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Veteran Advisor: VA Dental Service

Reprinted from PN/Paraplegia News February 2016

If you're a veteran, it’s very likely that over the years you've experienced some type of problem with the Department of Veterans Affairs Dental Service

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The most common scenario starts with you asking “What do you mean I’m not eligible for dental?!”

You’ve been drawing compensation at the 100% rate for as long as you can remember and now your teeth are in need of a little maintenance. You’ve filed your claim with the Dental Services Department only to be told you aren’t entitled to treatment through the VA, because you’re not rated at 100%.  

Before your blood pressure rises to a critical stage, the veins in your forehead begin to stretch to the rupture point and the bulge of your eyes makes it nearly impossible to focus, let’s evaluate what is really going on.

If you are 60, 70, 80 or 90% disabled but are being compensated at the 100% rate because of your entitlement to Individual Unemployability (IU), then the computer will only indicate the percentage you’re rated and not the 100% rate you’re receiving.

So, in all actuality, you’re not rated as 100% disabled and were given the correct information according to the Department of Veterans Affairs (VA).


Fixing The Mistake

How do you correct this? First, don’t lose your cool on the Dental Services clerk. Head straight to the Eligibility clerk of the facility and explain the situation.

They’ll then check the VA system (a section of which isn’t available to the Dental Services clerk) and verify the information as to whether you’re entitled to the dental treatments needed.   

If the system has been updated correctly, the Eligibility clerk will then call down to inform the Dental Services clerk, that “Yes, indeed, Mr. Veteran is entitled to dental care in our facility.”

However, what if the Eligibility clerk can’t find the information verifying you’re drawing the 100% rate, and thus you’re not entitled?

Well, all you have to do is provide a copy of the latest VA award letter that indicates what percentage you are rated, and that you are being compensated at the 100% rate.

Take Responsibility

This is why it’s important to take your award letter to the medical facility and have them input that into the computer.

Don’t rely on the VA Regional Office and VA Healthcare System to exchange the correct information. It’s your health care, take responsibility and the necessary steps to ensure you get the treatment to which you are entitled.

For those who like having the regulations to quote, 38 CFR 17.161 (h) is where you’ll find eligibility for dental when a veteran is rated less than 100%, but is being compensated at the 100% rate because of IU. 

If you’re rated at 100%, there should be no problem in getting the appropriate dental care. Dental appointments are just like medical appointments. They’re limited based on the number of qualified veterans being served, so keeping your appointment is crucial, both to yourself and the provider of care at the clinic. 

These are the two most common problems that veterans experience when seeking dental care. However, there are numerous situations which could occur that would entitle you to dental care.

Emergency Treatment

These are a few other situations that could possibly qualify you for treatment.

The Chief of Dental Services may authorize outpatient dental care which is reasonably necessary to complete treatment of a non-service-connected dental condition which was begun while the veteran was receiving VA authorized hospital care.

When outpatient emergency dental care is provided, as a humanitarian service, to individuals who have no established eligibility for outpatient dental care, the treatment will be restricted to the alleviation of pain or extreme discomfort, or the remediation of a dental condition which is determined to be endangering life or health.

The provision of emergency treatment to persons found ineligible for dental care won’t entitle the applicant to further dental treatment. Individuals provided emergency dental care who are found to be ineligible for such care will be billed.

Persons receiving hospital, nursing home or domiciliary care pursuant to the provisions of section 17.46 and 17.47, will be furnished such dental services as are professionally determined necessary to the patients’ or members’ overall hospital, nursing home or domiciliary care.

For more information, visit pva.org or contact your nearest Paralyzed Veterans of America (PVA) National Service Officer from the roster.

John Allen is the PVA Senior Veterans Health & Benefits Specialist in Dallas.   

 

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Veteran Advisor: VA Dental Service

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