charges
Many veterans will find that they are required to pay a "copay" amount for their prescribed medications. This usually depends on the Priority Group that the veteran is assigned to. |
| Public Domain: Reflection at Vietnam Veterans Memorial from DOD, 1987 |
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