The U.S. Department of Veterans Affairs (V.A.) is the current American embodiment of an ancient social pact, one that has existed in many forms since antiquity, between a society and those who go to war on its behalf. The agreement is that in return for the soldier risking his (or her) life, society will care for an injured soldier, and sometimes his dependent family members, until death. In the era of Greek city-states and even the Plymouth Colony, the average life expectancy for humans was four decades or less, and the number of individuals affected numbered at most in the hundreds. Now, as expectancy is more than eight decades and military service engages millions of individuals whose ages cover the full adult lifespan, the promise of lifetime care for former warriors has become an enormous, costly, complex, and mostly elderly-focused health and support services enterprise.
According to the 2012 United States Census brief, more than 12.4 million veterans age 65 or older. This elderly veteran population served in conflicts such as World War II, the Korean War, the Vietnam War, and the Persian Gulf War. Issues affect all veterans as they battle the V.A. for the benefits they deserve, but today, we will look at some of the problems that are commonly faced by elderly veterans in particular.
Lack of Evidence
To obtain V.A. disability benefits, a veteran must have medical proof showing they have a current disability, medical or lay evidence showing the disability began or was aggravated in service, and medical evidence of a link, or nexus, between their current disability and the in-service event. Additionally, to show the severity of their disability, the veteran will need evidence such as V.A. treatment records, private medical records, and/or statements from family and friends describing how the veteran’s disability affects them.
One problem that many elderly veterans may run in to is locating and obtaining their service records. Getting service records for elderly veterans can be especially difficult due to a fire at the National Personnel Records Center (NPRC) in 1973 that destroyed millions of official military service records. The VA is required to assist veterans in obtaining their service records, but a veteran needs to make sure the V.A. has notified all potential locations of service records. The following is a list of organizations that may have service records:
• The NPRC
• The United States Army and Joint Services Records Research Center (JSRRC): The JSRRC works to find military records supporting veterans’ inquiries related to PTSD and Agent Orange VA disability claims.
• The National Archives and Record Administration (NARA): This is the official location where records for military personnel discharged from the Navy, Army, Marine Corps, and Coast Guard are stored.
• The Naval Historical Center: This is the official center for historical information related to
Navy military records and includes information such as deck logs and ship histories, which can help Agent Orange claims.
A veteran does not have to rely solely on service records for evidence of an in-service event; they can also use lay evidence such as buddy statements. However, elderly veterans may find it challenging to obtain this kind of evidence as well. For example, elderly veterans’ fellow service members might no longer be alive or suffer from memory loss.
The process involved with getting V.A. disability benefits often requires a veteran to go to V.A. offices and medical centers. Many times, these visits are mandatory, such as appearing at Compensation and Pension Exams (C&P exams). If a veteran does not show up for a C&P exam, the V.A. can reduce or even take away their benefits. Even worse is the fact that the V.A. doesn’t provide transportation to their facilities. However, some regulations allow for veterans to get a transportation allowance or a reimbursement for transportation costs. For example, 38. C.F.R. § 21.154 that states, “a veteran who because of the effects of disability has transportation expenses in addition to those incurred by persons not so disabled, shall be provided a transportation allowance to defray such additional expenses.”
The Slow Process
Perhaps one of the most severe issues facing the elderly veteran population is the length of time it takes the V.A. to complete the disability claim appeal process. Some Regional Offices are so backlogged that they’re up to 2 years behind on deciding veterans’ appeals. The Board of Veterans Appeals (B.V.A.) is even more backlogged. Appeals at the B.V.A. are taking up to 3 years to get decided. The problem is, elderly veterans, don’t always have time on their side. A study cited in a research article discussing issues facing the elderly veteran population stated: “approximately 3,000 veterans die each year with their disability compensation claims still mired in some stage of the agency’s adjudication process.”
Claims can be expedited due to advanced, but the V.A.’s regulations state that veterans must be 85 years or older for their claim to receive priority processing. If a veteran is under 85 years old, their claim can still be expedited due to other factors such as financial hardship or being terminally ill.
Unfortunately, many elderly veterans might not generalize the extent of V.A. benefits they are entitled to, or they might be completely unaware of benefits they may be eligible for. Elderly veterans may be entitled to receive additional compensation on top of any service-connected compensation they’re already receiving. Also, elderly veterans may be entitled to different health care programs tailored to their needs. The following is a list of some common benefits and health care programs that elderly veterans may be entitled to:
• Aid and Attendance: available for veterans who require help with performing daily functions, are bedridden, a patient in a nursing home, or are blind.
• Housebound: available for veterans that are confined to their home because of a permanent disability
• Adult Day Health Care: this is a day program that provides recreation, companionship, and health care services such as care from nurses, therapists, social workers, etc.
• Home Based Primary Care: this program is for veterans with complex health care needs that are not being met by routine clinic-based care. A VA doctor will supervise a team that provides health care in the veteran’s home.
• Homemaker and Home Health Aide: available for veterans who need assistance with activities of daily living.
• Palliative Care: this involves helping veterans (and their families) manage their illness with a plan of care that focuses on the relief of suffering and control of symptoms.
• Hospice Care: available for veterans who have terminal conditions with less than six months to live.
• Skilled Home Health Care: this is a short-term service for veterans that are homebound or live far away from the V.A. Care is provided by a local community-based health agency that contracts with the V.A.
• Respite Care: This service offers a person to come to a veteran’s home while the veteran’s primary caregiver takes a break.
• Telehealth: allows a veteran’s doctor or nurse to monitor the veteran’s condition remotely using home monitoring equipment.
• Veteran Directed Care: available for veterans in need of skilled services, case management, or assistance with daily living activities. This program allows a veteran to customize a health care plan that best meets their needs.
It should be apparent from the preceding comments that V.A. is a very large, complex, and continuously evolving enterprise. Veterans Affairs’ commitment to serving those who were willing to put their lives at risk for their countrymen has never wavered, but the challenges of a large governmental organization that has to be responsive to changing demography, shifting societal priorities, political forces, and technological improvements are numerous, complex, elusive and daunting. Nevertheless, VA has made an enormous, positive mark on the health and health care of all older Americans through its decades of effort on behalf of aging veterans and undoubtedly will continue to do so for decades to come.
Linscott, A. (2016). Common Issues Facing the Elderly Veteran Population. Hill & Ponton Disability Attorneys. Retrieved from https://www.hillandponton.com/common-issues-facing-elderly-veteran-population/
Image provided by Adomaitis, M. (2016). How Veterans Can Get Senior Housing and Care Help. After55.com. Retrieved from https://www.after55.com/blog/veterans-senior-housing-senior-care/