Q for Vets with Service Related Injuries

[Mike C]

How is physical therapy regulated once your back home? Are you eligable for continuous out patient treatment? Are you fully covered, or is there co-pay above a set amount? Can you use Tricare healthcare provider networks for medical care/therapy if you travel outside of the US?

[SCI-Nurse]

Tricare is not regulated by the VA. It is a DOD program. If you pay to continue TriCare coverage after you are medically retired, you can still use it. I don't know if you can get non-military medical care outside of the USA through TriCare.

In the VA, if you are service connected for SCI, you would not have a co-payment for physical or occupational therapy. Whether you can get it on an ongoing basis depends on what the goals of therapy are and getting a periodic recertification of medical need, which requires a physician's prescription. We have many veterans (NSC and SC) who come to the SCI therapy gym daily, but this may not be available if you are going to a non-SCI center VA medical center for care.

(KLD)

[Mike C]

Thanks Kathy. I just found a treasure trove of information about the VA´s Foreign Medical Program, which I never heard about before. http://www.va.gov/hac/forbeneficiaries/fmp/fmp.asp

[Timo]

Kathy, why the SCI therapy may not be available if we live in the state that has Non-SCI center VA? Can the VA doctor precribes so the patient can go to outside SCI center for outpatient therapy?

[SCI-Nurse]

Non-SCI Center VAMCs may not have sufficient staff to allow you unlimited PT or OT as an outpatient. Remember that their first priority is the acute care patients in the hospital, as well as recent OEF/OIF veterans.

First, your VA physician would need to prescribe therapy according to established medical criteria and send in the consult to the appropriate therapy area. If you are turned down, or told there is a long waiting list, then I would recommend that you ask your provider (with help from your PVA NSO if needed) to apply for fee-basis therapy outside the VA. It may or may not be granted; appeals are possible.

If your son is still active duty, he will probably NOT be eligible for fee-basis, but could try accessing non-VA therapy services through his TriCare. This would need to be approved by his Tri-West case manager. His command may have some influence on this decision.

(KLD)

[Timo]

Kathy,
I am very confused about his therapy. Currently my son gets 2 home PT/week. 2 OT as the outpatient at VA clinic. I don't know how long will it last.
My son just gets the PEB from Balboa, then what is going to happen next? When will he be in VA system? Can he go back to San Diego SCI for his annual check up?

Vutiny

[SCI-Nurse]

Once his PEB and line-of-duty are completely, they go to the Pentagon for processing. The typical time this takes for Navy or Marine Corps is 4-6 months. He will then get his DD214 (discharge papers) in the mail and must present these to the VA (can be done through his PVA NSO if he wishes, assuming he has already done the necessary paperwork with his NSO). Once this is done, he converts from active duty to veteran status with the VA. It takes about 3 months from then until he will start getting his VA pension. His military pay stops immediately. The VA pension will back-date to the date of the discharge, but it is important to plan for the lack of cash flow for those couple of months.

You need to talk to the VA OT about how long his therapy is ordered for, and if it is still medically justified. Unless he is making functional gains (not just getting maintenance exercises or ROM) it is likely it would not be continued. I am assuming the homecare PT is being paid for by TriWest, and his case manager there would be the one to ask about how long this will continue. It will of course stop once he is discharged from the military, unless he then signs up for and pays for Tricare Prime and they continue to authorize it.

SCI veterans can go to any of the 23 SCI Centers for their care and annual evaluations, but the VA is only obligated to pay for their travel to their local/designated VA, and of course the VA SCI Center in question would have to be willing to admit him. That would be Seattle for your son.

(KLD)

[Sue Pendleton]

Thanks Kathy. I just found a treasure trove of information about the VA´s Foreign Medical Program, which I never heard about before. http://www.va.gov/hac/forbeneficiaries/fmp/fmp.asp

Mike, have you found anymore on the medical assistance at home part? That is the sword the DOD has held over us for all overseas assignments. They require proof of care as in a family member always at home. Well my family member travels 3 to 5 days a week when overseas and doing what he was trained for and loves. Although at this point, and age, he would probably travel a lot less and we know which areas are most accessible. I would so love to see him retire from the street and not that damn desk.

[Mike C]

Sue, nothing more concrete as of now, however I can´t understand why the DOD would not allow a family to acquire care services from the local area. Only problem would be if the DOD civilian was living on post because of anti-terror access restrictions, but hardly any civilians with families live on post for any substantial length of time as far as I know. There are so many healthcare service providers here in Germany willing to be hired (not to mention the hoards of PCA´s available from eastern european countries). Me thinks the DOD just doesn´t want to deal with ramps and accessable bathrooms, be it at the workplace, at the PX, or finding accessable civilian housing.