From the Expert: Basic Veterans Health Administration (VHA) eligibility entails individuals who served in the active military, or qualified Reserve or National Guard members, who were discharged or released under conditions other than dishonorable. Typical minimum service requirements are 24 continuous months or the full period for which they were called to active duty.

Once eligibility has been established, the VA assigns the veteran one of eight VA Health Care Priority Groups (PGs).  

When asked about a VHA denial, my first question is always, “Do you have a VA disability compensation rating?” Almost universally, the answer is “No.”

VHA prioritizes priority groups for veterans with service-connected disabilities. When the veteran has no VA rating, the VA determines group assignment by special circumstance (for example: Medal of Honor recipient, Purple Heart recipient, or former prisoner of war) or by income. For veterans with no rating or special circumstance, then gross household income must be below VA income limits. Most officer retirees exceed this income threshold and are placed in PG8, the lowest priority group. Shortly after Sept. 11, 2001, in an effort to prioritize limited care resources, VHA stopped providing care to veterans assigned PG8. 

The bottom line: These retirees are enrolled in VHA, but they are assigned PG8 and therefore will not be afforded access to VHA.

[RELATED: VHA Income Limits]

Let’s examine the criteria for each VHA Priority Group:

Priority Group 1

• Veterans with VA-rated service-connected disabilities 50% or more disabling
• Veterans determined by the VA to be unemployable due to service-connected conditions
  
  

Priority Group 2

• Veterans with VA-rated service-connected disabilities 30% or 40% disabling
  
  

Priority Group 3

• Veterans with VA-rated service-connected disabilities 10% or 20% disabling
• Veterans who are former prisoners of war or have been awarded the Medal of Honor or Purple Heart
  
  

Priority Group 4

• Veterans in receipt of aid and attendance or housebound benefits
  
  

Priority Group 5

• Veterans with no rating or a non-compensable 0% rating who fall below income threshold
  
  

Priority Group 6

• Veterans with VA-rated service-connected disabilities 0% disabling
• Veterans exposed to ionizing radiation
• Veterans who served in Vietnam between Jan. 9, 1962, and May 7, 1975
• Veterans who served on active duty at Camp Lejeune, N.C., between Aug. 1, 1953, and Dec. 31, 1987  
• Veterans of the Persian Gulf War who served between Aug. 2, 1990 and Nov. 11, 1998
• Veterans who served in a theater of combat operations after Nov. 11, 1998, and those discharged from active duty on or after Jan. 28, 2003, are eligible for enhanced benefits for 5 years post-discharge.
  
  

Priority Group 7

• Veterans with gross household income below the geographically-adjusted income limits
  
  

Priority Group 8

• Veterans with gross household income above the VA geographically-adjusted income limits

Treatment for service-connected conditions, and treatment for those assigned to PG1, come at no cost to the veteran. In most cases, those in PGs 2-7 incur a copay for nonservice-connected care.