Dental Benefits - a crack in the system

chaplaincharlie

chaplaincharlie

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My VA ratings are: 100%, 50%, 30%, 30%, 20% x 5, 10% x 9.

So today I tried to make a VA dental appointment, but was denied service because
"Veterans paid at the 100% rate
based on a temporary rating, such as
extended hospitalization for a service-
connected disability, convalescence
or pre-stabilization are not eligible for
comprehensive outpatient dental services
based on this temporary rating"

The VA says my ratings are considered temporary. There "rationale" is:
"You are not considered to be permanently disabled due to your service-connected disabilities because your case is scheduled for review on: May 01, 2020"
AND
"You are not considered to be permanently disabled due to your service-connected disabilities at this time because you are scheduled for a future reduction in rating on: May 01, 2020"
In short, The VA really gives no reason for the ratings being temporary or than they will rate me again in 5 years. The single condition rated 100% by the VA, in my case, has a mean life expectancy of 5.5 years. No one gets better from this condition.

Any ideas how to poke the system to resolve this issue are appreciated. Thanks.
 
Chaps, Im sorry for your troubles but glad you made the post. I assumed the VA would cover dental on TDRL rated at 100% from the va
 
I'm 100% permanent and total. I have in the past successfully forced the VA to send me to an outside high end cosmetic dentist for thousands of dollars in periodontal deep cleaning as well as teeth cleaning and a filling. This was before the big scandal about wait lists and the recent law changes. That being said, I am tired of arguing with bureaucrats (even though I always win). They literally fight me on everything. So I'm taking advantage of a workaround created my the VA itself:

http://www.va.gov/healthbenefits/VADIP/

Do I have to pay a small premium? Yes. Do I have to pay cost sharing? Yes. Do I have to lay down for a VA dental exam and point out to the dentist that there is a loose screw hanging by a thread over my open mouth? No. Do I have to get angry when said VA dentist tells me, "oh yeah, other veterans have pointed that out to us too?" No. Do I get all the luxuries of my high end dentist - a chair that massages me, peaceful music, and a cappuccino machine? Yes. Do I get high standards and wonderful treatment? Yes. Do I have to draft 5 page legal documents to get all this? No!

Thank you VADIP!
 
chaplaincharlie said:
My VA ratings are: 100%, 50%, 30%, 30%, 20% x 5, 10% x 9.

So today I tried to make a VA dental appointment, but was denied service because
"Veterans paid at the 100% rate
based on a temporary rating, such as
extended hospitalization for a service-
connected disability, convalescence
or pre-stabilization are not eligible for
comprehensive outpatient dental services
based on this temporary rating"

The VA says my ratings are considered temporary. There "rationale" is:
"You are not considered to be permanently disabled due to your service-connected disabilities because your case is scheduled for review on: May 01, 2020"
AND
"You are not considered to be permanently disabled due to your service-connected disabilities at this time because you are scheduled for a future reduction in rating on: May 01, 2020"
In short, The VA really gives no reason for the ratings being temporary or than they will rate me again in 5 years. The single condition rated 100% by the VA, in my case, has a mean life expectancy of 5.5 years. No one gets better from this condition.

Any ideas how to poke the system to resolve this issue are appreciated. Thanks.
Click to expand...
Wow! A very interesting situation indeed in reference to a "temporary rating" adjudicated by the DoVA D-RAS for sure!

Hmm, upon using the VA combined ratings method on the remainder of your VA ratings minus the 100% rating, it seems that you have obtained a VA 100% Schedular rating with those VA official ratings.

As such, does the VA 100% rating qualify as a "temporary rating" due to that standalone medical condition? Are any of your remaining VA official ratings meet the "temporary rating" criteria at this point? If not, then it seems that you definitely meet the qualification of a VA 100% Schedular rating with the combination of all remaining medical conditions via the VA combined ratings method!

With that all said, maybe you should submit a VA NOD or similar complaint inquiry explaining that you meet full qualifications for a VA 100% Schedular rating via the VA combined ratings method with the exclusion of the single VA 100% temporary rating.

To that extent, I foresee one concern only if you are currently receiving SMC-S compensation as a direct result of potentially meeting the VA criteria for applicable benefits due to the receipt of the VA 100% rating for the single medical condition.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 
@Warrior644
I am receiving SMC, but I don't expect any of the ratings to decrease when 2020 hits.
 
chaplaincharlie said:
@Warrior644
I am receiving SMC, but I don't expect any of the ratings to decrease when 2020 hits.
Click to expand...
Okay, that's good to hear in reference to your VA official ratings and therefore potentially maintaining the SMC-S compensation at that particular time. :)

As such, unfortunately, in my opinion it may seem that the VHA shall still maintain their position to ultimately deny "comprehensive outpatient dental services" as based upon a VA "temporary rating" due to your receipt of being paid at the 100% rate! :(

Hmm, hopefully other PEB Form members may be able to provide additional sound insightful feedback in reference to your current situation. Please take care and continue to enjoy life to its fullest as feasibly possible! :cool:

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 
Don't beat me for this. But you could still sign up for the VA Dental Plan it is pretty cheap. Like $18 per month.
 
My understanding is the VA dental plan is part of CHAMPVA, so will also require the Permanent designation.

I do not believe there is an alternative to filing a NOD over the permanency designation. You can do a NOD for any decision the VA makes, including the permanency. I have seen a couple BVA cases where this was successful, but the rub is that the appeal process is so long that almost all of these cases the veteran ended up having a reexam that said things were permanent and the BVA ended up only backdating the permanency date. These were in the context of a DEA request, so ended up providing backpay for someone who already had paid for school. This won't help much when you need dental care, and a means of paying for it, now.
 
The VA dental plan (VADIP) is open to all Veterans and CHAMPVA beneficiaries. Any veteran can use the program but dependents are not eligible unless enrolled in CHAMPVA.

http://www.va.gov/healthbenefits/VADIP/VADIP_fact_sheet_02-18-15.pdf

One can go to the special Metlife or Delta Dental websites to see premiums, deductibles, coverages, etc.

This program was created specifically to deal with deficiencies in the law and what VA can cover.

My premium is $30/month and deductible is $50/year. My dentist gives me reduced rates for being in network. Yes I'm paying out money that I shouldn't have to with my rating, but it is totally worth not having the stress associated with dealing with the VA dental clinic.
 
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TopSecret,

You beat me to it. I might also add that there is a Tricare Retiree's Dental Plan available also.
 
Thanks, I have TriCare retiree dental. It appears a NOD will not be timely.
 
Your condition is not 100% Permanent and Total. If it was, you would not receive any more examinations on the 100% rating you have. If you are scheduled for future exams, they can decrease your ratings at any time - even the 100% one. I was 100% for 3 years with 7 rated conditions I received in combat, but it was temporary with future apts. Then after one of my exams one was lowered and one rating was 100% permanent and total with no future evals with any of the rated conditions. Then I received a packet in the mail about free dental. You go to the VA and fill some forms out and they sent me to University of Md Dental Hospital for cleanings/xrays/dental work free of charge. You just have to have the 100% permanent and total.
 
PSYOP Warrior said:
Your condition is not 100% Permanent and Total. If it was, you would not receive any more examinations on the 100% rating you have. If you are scheduled for future exams, they can decrease your ratings at any time - even the 100% one. I was 100% for 3 years with 7 rated conditions I received in combat, but it was temporary with future apts. Then after one of my exams one was lowered and one rating was 100% permanent and total with no future evals with any of the rated conditions. Then I received a packet in the mail about free dental. You go to the VA and fill some forms out and they sent me to University of Md Dental Hospital for cleanings/xrays/dental work free of charge. You just have to have the 100% permanent and total.
Click to expand...

Indeed in reference to your particular situation albeit it's important to note that dental benefits are provided by the DoVA according to Public Law 83 enacted June 16, 1955. In some instances, the VHA is authorized to provide extensive dental care while in other cases dental treatment may be limited unfortunately.

To that extent, the VA Outpatient Dental Program's eligibility for outpatient dental care is not the same as for most other DoVA medical benefits and is therefore categorized into functional classes.

As such, if the military veteran is eligible for VA dental care under Class I, IIA, IIC, or IV then the veteran is eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care.

With that all said, the other functional classes (e.g., II, III, V, VI, and IIB) all have its own time and/or service limitations for specific eligibility of VA dental benefits.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 
I'm class one. Under VA law, cardiac conditions that necessitate an implanted cardiac defibrillator (ICD), are 100%. There are no plans to remove the ICD, except to replace it when the battery dies. The VA's logic of not making me P&T is mystifying.
 
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