The Orange Stripe

Your Information Center For All Veterans

Agent Orange - Veterans' Health Care Eligibility

Agent Orange, Anthrax, Depleted Uranium, Dioxin, Gulf War Veterans' Health, Iraq and Afghanistan Veterans, Herbicidal Warfare, Hodgkin's Disease, News, Non-Hodgkin's Lymphomas PTSD, Multiple Myeloma, Radiation-Related Health Issues, Respiratory cancers, Spinal Cord Injury, Traumatic Brain Injury, Veterans' Health, WWII, Korean, Vietnam Veterans and more.

Agent Orange - Veterans' Health Care Eligibility

Agent Orange Brief

Agent Orange - Veterans' Health Care Eligibility

What is it?

In October 1996, Public Law 104-262, the Veterans' Health Care Eligibility Reform Act of 1996, was enacted. This law contains the following provisions, which defines how the Department of Veterans Affairs (VA) now delivers hospital care and medical services to veterans. There was no change in nursing home care.

The 1996 law makes VA eligibility rules the same for both inpatient hospital care and medical services.

The law establishes two categories of veterans who are eligible for care. The first category includes veterans to whom VA "shall" furnish any needed hospital and medical services, but only to the extent and in the amount that Congress appropriates funds to provide the care. The second category includes veterans to whom VA "may" furnish any needed hospital and medical services, but only to the extent resources and facilities are available, and only if the veteran agrees to pay VA a co-payment in exchange for care.

Vietnam veterans -- as individuals presumed to be exposed to Agent Orange -- are included in the first category, and they have mandatory eligibility for hospital care and medical services. In addition, they have discretionary eligibility for nursing home care for any disability, even if there is insufficient medical evidence to conclude that such disability may be associated with such exposure.

What are the restrictions on this care?

There are some restrictions on the care that can be provided under this law. VA cannot provide such care for a (1) disability which VA determines did not result from exposure to Agent Orange or (2) disease, which the National Academy of Sciences (NAS) has determined that there is "limited/suggestive" evidence of no association between occurrence of the disease and exposure to a herbicide agent.

The following types of conditions are not ordinarily thought to be due to such exposure (the first restriction): (a) congenital, that is, existing at or from one's birth, or developmental conditions, for example, scoliosis;(b) conditions which are known to have pre-existed military service; (c) conditions resulting from trauma, for example, deformity or limitation of motion of an extremity; (d) conditions having a specific and well established etiology, for example, tuberculosis and gout; and (e) common conditions having a well recognized clinical course, for example, inguinal hernia and acute appendicitis.

As for the second restriction, the NAS, in its most recent comprehensive report (released in January 2003), categorized the following diseases as "limited/suggestive" evidence of no association with a herbicide agent: gastrointestinal tumors (stomach cancer, pancreatic cancer, colon cancer, rectal cancer), and brain tumors.

Any veteran already receiving hospital care, medical services, or nursing home care for condition(s) possibly associated with exposure to herbicides, under the old health care law who would not be eligible for care under the new law, remains eligible for such care on the basis of presumed exposure with respect to the disability for which care and services were being furnished.

Public Law 104-262 also mandates VA to establish and implement a national enrollment system to manage the delivery of healthcare services. The law requires that effective October 1, 1998, veterans (with some exceptions) must be "enrolled" to receive care. The exceptions are veterans needing treatment for a service-connected condition, veterans with service-connected disabilities rated 50 percent or more, and veterans discharged or released from active duty for a disability that was incurred or aggravated in the line of duty during the 12-month period following separation. The law also requires VA to manage the enrollment of veterans in accordance with a series of priorities, which includes veterans receiving care for exposure to toxic substances or environmental hazards. Agent Orange-exposed veterans are included in enrollment priority group 6, unless they have eligibility based on other issues that would place them in a higher priority group.

There is no question that the eligibility and priority system is complex. Readers are encouraged to see the VA home page at www.va.gov which contains links to sections on compensation and pension benefits, health benefits, burial and memorial benefits, home loan guarantees, and other benefits. The site on health benefits and services is www.va.gov/vbs/health/. The annually published "Federal Benefits for Veterans and Dependents" is an excellent resource on this subject.

How does a decision that a veteran is eligible for health care affect disability compensation?

It is important to understand that a decision by VA that a veteran is eligible for health care does not constitute a basis for service-connection or in any way affect determinations regarding service-connection.

Where can a veteran obtain additional information on VA health care eligibility?

A great deal of information can be obtained from our website: www.va.gov/AgentOrange. Because of the complexity in determining eligibility for VA medical care benefits; veterans with questions regarding this matter are strongly encouraged to contact the admissions office at the nearest VA health care facility. Veterans will be interviewed individually and their eligibility will be determined accordingly.

Where can a veteran obtain additional information about Agent Orange related issues?

The following Agent Orange Brief fact sheets (including the one that you are reading) are available at VA medical centers nationwide and on-line at www.va.gov/AgentOrange: A1.Agent Orange General Information; A2.Agent Orange Class Action Lawsuit; B1.Agent Orange Registry; B2.Agent Orange - Health Care Eligibility; B3.Agent Orange and VA Disability Compensation; B4.VA Information Resources on Agent Orange and Related Matters; C1.Agent Orange - The Problem Encountered in Research; C2.Agent Orange and Vietnam Related Research - VA Projects; C3.Agent Orange and Vietnam Related Research - Non-VA Projects; D1.Agent Orange and Birth Defects; D2.Agent Orange and Chloracne; D3.Agent Orange and Non-Hodgkin's Lymphoma; D4.Agent Orange and Soft Tissue Sarcomas; D5.Agent Orange and Peripheral Neuropathy; D6.Agent Orange and Hodgkin's Disease; D7.Agent Orange and Porphyria Cutanea Tarda; D8.Agent Orange and Multiple Myeloma; D9.Agent Orange and Respiratory Cancers; D10.Agent Orange and Prostate Cancer; D11.Agent Orange and Spina Bifida; D12.Agent Orange and Diabetes; and D13.Agent Orange and Chronic Lymphocytic Leukemia.

Also at the same Web site you will find copies of past and current issues of the "Agent Orange Review" newsletter and other items of interest.

This fact sheet was updated in August 2005 and does not include any subsequent developments.