VA STARS AND STRIPES HEALTHCARE NETWORK

HISTORY OF U.S. ARMED FORCES HEALTH CARE

A BRIEF HISTORY OF THE DEVELOPMENT OF MILITARY HEALTH CARE IN THE UNITED STATES
By Colonel James Bond Johnson, US Army-Ret
Table of Contents

1. Congress Has Provided Health Care for Military Service Members From the Earliest Years of Our Nation's History.

2. In 1799, Congress Took Formal Steps to Regulate the Military Medical Establishment; Health Care for Retired Personnel and Dependents Was Provided When They Were Authorized.

3. Congress Over the Years Statutorily Implemented and Reinforced Its Delegated Support for the Medical Establishment of the Military Services, and Which Provided Health Care both for Serving Members and Retirees.

4. In 1956, Congress Enacted a Military Dependents Medical Care Act Which Further Clarified No Patient Cost Care for Retired Military Personnel and Their Families.

5. In 1959, Congress Appropriated Funds to Construct and Operate General Hospitals and Related Facilities, Diagnostic and Treatment Centers, Hospitals for the Chronically Ill and Impaired, and for Nursing Homes for Military Retirees and Dependents.

6. In 1966, Congress Created the CHAMPUS Program to Mirror Care for Military Retirees and Dependents With FEHBP, as Provided to Civilian Employees, But at a Much Lower Cost to the Military Related Beneficiaries.

7. Acting In Total Disregard of the Will of Congress, the DOD's CHAMPUS Plan As Designed and Implemented Was Inferior to the FEHBP, Yet Was Provided At a Much Greater Cost to the Taxpayers.

8. The DOD's CHAMPUS Plan Regulation Also Was Invalidated By the United States Court of Appeals for the District of Columbia.

9. Congress' Intentions Re Military Retiree and Dependent Health Care Options Were Greatly Compromised Due to BRAC Base and Hospital Closures.

10. The United States Supreme Court Has Upheld That the US Government Must Honor Its Contractual Commitments to Its Employees and Others.

11. The Obligation to Provide Health Care to Retired Members of the Military Services Has Been Recognized By Congress in the Past.

12. Enactment of HR 2966 Will Cure, at Least In Part, the Unintended Extant Lack of Health Care Parity Between Military Retirees and Federal Civilian Employees.
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1. Congress Has Provided Health Care for Military Service Members From the Earliest Years of Our Nation's History. Since the earliest years of the United States our founding fathers showed a concern for those who served their country in its military forces, and for their families. The Army Medical Department and the Medical Corps trace their origins to July 27, 1775, when the Continental Congress established Army hospitals headed by a Director General and Chief Physician. During the War for Independence, due to a lack of permanent hospital facilities, Army battle wounded and sick often were cared for in churches of various denominations.

In 1777, Army hospitals existed in several locations in churches and barns, including at Yorktown, PA, Black River, NJ and Mendham, NJ. General George Washington often visited patients in these facilities and, in an effort to increase professionalism, urged the replacement of male nurses by women! In November of 1777 famed Dr. Benjamin Rush was assigned the task of opening a military hospital at Red Bank, NJ, to care for the wounded of the Delaware River forts. Military troops and on occasion their families were cared for in these treatment facilities.

2. In 1799, Congress Took Formal Steps to Regulate the Military Medical Establishment; Health Care for Retired Personnel and Dependents Properly Was Provided When They Were Authorized

On March 2, 1799, the Fifth Congress formally established a military medical department by enactment of an Act to Regulate the Medical Establishment (Session III, Chapter 27). By such statutory action Congress conferred full authority and charged the Surgeon General with superintendence and development of all military hospitals and other treatment facilities and directed that necessary orders, regulations and manuals be issued in support thereof.

The Surgeon General was SPECIFICALLY DELEGATED to determine who would be eligible for care in military hospitals and other treatment facilities.

In February 1855, it was authorized for the first time for Navy officers to be removed involuntarily from the active list and for other reasons, and in August 1861 the officers of all military services first were offered voluntary retirement after 40 years of service. In March of 1899, Navy enlisted personnel were authorized retirement after 30 years of active service.

Military retirement pay is not a pension, therefore a comparison cannot be made between it and a civilian pension. Military retirement is an earned entitlement for honorable service rendered, as well as retainer pay for future recall to active duty service. The military retirement system serves the objective of ensuring military readiness by providing retainer pay in the event of mobilization.

An 1881 Supreme Court Decision (US v. Tyler) established the basis for the claim that military retirement pay is reduced compensation for reduced services. The court took note of the fact that those on the retired list were in all aspects still performing "service," albeit retired service. Thus retired military servicemen and women represent a wealth of experience vital to military readiness. Retirees are reasonably available to relieve active duty forces to be reassigned to combat-related elements or service support units.

In 1884, Congress directed that the "medical officers of the Army and contract surgeons shall whenever possible attend the families of the officers and soldiers free of charge."

In 1900, a total of 3,029 former military personnel were receiving retired pay; most of these were wounded or injured in the Spanish-American War. There is no record that any policy or regulation barred care for injured or ill retired personnel and their dependents and several policy regulations issued by the various uniformed services specifically directed that retirees were to be provided equal health care with serving members. Several Presidents of the United States, including Roosevelt and Truman, also endorsed this policy over the years. This Congressional military health care edict remained essentially unchanged until 1956.

3. Congress Over the Years Statutorily Implemented and Reinforced Its Delegated Support for the Medical Establishment of the Military Services, and Which Provided Health Care both for Serving Members and Retirees. There seems to be some disagreement persisting as to whether or not the promise of no cost ("free"), lifetime health care properly was made to military retirees. A survey of the written record proves conclusively that service members consistently were indeed promised no cost ("free"), lifetime health care in return for the hardships and comparatively low pay of a military career. The promise was made, in writing, well into this decade. Included below are samples of government documents (recruiting and retention literature from all service branches as well as rules and regulations) developed at the highest levels that promised retirement benefits:

The Navy Bureau of Medicine and Surgery was established by the Act of August 31, 1842 (Section 419, Revised Statutes). Thereafter, all regulations pertaining to medical matters came to be published in the Manual of the Medical Department of the Navy customarily referred to as the "Medman."

In responding to this delegated responsibility to operate heath care services, the military services issued necessary directives that included rules as to care for retirees and their dependents. As an example, the Navy Medical Manual, Para. 4132.2 stated "Retired enlisted personnel of the Navy and Marine Corps not admitted as beneficiaries of the Veteran's Administration SHALL in need of hospital care, be admitted to any naval hospital on the application of the individual."

Other service directives included the old Hospital Fund, Public Law 51, 4 Stat. 570, Sect. 4810, Revised Statutes, and the Army Organization Act of 1950. All conferred the authority to provide for retiree medical care.

Authority over the old Hospital Fund as well as over construction and operations of Hospitals was granted to the Secretary of the Navy by the Act of 1832, 4 Stat 570, Chapters 189 and 190. The 1832 Act was reaffirmed in 1862 (Section 1547, Revised Statutes) and again in 1913 (Section 4810, Revised Statutes).

Army Circular 310 dated October 6, 1945, DIRECTED "recruiting officers" at all levels of command to conduct "intensive recruiting efforts" ... and stipulated that all advertising material would originate within the Adjutant General's Office. It was signed by General George C. Marshall, Chief of Staff. These would include enlistment contract promises of "lifetime health care." There was NEVER any known directive which stated that recruiters were NOT to promise "lifetime health care" as an inducement for enlistment and to ignificantly supplement the low pay (and other hardships) offered to military enlistees

*Air Force Guide For Retirement, AFP 35-~1, 1 April 1962: "Eligible retired members will be furnished required medical and dental care and adjuncts thereto to the same extent as provided for active duty members in any medical facility of the Uniformed Services."

*Your Son's Future, Department of the Army, 1962: "He retires -- while still a young man -- equipped to start a second career. He has retirement pay, benefits and medical care."

*The Blue Jackets Manual, 1969, page 257: "What Navy Retirement means to you --- pay. Continued medical care for you and your dependents in government facilities." *The Blue Jacket Manual 19th Edition, 1973: "Free medical and dental care is provided to all active duty and retired personnel, and to dependent wives and children (with some exceptions)."

*Navy Guide for Retired Personnel and Their Families, page 51: Covered under the Uniformed Services Health Benefits Program (USHBP) are retired members, dependents of retired members and survivors of deceased active duty or retired members. This care is available anywhere in the world either in a uniformed services medical facility (meaning Army, Navy, Air Force and certain Public Health Service facilities) and under the part of the USHBP called CHAMPUS." (NAVPERS 15891D, November 1974.)

*Guide for Educators and Advisors of Student Marines, page 35: "Retired Marines are generally eligible to receive any type of health and dental care at those facilities provided for active duty personnel."

*Pre-Retirement Counseling Guide, Air Force Publication (AFP) 211-12, 1 April 1986: "One very important point, you never lose your eligibility for treatment in military hospitals and clinics."

*United States Coast Guard Career Information Guide, GPO 1991: "Retirement benefits mean more than pay too. You continue to receive free medical care and dental treatment for yourself plus medical care for dependents."

*Army Recruiting Brochure, "Army Benefits": "Superb Health Care. Health care is provided to you and your family members, while you are in the Army, and for the rest of your life if you serve a minimurn of 20 years of active federal service to earn your retirement." (RPI 909,

November 1991, USGPO, 1992, 643-711).

*RETIREMENT: Handbook for Military Families, 1 April 1996:

1) "And for the time being, the government stlll adheres to the promises it has made to retirees: They are eligible for free health care at military medical centers, although retirees may find it harder to use hospitals without paying to enroll in TRICARE, the military's new managed care plan."

2) "Almost as important as the retirement check is medical care. Military hospitals and clinics are open to retirees."

3) "Monthly retirement pay, medical care for life, and access to exchanges and commissaries are the major benefits of military retirement. *Figuring Your Future, Department of the Navy NRAF-26502: "As a Navy man, you ... receive free medical and dental care now and after retirement," *Navy Career Appraisal Team Representation Guide, Department of the Navy, NAVPERS 15897-A: "Just think when you do retire or go into the Fleet Reserve, you retain almost all of the benefits you enjoyed while on active duty, includ ing hospitalization for you and your dependents for life." Below are some additional government documents that further prove that the promise was made: *AFP 35-1-1 1962
*AFP 211-1-12 1967 ~972
*APP 211-12 1986
*AFP 3~4-3 1957
*Air Officers Guide, 1957
*AFP 160-73 1951
*AFP 39-19
*Department of the Army Field Manual 21-13

4. In 1956, Congress Enacted a Military Dependents Medical Care Act Which Further Clarified No Patient Cost Care for Retired Military Personnel and Their Families. The 1966 amendments to this act created what would be called CHAMPUS beginning in 1967. The law authorized ambulatory and psychiatric care for active-duty family members, effective Oct. 1, 1966. Retirees, their family members, and certain surviving family members of deceased military sponsors were brought into the program on Jan. 1, 1967.

The Korean conflict again strained the capabilities of the military health care system. On Dec. 7, 1956, Congress formally mandated eligibility for no patient cost hospital and other health care for this class and for all other military retirees and dependents by its enactment of Public Law 569, the Depen dents' Medical Care Act (37 USC, Chapter 7). The US Supreme Court took note that "The medical benefits legislation, 10 USC 1071, et seq., was enacted as the Dependents' Medical Care Act of 1956. As such it was designed to revise and make uniform the existing law relating to medical services for military personnel."
(emphasis added) Frontiero v. Richardson, 411 US 677 (1973) at F. N. 6.

5. In 1959, Congress Appropriated Funds to Construct and Operate General Hospitals and Related Facilities, Diagnostic and Treatment Centers, Hospitals for the Chronically Ill and Impaired, and for Nursing Homes for Military Retirees and Dependents.
On August 14, 1959, Congress went even further to insure availability of health benefits for all military retirees and their dependents by funding construction and operation of new general hospitals and related facilities, diagnostic and treatment centers, hospitals for the chronically ill and impaired, and for nursing homes for retirees and dependents, through the enactment of Public Law 86-158 -- all of which care was made available without any cost to the patients. This legislation expressly appropriated funds to provide medical care of various types and levels for military dependents and retired personnel under the Dependents' Medical Care Act of 1956.

6. In 1966, Congress Created the CHAMPUS Program to Mirror Care for Military Retirees and Dependents With FEHBP, as Provided to Civilian Employees, But at a Much Lower Cost to the Military Related Beneficiaries.

Effective October 1, 1966, Congress further enlarged health care options available to military retirees and dependents by enacting the Military Medical Benefits Act of 1966, known as "CHAMPUS." Congress mandated and authorized that the Department of Defense develop and supervise what has been described as a "Parity Plus" plan, in that the CHAMPUS was to mirror a specific existing FEHBP plan available to federal civilian employees, but offer it at a much lower cost to the military related beneficiaries.

Congress went to great pains to state its intentions in this regard: "The types of care in this (CHAMPUS) legislation for the various (military) beneficiaries are IDENTICAL to those authorized under the high option Blue Cross-Blue Shield plan that is available to Federal civilian employees (under the FEHBP)"; See Senate Report No. 1434, page 6. (1966), referenced at Title 10 US Code, Section 1086, Historical and Statutory Notes.

Congress also promised that "the benefits would be the same as the high-option (FEHBP) civilian program covering the larger number of federal employees as existed on July 1, 1966, with the provision that the benefits could change in the event there are other changes in the civilian program." See Senate Report No. 1434, p. 9 (1966). In this legislation Congress further provided "the DOD the flexibility to improve benefits in the future as health benefits expanded for other Government personnel and, at the same time, provid es a floor on (CHAMPUS) benefits so that they could not be reduced in the future by arbitrary administrative directive." (emphasis added) See Congressional Report, 03/31/66 and 54 FR 20386, 5/11/89.

The CHAMPUS budget for Fiscal Year 1967 was $106 million. Records don't indicate how many claims were filed in FY 1967, but the total probably wasn't more than a few thousand. In FY 1996, the TRICARE/CHAMPUS budget was more than $3.5 billion, and more than 20 million claims were received. Today, nearly 5.5 million people are eligible for TRICARE benefits.

7. Acting In Total Disregard of the Will of Congress, the DOD's CHAMPUS Plan As Designed and Implemented Was Inferior to the FEHBP, Yet Was Provided At a Much Greater Cost to the Taxpayers.

Unfortunately, contrary to the carefully expressed will of Congress, the DOD developed an extremely anomalous and complicated CHAMPUS plan which in no way mirrored the mandated FEHBP plan and which was provided at much greater cost to the taxpayers than the Congressionally intended plan. Further, CHAMPUS was anomalous to every other federally funded health care plan in its administration. In virtually every year of operation CHAMPUS' capricious administrative operations elevated costs to far exceed its anticipated budgets and which compelled the DOD to annually have to request massive "bail out" supplements at the end of the fiscal years to fund the program's extremely wasteful and excessive costs when compared to its counterpart FEHBP plan!

This has resulted in the DOD in recent years greatly curtailing payments to contracted hospitals and providers of health care to the degree that the program is unacceptable to most providers and thus is in serious jeopardy of complete implosion. Increasingly, hospitals and health care providers have refused to treat military families under CHAMPUS coverage.

8. The DOD's CHAMPUS Plan Regulation Also Was Invalidated By the United States Court of Appeals for the District of Columbia.

"On May 15, 1987, the United States Court of Appeals for the District of Columbia Circuit (in the case of) Barnett v. Weinberger, 818 F. 2d 953 (DC Cir. 1987) in reversing a district court decision, held the CHAMPUS regulation INVALID... In reaching the foregoing conclusion, the Court relied heavily upon an analysis of the relevant legislative history." 54 FR 20387, 5/11/89. The response of the DOD was to write new regulations that were even more complicated and confounding and hence increasingly unacceptable to both providers and beneficiaries.

9. Congress' Intentions Re Military Retiree and Dependent Health Care Options Were Greatly Compromised Due to BRAC Base and Hospital Closures.

In enacting the CHAMPUS plan in 1966, Congress clearly intended that health care benefits for military retirees and dependents were to continue throughout life at a comparable level with federal civilian employees -- whose FEHBP health plans all included lifetime care. For military retirees and dependents, health care reasonably was anticipated by Congress at that time to be adequately provided after beneficiaries reached age 65 by reliance in part on the brand new Medicare Program of 1965 to supplement readily available military treatment opportunities. However, Congress at that time could not have and did not anticipate the abrupt end of the Cold War with the resulting wide spread base and military hospital closures of recent years.

10. The United States Supreme Court Has Upheld That the US Government Must Honor Its Contractual Commitments to Its Employees and Others.

The US Supreme Court upheld in United States v. Winstar Corp. et al., 518 US 839 (1996) that the government in acting as an employer must honor its contractual commitments to its employees and others. The Court stated that where "the documents found that the realities of the transaction favored reading those documents as contractual commitments, not mere statements of policy, see Restatement (Second) of Contracts §202(1) (1981) ("Words and other conduct are interpreted in the light of all the circumstances, and if the principal purpose of the parties is ascertainable it is given great weight"), and we see no reason to disagree."

11. The Obligation to Provide Health Care to Retired Members of the Military Services Has Been Recognized By Congress in the Past.

The serious problems of uniformed services health care is NOT a new issue before the Congress. In October and November, 1974, following extensive hearings before the House Armed Services Committee on the problems of CHAMPUS and Military Health Care (HASC No. 93-70, 93rd Congress) it was concluded that "... the government has a clear moral obligation to provide medical care to retired personnel and their dependents... this Committee has found numerous examples of recruitment and retention literature which pledged ... medicare care for the man and his family following retirement."

12. Enactment of HR 2966 Will Cure, at Least In Part, the Unintended Extant Lack of Health Care Parity Between Military Retirees and Federal Civilian Employees. In conclusion, it is clear that the INTENTION of Congress from its earliest years always has been to provide adequate health care benefits for serving military members, military retirees and their families on at least a par with federal civilian employees and their families. Congress has been consistent in enacting legislation in support of its intentions. However, recent base and military hospital closures has created a serious lack of health care options and military facility medical care is virtually nonexistent for most military retirees and their families.

For instance, at the time of enactment of the Military Medical Benefits Act of 1966 (CHAMPUS) and until recent years there was the excellent Long Beach Naval Hospital as well as the El Toro USMCAS Dispensary readily available to treat ill and injured military retirees and dependents residing within the 38th and 39th Congressional Districts. Today there is NO such military treatment facility available within or within a reasonable commuting distance of the 38th or 39th District! Further, the DOD's flawed design and administration of the CHAMPUS and TRICARE plans have NOT been an adequate answer even for those retirees and families eligible for such care.

Of a certainty, at least until June of 1956, the military services ("the employer"), directed and delegated by Congress on behalf of the US Government ("the company"), to enter into formal and legal enlistment contracts for various terms of military service ("employment") with many of its citizens ("the employees") and with FULL AUTHORITY PROMISING as a very meaningful and valuable part of that enlistment contract "lifetime health care" TO ALL CONTRACTEES who fulfilled their part of the enlistment contract, incurred a legal and moral obligation to fulfill such contracts by providing "lifetime health care" to the promised employees and their dependents.

Continued lack of addressing the drastic loss of retiree health care benefits for retired uniformed services retirees will produce grave consequences. This will involve pain, suffering, mental anguish, and financial hardship for those retired American military veterans who put their lives in jeopardy for the preservation of freedom throughout the world. The tragedy centers on a broken promise.

Passage of HR 2966 will restore a meaningful health benefit option and cure that inequity for at least the covered class of retirees and their families, which includes nearly all of the members of our TROA chapter, and at least in part to fulfill "in honor, conscience and law" (see definition of "promise" in Black's Law Dictionary) the US government contracts entered into in good faith by all parties.

In order to honor the legal contractual promises made to career military personnel for their subsequent service to our nation over long periods of time and who endured hardships, family separations, and, for many, actual combat and war, and in so doing fulfilled in good faith their part of the contract, Congress is duty and honor bound to restore the level of health care formerly provided to military retirees and their families. This can fairly and best be achieved by the enactment of HR 2966 by the 106th Congress!

Respectfully submitted,
James Bond Johnson
Colonel, US Army-Ret.

President
Los Alamitos Area Chapter
The Retired Officers Association

Post Office Box 665
Los Alamitos, CA 90720
Phone: (562) 426-3622 - Fax: (562) 427-3931 email: JBONJO@aol.com
* -- Sincere appreciation is expressed to COL Robert Geasland, USAF-Ret., LTC Richard Manion, USA-Ret. and MSgt Floyd Sears, USAF-Ret. for providing much valuable research information included in this history.
DATED: December 7, 1999 (The 58th anniversary of the Japanese Attack upon Pearl Harbor.)

Obtaining Unit Records: Marines
Unit diaries, which include rosters, through 1966 are located at the Marine Corps Historical Center. The records are arranged by month and year, and list the officers and enlisted men within a unit at the company level or the battalion/squadron level. These documents may be examined in person or may be requested in writing, one month and year per letter. As soon as one request is received, another may be submitted. Specify exact unit information and state that the request is being made under the Freedom of Information Act. Send or fax written requests to the Marine Corps Historical Center, Reference Section, Building 58, Washington Navy Yard, Washington, DC 20374-0580, 202-433-3483, Fax: 202-433-4691.

Unit diaries and rosters from 1967 forward are available by written request only. The procedure above applies. Send requests to CMC HQ Marine Corps, Records Service Section, Code MMSB-10, "Unit Diaries", HQ, U.S. Marine Corps, 2008 Elliot Road, Suite 201, Quantico VA 22134-5030. 703-640-3934,3935,3939,3940.

Marine Corps operations reports, including plans, command diaries, command chronologies, and after action reports from 1964 are located at the Marine Corps Historical Center, Archives Section, Building 58, Washington Navy Yard, Washington, DC 20374, 201-433-3439. Call in advance and speak with the archivist about your request.

Marine Corps reports through 1963 are located at the Textual Reference Branch, National Archives II, 8601 Adelphi Road, College Park, MD 20740-6001, 301-713-7250, Fax: 301-713-7482. Again, call and speak with an archivist before sending a request or visiting.

Obtaining Military Records: Marines
Complete military and medical records, including DD-214s, can be obtained by veterans or their next of kin, if the veteran has died. Non relatives may also request this information, but what they will receive will be limited and will not include date of birth, official photo, records of court martial for active duty personnel, medical information, social security number, or present address. State that the request is being made under the Freedom of Information Act for all releasable data.

Requests for military records must be made on a government form, SF 180. This form is available on the Internet at : http://www.va.gov/forms/index.htm Scroll to the bottom of the page, as the SF 180: Request Pertaining to Military Records is the last one listed. You may also call 314-538-4243 and leave a message to have a form sent to you.

You cannot request an entire file, each document must be named and only those named specifically will be provided. Names of documents include unit orders, awards and commendations, efficiency reports and ratings, promotion orders, records of court martial or other disciplinary actions, assignment and reassignment orders, photographs, qualification records, and report of separation (DD-214).

When requesting medical records a statement should be included that they are needed by a current physician. If information is being requested regarding a specific injury or illness, that should be specified. If records regarding hospitalizations are needed, provide the dates that the hospitalization occurred and the name of the hospital. Provide as much information as possible about the person whose records are being requested. This might include name, service number, social security number, service dates, date of birth, and branch of service, as well as any other piece of known pertinent information.

Send the SF 180 to the National Personnel Records Center, 9700 Page Blvd., St. Louis, MO 63132-5100. Expect a significant waiting period before receiving the information. Requests citing VA claims and medical emergencies receive priority.

Obtaining and Replacing Medals: Marines
Form DD-214 and/or the awards and commendations document from the veteran's military records will list awards, commendations, and accompanying medals earned. Medals can be replaced by sending a copy of these documents and an accompanying request to National Personnel Records Center (Military Personnel Records), 9700 Page Blvd., St. Louis, MO 63132-5200.

BULLETIN

From: shirljo@texhoma.net (Shirley Watkins) Date: Sun, Apr 2, 2000, 7:12pm (EDT-1) To: kwvets@onelist.com Subject: [kwvets] Purple Hearts May Rate VA Upgrades Reply to: kwvets@onelist.com From: Armed Forces News Purple Hearts May Rate VA Upgrades The Veterans Millennium Health Care and Benefits Act has placed veterans awarded a Purple Heart in enrollment priority group 3 for VA medical care. The new law also exempts them from co-payments associated with VA care. The VA has directed its field stations to move qualified veterans previously in priority groups 4 through 7 to group 3 and to omit co-payment requirements. The agency also has ordered that such veterans be reimbursed for any co-payments paid on or after November 30, 1999. Eligible veterans may submit documentation, such as DD-214s, service records, orders of award, or the certificate, for inclusion in their VA health records.

LATEST PURPLE HEART/MEDICAL CARE

CHANGE IN THE ELIGIBILITY FOR CARE OF VETERANS AWARDED THE PURPLE HEART Department of Veteran Affairs Veterans Health Administration Washington, DC 20420 VHA DIRECTIVE 2000-006 February 29, 2000
CHANGE IN THE ELIGIBILITY FOR CARE OF VETERANS AWARDED THE PURPLE HEART

1. PURPOSE: This Veterans Health Administration (VHA) directive implements new eligibility and enrollment requirements for veterans awarded the Purple Heart.

2. POLICY: Public Law 106-117, the Veterans Millennium Health Care and Benefits Act, which amended the law to place veterans awarded the Purple Heart in enrollment priority group 3, and to exempt those veterans from co-payment requirements associated with provision of hospital care and outpatient medical services.

3. ACTION     a. Veterans awarded the Purple Heart may submit appropriate documentation (i.e., DD 214, service records, orders of award, certificate, etc.) for inclusion into the veteran's Consolidated Health Record (CHR) folder. Field stations are also to fax these documents to the Health Eligibility Center at (404) 235-1355.     b. As an interim measure, the Health Eligibility Center will provide each Department of Veterans Affairs (VA) health care facility with a partial listing of Purple Heart recipients to assist facilities in manually exempting these veterans from co-payment requirement associated with hospital care and outpatient medical services. The Office of Information (19) will develop software to capture data on veterans awarded a Purple Heart and effect other changes in the VHA information systems necessary to accommodate provisions to Public Law 106-117 relating to Purple Heart Award recipients.     c. Field stations must ensure that those veterans awarded a Purple Heart who were previously, or would be, classified in enrollment priority groups 4 through 7 are placed in enrollment priority group 3 and not charged co-payments.     d. Manual tracking is necessitated until Veterans Health Information Systems and Technology Architecture (VistA) software modifications are implemented to ensure these veterans are not inappropriately billed medical care co-payment charges.     e. Veterans awarded the Purple Heart are to be reimbursed for any medical care co-payments paid for VHA care provided on or after November 30, 1999.     f. VHA officials must have verifiable evidence that veterans received the Purple Heart before reimbursing any co-payments or changing veterans' enrollment status.

4. REFERENCE: Public Law 106-117, dated November 30, 1999.

5. FOLLOW-UP RESPONSIBILITY: Health Administration Services (10C3) is responsible for the content of this directive.

6. RESCISSION: This VHA Directive will expire March 1, 2005.
S/ by Frances Murphy, M.D. for Thomas L. Garthwaite, M.D. Deputy Under Secretary for Health