May 27, 2011

Combat Veteran Eligibility: Enhanced Eligibility For VA Health Care Benefits

I know, I know. I'm a little late on breaking the news (2008, hello), I just found it and posted it. If anyone has any experience in filing for these benefits let me know in the comments.

Taken from the VA website:

On January 28, 2008, “Public Law 110-181” titled the “National Defense Authorization Act of 2008” was signed into law. Section 1707 amended Title 38, United States Code (U.S.C.), Section 1710(e)(3), extending the period of eligibility for health care for Veterans who served in a theater of combat operations after November 11, 1998, (commonly referred to as combat veterans or OEF/OIF Veterans or to the recently established Operation New Dawn Veterans).

Under the “Combat Veteran” authority, the Department of Veterans Affairs (VA) provides cost-free health care services and nursing home care for conditions possibly related to military service and enrollment in Priority Group 6, unless eligible for enrollment in a higher priority group to:
  • Combat Veterans who were discharged or released from active service on or after January 28, 2003, are now eligible to enroll in the VA health care system for 5 years from the date of discharge or release. NOTE: The 5-year enrollment period applicable to these veterans begins on the discharge or separation date of the service member from active duty military service, or in the case of multiple call-ups, the most recent discharge date. Combat Veterans, while not required to disclose their income information, may do so to determine their eligibility for a higher priority status, beneficiary travel benefits, and exemption of co-pays for care unrelated to their military service.
Who’s Eligible?

Veterans, including activated Reservists and members of the National Guard, are eligible if they served on active duty in a theater of combat operations after November 11, 1998, and have been discharged under other than dishonorable conditions. Documentation Used To Determine Service in Theater Of Combat Operations,
  • Military service documentation that reflects service in a combat theater, or
  • Receipt of combat service medals, and/or
  • Receipt of imminent danger or hostile fire pay or tax benefits. Page 2 of 3 Health Benefits Under The “Combat Veteran” Authority
  • Cost-free care and medications provided for conditions potentially related to combat service.
  • Enrollment in Priority Group 6 unless eligible for enrollment in a higher priority group.
  • Full access to VA’s Medical Benefits Package.
What Happens After The Enhanced Eligibility Period Expires?

Veterans who enroll with VA under this authority will continue to be enrolled even after their enhanced eligibility period ends. At the end of their enhanced eligibility period, Veterans enrolled in Priority Group 6 may be shifted to Priority Group 7 or 8, depending on their income level, and required to make applicable co-pays.

What about Combat Veterans Who Do Not Enroll During Their Enhanced Authority Period?

For those Veterans who do not enroll during their enhanced eligibility period, eligibility for enrollment and subsequent care is based on other factors such as: a compensable service-connected disability, VA pension status, catastrophic disability determination, or the Veteran’s financial circumstances. For this reason, combat Veterans are strongly encouraged to apply for enrollment within their enhanced eligibility period, even if no medical care is currently needed.


Veterans who qualify under this special eligibility are not subject to co-pays for conditions potentially related to their combat service. However, unless otherwise exempted, combat Veterans must either disclose their prior year gross household income OR decline to provide their financial information and agree to make applicable co-pays for care or services VA determines are clearly unrelated to their military service.

Note: While income disclosure by a recently discharged combat Veteran is not a requirement, this disclosure may provide additional benefits such as eligibility for travel reimbursement, cost-free medication and/or medical care for services unrelated to combat.

Dental Care:

Eligibility for VA dental benefits is based on very specific guidelines and differs significantly from eligibility requirements for medical care. Combat Veterans may be authorized dental treatment as reasonably necessary for the one-time correction of dental conditions if:
  • They served on active duty and were discharged or released from active duty under conditions other than dishonorable from a period of service not less than 90 days
  • The certificate of discharge or release does not bear a certification that the Veteran was provided, within the 90-day period immediately before the date of such discharge or release, a complete dental examination (including dental X-rays) and all appropriate dental service and treatment indicated by the examination to be needed
  • Application for VA dental treatment is made within 180 days of discharge or release under conditions other than dishonorable)
Additional information is available at the nearest VA medical facility. VA facilities listing and telephone numbers can be found on the internet at, or in the local telephone directory under the “U.S. Government” listings. Veterans can also visit the VA health eligibility website at or call VA toll free at 1-877-222-VETS (8387).


  1. Fact Sheet 16-8
    October 2008
    Other Than Honorable Discharges
    Impact on Eligibility for VA Health Care Benefits
    Benefit Description
    To be considered a “veteran” eligible for Department of Veterans Affairs (VA) Health Care benefits, a former service-member must have been discharged “under conditions other than dishonorable.” Under VA regulations, administrative discharges characterized by the armed services as “Honorable” or “General Under Honorable Conditions” are qualifying, and punitive discharges (“Dishonorable” or “Bad Conduct”) issued by general courts-martial are disqualifying.
    The in-between categories, administrative “Other than Honorable” discharges, and punitive “Bad Conduct Discharges” issued by special courts-martial, may or may not be disqualifying for purposes of general VA benefit eligibility or VA health benefits eligibility specifically. In assessing whether such discharges were issued “under conditions other than dishonorable,” VA must apply the standards set forth in Title 38 Code of Federal Regulations (C.F.R.) §3.12.
    “Other than Honorable” Discharges – Special Health Care Rule
    An individual with an “Other than Honorable” discharge that VA has determined to be disqualifying under application of title 38 C.F.R. §3.12 still retains eligibility for VA health care benefits for service-incurred or service-aggravated disabilities unless he or she is subject to one of the statutory bars to benefits set forth in Title 38 United States Code §5303(a). Authority: Section 2 of Public Law 95-126 (Oct. 8, 1977).
    VA Health Care Benefits: If an individual presents or makes an application for VA health care benefits and has an "other than honorable" or "bad conduct" discharge, eligibility staff may register the individual and place in a Pending Verification Status. A request for an administrative decision regarding the character of service for VA health care purposes must be made to the local VA Regional Office (VARO). This request may be submitted using a VA Form 7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action. In making determinations of health care eligibility the same criteria will be used as are now applicable to determinations of service connection when there is no character of discharge bar.
    Reference: M21-1 Part IV, Chapter 11 “Special Determinations and Administrative Decisions.”
    Page 1 of 2
    Note: Emergent treatment may be provided with a signed statement by the veteran (may be on a VA Form 119, Report of Contact) that if s/he is subsequently found to be NOT Eligible for VA Health Care, they agree to pay the Humanitarian Rate for any emergent care or services provided while under this Pending Verification status.
    For Further Information: Contact your local VA health care facility’s Eligibility office or the Health Eligibility Center at 404-828-5257. This and other eligibility related fact sheets are available at
    Authorities:Title 38, United States Code, §5303(a); Pub. L. No. 95-126,§2; and Title 38, Code of Federal Regulations, §§3.12.

  2. I'm trying to assist a Vet with VA Benefits. Need to locate a 7131. Haven't been able to find one online. Do you know a link to one? I'd really appreciate some assistance. Thanks.

    1. I have used all the Google search tricks I know I look for this elusive paperwork. You will find Google searches where other people are looking for it also. The thing with the VA is that they are supposed to give us this paperwork when we ask for it. But, we are still fighting the old guard at the VA who as a matter of practice would deny veterans the paperwork exists or give you the run around until you give up. Keep asking different people at your local Veterans Administration Local Regional Office. Eventually you will find someone willing to give you the help you need and I hope this helped.


Please share your comments, stories and information. Thank you. ~ Scott Lee