This post is a follow-up to July post, HCV infection and veterans’ oral health. Can we decipher this VA-speak together?
Class III and VI are of interest to us at ASKNOD, but not just because of HCV.
From Handbook 11130.01, page 3.
(6) Class III. Veterans referred by a treating physician who have a dental condition professionally determined by the VA dentist(s) to be aggravating or complicating the management of a service-connected medical condition under active treatment are eligible for care to treat the dental condition. However, there is no provision granting eligibility for dental care under this classification in case of the opposite relationship, where a medical condition (e.g. Post Traumatic Stress Disorder (PTSD)), may be contributing to a dental condition (e.g bruxism) because the dental condition identified is not professionally determined to aggravate the medical condition. The goal is to provide focused care to treat only the oral conditions that directly impact the clinical management of the service-connected medical condition. Eligibility for each episode of dental care must be predicated on referral (consult), followed by a new dental evaluation.
Class VI covers non-service-connected cases.
(9) Class VI. Any Veteran scheduled for admission or who is receiving care under chapter 17 of title 38, U.S.C., may receive outpatient dental care if the dental condition is clinically determined to be complicating the medical condition currently under VA treatment. Eligibility for each episode of dental care will be predicated on referral and consultation, followed by a decision based upon clinical judgment. The goal is to provide focused care to treat only the oral conditions that are complicating impact the clinical management of the medical condition currently under treatment. This classification includes medically necessary dental care for Veterans receiving care for Military Sexual Trauma under Title 38 U.S.C. 1720D.
Does ANY veteran really mean ANY veteran? The VA uses these terms regarding care types: Comprehensive (includes preventative), Focused, or Emergent. From the handy dandy Fact Sheet Chart for Class III:
IF YOU, Have a dental condition clinically determined by VA to be associated with and aggravating a service-connected medical condition YOU ARE ELIGIBLE FOR Dental care to treat the oral conditions that are determined by a VA dental professional to have a direct and material detrimental effect to your service connected medical condition.
Almost the same language for Class VI:
IF YOU Are receiving VA care or are scheduled for inpatient care and require dental care for a condition complicating a medical condition currently under treatment. YOU ARE ELIGIBLE FOR Dental care to treat the oral conditions that are determined by a VA dental professional to complicate your medical condition currently under treatment.
What oral conditions might apply? I’m guessing here but chronic dry mouth comes to mind because it’s caused by a multitude of medications, medical conditions and creates an unhealthy mouth. This must-see presentation–with images–summarizes some of the linked problems. Diseases/Infections include hepatitis, radiation of neck/head; diabetes (slide 9). Medication examples are on Slide 11. Inhalants stick out since lung ailments among veterans are common and inhalants are often required. Inhalants can cause dry mouth which leads to gum disease. This is expensive to treat and the farce known as “dental insurance” rarely covers it. Dry mouth is a recognized complication of HCV infection but if a veteran is SRV, and still has HCV-related oral diseases, will he be covered by the VA?
So what actions can you take if you have lung disease, dry mouth, pain, your gums are a mess and you suspect your VA-prescribed Symbicort? Use secure messaging to notify your PCP and get it in the record! Your meds may get changed. If nothing helps, ask for a VA dental examination consult. “I want to obtain a formal dental classification.”
Your medical records and results of your dental exam will be reviewed by the Dental Service and your dental classification will be issued. If you don’t like their answers, it’s NOD-time. Now, I could have the flow of this all wrong so if you have experience with this process, please let us know. We are not VA employees and are fumbling around their documents for those elusive answers.