Friday Q&A: Get Your VA Questions Answered

Amyloidosis is covered under 38 CFR 4.1117 (diagnostic code 7717). Although there is no specific wording for “wild type” amyloidosis under this code, it does not mean there is no possibility of service connection.

It’s important to understand the difference between presumptive conditions and conditions requiring direct service connection:

• Presumptive conditions: Some conditions, like AL amyloidosis, are presumed to be connected to Agent Orange exposure. This means veterans are automatically considered for benefits if they have these conditions and served in specific locations during certain timeframes.
• Direct service connection: For conditions like “wild type” amyloidosis, veterans need to provide evidence directly linking their condition to their military service.

In your case, we strongly recommend filing a disability claim due to your toxic exposure (if you haven’t already). If the claim is denied, providing a positive medical opinion from a doctor stating that your “wild type” amyloidosis was caused by your toxic exposure will significantly strengthen your case. The VA is more likely to grant service connection with this supporting evidence.

Answered by: Former Senior Case Manager, Zach Zdroik

As a veteran, you will receive dependent pay if you are 30% or more service-connected for a spouse, even if legally separated until the time of the divorce. If you are a spouse lawfully separated from a veteran, you are not entitled to the dependent pay unless an apportionment is filed and approved.

If you are a surviving spouse that was legally separated from the veteran at the time of his death, you may still be eligible for benefits under certain conditions.

Only “surviving spouses” may be eligible for benefits upon the veteran’s death. To be considered a surviving spouse, the widow or widower must have been continuously living with the Veteran since the time of the marriage; or, if the veteran and his spouse lived apart due to the legal separation, the separation must be initiated by or the fault of the veteran.

Additionally, the following must be true:

• You’re legally married: You were legally married to the veteran at the time of their death.
• Valid marriage: If there was a legal impediment to your marriage, it may still be considered valid if:
  • The marriage lasted at least one year before the veteran’s death, or a child was born of the marriage.
  • You entered the marriage without knowing about the impediment.
  • You lived continuously with the veteran from the date of marriage until their death.
  • No legal surviving spouse has filed a claim for benefits.

In a nutshell, if you were married to a veteran but were legally separated, you may still be eligible for benefits, particularly if the separation was due to the veteran’s actions. You may also need to demonstrate financial need based on low income.

Answered by: Supervising Attorney, Megan Ellis

Simply having a VA disability rating doesn’t automatically qualify you for TRICARE. TRICARE eligibility is primarily based on your status as a:

• Uniformed service member (active duty)
• Retired service member (typically after 20 years of service)
• National Guard/Reserve member
• Medal of Honor recipient
• Survivor of a qualifying service member

However, there are specific circumstances where a disabled veteran might be eligible:

• Medically retired: If you were medically retired from service due to a service-connected disability and are on the Temporary Disability Retirement List (TDRL) or Permanent Disability Retirement List (PDRL), you are eligible for TRICARE.
• VA Disability rating and other qualifying factors: While a disability rating alone doesn’t guarantee TRICARE, it can be a factor in combination with other qualifying factors, such as being the spouse or child of a veteran who is rated as permanently and totally disabled due to a service-connected condition. In these cases, you might be eligible for the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).

Important Considerations for Disabled Veterans:

• VA healthcare: Most veterans with a service-connected disability are eligible for healthcare through the VA. It’s important to note that if your disability rating is 50% or higher, the VA will cover most of your healthcare expenses.
• Dual eligibility: It’s possible to be eligible for both VA healthcare and TRICARE (or CHAMPVA). In these cases, it’s important to understand how the programs work together and coordinate your care.

Answered by: Former Senior Case Manager, Zach Zdroik

Yes, a disabled veteran can be recalled to active duty. However, it’s not automatic and depends on a few factors:

• Severity of disability: Veterans with disabilities rated below 30% are more likely to be recalled than those with higher ratings.
• Military needs: The likelihood of recall increases if the military has a high demand for personnel with specific skills or experience.
• Overall health: A veteran’s current health status plays a significant role. They must be able to meet the physical and mental demands of military service.
• Medical waivers: In some cases, veterans can obtain medical waivers to return to active duty even if their disability rating would typically preclude them.

Answered by: Former Senior Case Manager, Zach Zdroik

The VA uses a rating system to determine mental health disability payments. Here’s a breakdown for a single veteran in 2025:

• 0%: $0
• 10%: $175.51
• 30%: $537.42
• 50%: $1,102.04
• 70%: $1,759.19
• 100%: $3,831.30

Answered by: Former Senior Case Manager, Zach Zdroik

The VA updates claim status weekly for compensation, pension, education, and other special mission benefits. Even though it is updated weekly, this does not guarantee a change in your status. The VA must follow the following steps for every claim received:

1) Claim received – Where the VA informs the Veteran that the claim was received.

2) Initial review – Check the claim for basic information.

3) Evidence gathering – The VA will ask for specific evidence, request exams and medical records, and gather all evidence from VA records.

4) Evidence review – Formal review of all evidence.

5) Rating – VA will decide the claim and determine disability rating.

6) Preparation of decision letter

7) Final review – A senior VA reviewer will do a final review of the claim and decision letter.

8) Claim decision letter – Veterans can review and download decision letters in the claim status tool.

According to the U.S. Department of Veterans Affairs, the average processing time for a VA disability claim is 140.5 days (as of Oct 2024). However, there is no set time frame. If the veteran is able to submit all evidence for a claim in a timely manner, it increases your chances of a positive claim decision within that 140.5-day period.

The VA currently has a backlog of over 300,000 disability claims, this is largely due to the influx of PACT Act claims. But keep in mind simple mistakes like missing deadlines or not filling out forms correctly are known reasons for delays as well.

Answered by: Former Senior Case Manager, Zach Zdroik

Veteran Service Officers (VSOs) are invaluable resources for veterans navigating VA benefits. They assist with filing claims, understanding the VA system, and pursuing appeals, including identifying potential state benefits. VSOs alleviate the stress and confusion associated with securing earned benefits.

Answered by: Former Senior Case Manager, Zach Zdroik

The VA Dependents Educational Assistance program (Chapter 35) has age limits that vary based on your eligibility date:

• Eligible before August 1, 2023: Must use benefits before age 26.
• Eligible after August 1, 2023: No age limit.

This information is based on Title 38 CFR 21.3041.

Answered by: Former Senior Case Manager, Zach Zdroik

Unfortunately, pre-diabetes itself does not qualify for VA disability compensation. However, if pre-diabetes progresses to type 2 diabetes mellitus, and it is service-connected, then you will likely be eligible to receive VA disability compensation. Veterans can be assigned 100%, 60%, 40%, 20%, or 10% for type 2 diabetes mellitus according to the VA’s Schedule of Ratings (38 CFR 4.1119, Diagnostic code 7913). 

Answered by: Former Senior Case Manager, Zach Zdroik

Here are some of the key VA benefits available to 100% disabled veterans:

• No-Cost Healthcare & Prescriptions:
  • Free VA healthcare for service-connected conditions.
  • Waived copayments for most non-service-connected care.
  • Prescription medications covered at no cost.
• Dependents Educational Assistance (DEA):
  • Spouse and children eligible for up to 36 months of educational benefits.
  • Monthly stipend for college students.
  • Guidance counseling and tutoring.
• CHAMPVA Health Insurance:
  • Spouse and dependent children can receive civilian health insurance through CHAMPVA.
  • Covers most medical expenses at private facilities.
• VA Dental Coverage:
  • Free dental care for service-connected disabilities or vocational rehabilitation.
• Uniformed Services ID Card (USID):
  • Access to military facilities, discounts, and services.
  • Available for veteran, spouse, and dependent children.
• Free and Discounted Hunting Tags and Licenses:
  • Varies by state, but often offered at reduced cost or free.
• Property Tax Breaks:
  • May be available depending on state and local laws.
• Other Perks:
  • Priority travel on military aircraft (“Space A”).
  • Discounted lodging on military bases.
  • Access to recreational facilities and activities.
  • Potential for student loan forgiveness.

While VA health care benefits provide comprehensive coverage for eligible veterans, maintaining additional health insurance can offer important advantages. The Department of Veterans Affairs (VA) recommends that veterans consider keeping their private health insurance or enrolling in programs like Medicare for several reasons:

• Family coverage: VA benefits don’t cover your family. Private insurance keeps them protected.
• More options: VA care can be limited to VA facilities. Other insurance lets you see non-VA doctors.
• Future security: VA eligibility and funding can change. Extra coverage gives you a backup.
• Medicare penalties: If you don’t sign up for Medicare Part B when eligible, you’ll pay lifelong penalties.

The bottom line is that the VA benefits are great, but having additional insurance gives you more flexibility and protection. See more info at www.va.gov. 

The Department of Veterans Affairs (VA) evaluates Temporomandibular Joint Disorder (TMJ) under 38 CFR § 4.150, Diagnostic Code 9905. Ratings range from 10% to 50%, primarily based on the range of motion of the jaw and any dietary restrictions necessitated by the condition.

Here’s a breakdown of the rating criteria:

• 50% Rating: Inter-incisal range (distance between upper and lower front teeth when mouth is open) of 0 to 10 millimeters (mm) with dietary restrictions to all mechanically altered foods.
• 40% Rating: Inter-incisal range of 0 to 10 mm without dietary restrictions; 11 to 20 mm with dietary restrictions to all mechanically altered foods; or 21 to 29 mm with dietary restrictions to full liquid and pureed foods.
• 30% Rating: Inter-incisal range of 11 to 20 mm without dietary restrictions; 21 to 29 mm with dietary restrictions to soft and semi-solid foods; or 30 to 34 mm with dietary restrictions to full liquid and pureed foods.
• 20% Rating: Inter-incisal range of 21 to 29 mm without dietary restrictions; or 30 to 34 mm with dietary restrictions to soft and semi-solid foods.
• 10% Rating: Inter-incisal range of 30 to 34 mm without dietary restrictions; or lateral excursion (side-to-side movement) of 0 to 4 mm.

For VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is 35 to 50 mm. “Mechanically altered foods” refer to foods that have been blended, chopped, ground, or mashed to make them easier to chew and swallow. To qualify for a higher rating based on dietary restrictions, a physician must document the necessity for such a diet.

It’s important to note that ratings for limited inter-incisal movement cannot be combined with ratings for limited lateral excursion. Instead, the VA will assign a single rating based on the predominant limitation.

For more detailed information, refer to the VA’s Schedule for Rating Disabilities under 38 CFR § 4.150. (ecfr.gov)

If you’re considering filing a claim for TMJ, ensure that your medical records comprehensively document your condition, including range of motion measurements and any prescribed dietary modifications. This documentation will support an accurate evaluation of your disability rating.

The average VA disability rating for neck pain is typically between 10% and 40%, depending on the severity of the condition. Higher ratings (50% or above) are reserved for cases with significant limitations, such as severe ankylosis (spinal fusion) or neurological involvement.

The VA uses the General Rating Formula for Diseases and Injuries of the Spine under 38 CFR § 4.71a to evaluate most neck pain conditions. This rating formula is based mainly on range of motion measurements and the presence of symptoms such as pain, stiffness, or aching in the area of the spine affected by residuals of injury or disease.

The time it takes the VA to correct an error can vary significantly depending on several factors, including the type of error, the complexity of the issue, and the availability of necessary information and resources.  

Here’s a general overview of the timelines for correcting errors through different review processes:

Higher-Level Review (HLR):

• VA Goal: 125 days (approximately 4-5 months) on average for claims not related to healthcare benefits.  
• Factors that may cause delays: Obtaining records, scheduling new exams, or if the veteran requests an informal conference with the reviewer.

Supplemental Claim:

• Timeline: Similar to HLR, the VA aims to complete supplemental claims within 125 days.  
• Purpose: Used to submit new and relevant evidence to support a previously denied claim.  

Clear and Unmistakable Error (CUE):

• Timeline: No specific time limit for filing a CUE claim or for the VA to make a decision.  
• Factors affecting timeline: Complexity of the error, availability of evidence, and the VA’s workload. CUE claims can be straightforward if done correctly, potentially leading to quicker decisions.  

Duty to Assist (DTA) Errors:

• Timeline: No concrete timeframe for correcting DTA errors.  
• Factors affecting timeline: Obtaining missing records, scheduling necessary medical exams, and the responsiveness of healthcare providers or other entities involved.

General Considerations:

• Complex Errors: Some errors may take longer to correct due to their complex nature.  
• Initiation of Corrective Actions: The VA aims to initiate corrective actions on all national errors within 30 days of notification.
• VBMS Notes: For errors that cannot be immediately resolved, the VA will enter permanent VBMS claim notes to track the progress of the correction.  

Tips for Veterans:

• Be proactive: Follow up on your claim and inquire about the status of the correction.
• Provide complete information: Ensure you submit all necessary evidence and documentation to support your claim.
• Seek assistance: If you encounter delays or difficulties, consider seeking assistance from a Veterans Service Organization (VSO) or an accredited representative.