Veterans News: Understanding the definition of ‘catastrophically disabled’
By Tammy Javenkoski
Oneida County Veterans Services Officer
Veterans are considered to be catastrophically disabled when they have a severely disabling injury, disorder, or disease that permanently compromises their ability to carry out the activities of daily living. The disability must be of such a degree that the veteran requires personal or mechanical assistance to leave their home or bed or requires constant supervision to avoid physical harm to themselves or others.
Veterans determined to be catastrophically disabled are eligible for VA health care and placed into priority group four unless eligible for a higher priority group placement based on other eligibility criteria. A catastrophically disabled determination may be authorized when a VA clinician determines there is sufficient medical documentation without further evaluation (this would be for veterans already in the VA health care system but in a priority group lower than four). Veterans who are not in the VA health care system may request a catastrophically disabled evaluation by contacting the eligibility and enrollment coordinator at their local VA health care facility. It is VA policy to provide a catastrophically disabled veteran an evaluation within 30 days of the request and there is no charge for this examination. Due to COVID, however, it may now take longer than 30 days.
Veterans determined by the VA to be catastrophically disabled are exempt from inpatient, outpatient, and prescription copays. They are also exempt from copays applicable to the receipt of non-institutional respite care, geriatric evaluation, adult day health care, homemaker/home health aide, purchased skilled home care, home-based primary care, and any other non-institutional alternative extended care services. Copays for other extended care services not mentioned, such as nursing home care, still apply.
The following is a list of some injuries, disorders and diseases that may qualify as a catastrophic disability:
• Spinal cord injury, quadriplegia and quadriparesis or paraplegia
• Persistent vegetative state
• Traumatic Brain Injury
• Amputations, two amputations but not of the same limb
• Multiple Sclerosis
• Parkinson’s disease
• Amyotrophic Lateral Sclerosis (ALS)
• Neurological disorders
• Psychological conditions
Catastrophically-disabled veterans may have unique and costly medical expenses and needs. The VA health care system may be able to help, which is why these veterans are eligible for VA health care. For more information, contact the eligibility and enrollment office at the Oscar G. Johnson VA Medical Center in Iron Mountain at 800-215-8262, extension 32810.
Tammy Javenkoski can be reached at 715-369-6127 or [email protected] Jason Dailey, Assistant CVSO, can be reached at the same number or [email protected], or you can contact us via Facebook at Facebook.com/oneidacvso. Vilas County residents can contact Brian Thomas at 715-479-3629 or [email protected] Deborah Eicher, Deputy CVSO, can be reached at the same number or [email protected]
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