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| ##  Veterans Affairs                                                  |
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### Agent Orange Brief

**Prepared by the Environmental Agents Service (131)**

B2 VA Central Office, Washington, DC 20420 August 2005

## 

# AGENT ORANGE -- VETERAN 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]{.underline} 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]{.underline}** 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](http://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/](http://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](http://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]{.underline}: **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.