Resources for Veterans with Parkinson's 2024

Crista Ellis 00:00:01
Hello and welcome to the Parkinson's Foundation's webinar on resources for veterans with Parkinson's. I'm Crista Ellis, your host for today's webinar. Helping me behind the scenes are my colleagues Danielle Agpalo and Laura Cameron. More than 110,000 veterans with Parkinson's disease receive care through the U.S. Department of Veterans Affairs. Many U.S. military veterans with Parkinson's have access to specialized medical care and financial assistance through the VA. During this webinar, we will dive into an exploration of the extensive resources and dedicated support services that veterans have access to through the VA and the Parkinson's Foundation.

Today's webinar and the entire veterans webinar series is presented with support from the Don and Lorraine Freeberg Foundation. We want to take this moment to thank the Freeberg Foundation for helping to make these programs possible.

The mission of the Foundation is to make lives better for people with Parkinson's. Whether you are living with Parkinson's, caring for someone with Parkinson's, or working to end the disease, we are here to support you.

To achieve our mission, we pursue three goals: improve care for everyone with Parkinson's, advance research toward a cure, and empower and educate our global Parkinson's community. Today's program is a great example of one of the things we are doing to help us meet these goals.

The Parkinson's Foundation hosts weekly education and wellness programs through our PD Health at Home virtual programming. Join us for Mindfulness Mondays, Wellness Wednesdays, and Fitness Fridays. Most of the PD Health at Home programs are recorded and posted on the Foundation's YouTube channel. You can scan the QR code on the screen to connect to that channel, or find out more and register to attend our live PD Health at Home programs at Parkinson.org/PDHealth.

Part of the Foundation's commitment is to reach every person living with Parkinson's. A critical way we do that is through our partnerships. With more than 110,000 veterans living with Parkinson's disease, the Foundation is proud to have established a formal partnership with the Veterans Administration. This partnership has the overarching goal to improve the quality of life for veterans living with Parkinson's disease and their care partners through greater access to education, resources and support.

I'd like to invite you to visit our webpage and explore the resources offered by the Parkinson's Foundation that can support your navigation of living well with Parkinson's as a veteran. That website is Parkinson.org/Veterans.

Before we dive into the formal part of the webinar, I'd like to outline today's agenda. We'll start with a presentation from the associate director of education, who will discuss the resources available to veterans with Parkinson's. After that, we'll have a question-and-answer session. Then we'll move on to a second presentation providing an overview of VA disability benefits led by a veteran service representative, which will also conclude with a Q&A session.

We're happy to kick things off by welcoming Gretchen Glenn, a dedicated social worker and the associate director of education at the Philadelphia Parkinson's Disease Research, Education and Clinical Center. With a deep commitment to helping veterans and their families, Gretchen specializes in guiding individuals through the challenges of chronic illness. Her work focuses on disease education, supportive counseling, resource coordination, case management and community outreach, all centered around those impacted by Parkinson's disease and related movement disorders.

In addition to her work at the center, Gretchen leads as the chair of the National VA Parkinson's Disease Consortium Education Subcommittee. In this role, she plays a crucial part in providing educational resources to VA healthcare providers, ensuring veterans with Parkinson's disease receive the best possible care. Gretchen's passion for helping others shines through in everything she does. She has dedicated her career to supporting individuals as they navigate the complexities of chronic illness and end-of-life care. Gretchen, we're truly grateful for your time and expertise today. Thank you for being with us.

Gretchen Glenn 00:04:23
Good afternoon, everyone, and thanks for having me present today.

First, I'm going to review what we're going to talk about. I'm going to give you an overview of the PADRECCs and the National VA PD Network. I'm going to go over a little bit about the eligibility for care at a PADRECC or associated site, and then review some of the VA resources available to veterans receiving care at the VA.

The Parkinson's Disease Research, Education and Clinical Centers, otherwise known as the PADRECCs, were established in 2001 by the Department of Veterans Affairs to revolutionize services for the then-approximately 80,000 veterans afflicted with PD. That number has since grown to 110,000, and research is currently happening to obtain a more accurate number.

Each PADRECC is designed to deliver state-of-the-art clinical care, research and education to an expansive geographic region, which we refer to as our service area. All these centers are staffed by movement disorder specialists and researchers. The six VA PADRECCs are located at Philadelphia; Richmond, Virginia; Houston, Texas; West Los Angeles; San Francisco; and a split center in Portland and Seattle.

The National VA PD Network was established in 2003 to broaden the impact of the PADRECCs and promote PD awareness across the VA healthcare system by providing professional networking, mentorship and training to VA clinicians and allied health professionals who have an interest in PD and movement disorders.

Gretchen Glenn 00:05:58
The PADRECC Associated Sites were launched in 2006 to broaden the impact and reach of the PADRECC mission and provide access to specialized movement disorders care throughout the VA healthcare system. The PADRECCs and over 60 associated sites create a hub-and-spoke model of care.

In 2020, the PADRECCs were fortunate to form a partnership with the Parkinson's Foundation. As you can see from this map, many of the PF Centers of Excellence are close to VA PADRECCs or associated sites.

You can see on the map, the blue dots represent the Parkinson's Foundation Centers of Excellence. The red dots represent the six PADRECC centers. The gray dots represent the over 60 PADRECC Associated Sites. As you can see, the PADRECCs sort of outline the United States like a necklace around it. In order to provide care to our veterans across the United States, that was the reason we developed the PADRECC Associated Sites: to make accessing our specialized care easier for our veterans.

Now, to review our PADRECC mission, which is clinical care, education and research.

Our clinical services provide a multidisciplinary team approach, which can include attending neurologists, movement disorder fellows, nurses, nurse practitioners, geriatric psychiatry, neuropsychologists, social workers, pharmacists, PTs, OTs, speech therapists and several others.

The PADRECCs all do diagnosis and treatment of movement disorders; DBS and focused ultrasound evaluations for Parkinson's disease and essential tremor; neurostimulation for DBS, which is adjustments of the DBS device; Botox injections for dystonia, hemifacial spasms, spasticity and other indications requiring injections; neuropsychiatric assessments looking at the cognition of our veterans; disease education; psychosocial assessments; and palliative care discussions, which can include goals-of-care conversations, advance directives and help in treating more difficult complications related to Parkinson's disease.

We can also make referrals to PT, OT and speech therapy.

Gretchen Glenn 00:08:28
Our education program is twofold. We have patient education and professional education. For our patient education programs, we provide monthly virtual support groups and annual symposiums, which are in-person and/or virtual; distribution and creation of print and media resources; and we do a lot of community outreach. You can visit our website that's listed here to see a full listing of our education opportunities.

Professional education consists of the Movement Disorder Fellowship Program, where we train neurologists who want to become movement disorder specialists. We provide two movement disorder webinars a year, which are about four hours in length and are open to any VA clinician interested in learning more about Parkinson's disease and movement disorders. We also provide monthly case conferences and journal clubs for our associated sites to discuss and explore difficult cases that they may be experiencing.

On this slide, this shows you our PADRECC education and support groups that are currently happening. They're open to anyone, so if you're interested in joining, you can reach out to the contact person listed, and they will provide you with the meeting information.

The PADRECCs have a very robust research program. This is not an exhaustive list, but I'm just going to go over some of them with you. We do research in surgical interventions. The VA and the NIH completed the first large-scale trial of DBS, known as Cooperative Study 468, and this was conducted at all seven PADRECC sites. Drug therapies: we are currently doing a multicenter study comparing the antipsychotics pimavanserin and quetiapine.

We do research into gait and falling issues; depression and other psychiatric problems; non-motor fluctuations, such as anxiety, urinary incontinence, sense of smell and sleep issues; and looking at the benefits of exercise in Parkinson's. Basic science or lab studies look at the cause, treatment and hopefully cure for Parkinson's disease.

We are looking at drug-induced parkinsonism and the long-term exposure to antipsychotic medications, such as lithium and Haldol; gene mapping and genetic predictors; biomarkers to help diagnose PD earlier and with greater precision and track progression; and toxin exposures, looking at the environmental chemical and toxin pollutants like pesticides, Agent Orange and paraquat that are especially of interest to our veteran populations. A lot of that research has helped to make Parkinson's a presumptive service-connected condition, which I'll explain later on in this presentation.

Gretchen Glenn 00:11:12
If you're a veteran, how do you access healthcare through Veterans Affairs? Some eligibility factors are service history, VA disability rating, income and other factors. To be eligible, first you have to have served active military, naval or air service and not have received a dishonorable discharge. If you served in the Reserves or National Guard, it depends on your active duty status. If you are a service-connected veteran, you are eligible for VA healthcare through the VA, but you still need to apply for it. The PACT Act has also expanded eligibility for veterans, so it's definitely worth applying to see if you are eligible.

You can go to the VA.gov healthcare eligibility website to see if you're eligible and even apply online.

How does a veteran get care at a PADRECC or associated site? First, you must be enrolled in and eligible for VA healthcare. You would then choose a PADRECC or a PADRECC Associated Site to receive care. You go to our Getting Care page to find a center close to you. You would then ask your VA primary care provider or neurologist to make a referral to a PADRECC or associated site using an inter-facility consult. If you need any help with this process, you can reach out to our national PADRECC network hotline at 1-800-949-1001, extension 205769, and we'll be happy to provide you some guidance.

Before we move on, I want to go over some important VA lingo, and that's what service-connected versus non-service-connected means. These terms are important as we move forward talking about VA resources available, and they're terms that you'll hear often within the VA system.

Service-connected refers to veterans who are disabled by an injury or disease that was caused or aggravated by military service, or occurred while serving in the military.

Parkinson's disease is considered a presumptive condition for some veterans, which means that it's presumed that the disability is caused by military service if you served during specific wartime and/or were exposed to certain toxins.

Veterans who are service-connected receive disability compensation, which is a tax-free monetary benefit, and the amount is based on the determined level of disability.

Gretchen Glenn 00:13:41
Non-service-connected refers to veterans who have a disability or health issue not related to their military service. Veterans diagnosed with PD who do not meet the criteria for a presumptive service-connected condition may be eligible for some VA benefits under non-service-connected status, but typically there's an income limit.

Veterans who are non-service-connected might be eligible for a VA pension, which is a tax-free monetary benefit payable to low-income wartime veterans. Veterans who are eligible for a pension and are also housebound or require the aid and assistance of another person may be eligible to receive additional monetary amounts. It's just important to note that you can apply for VA service connection without enrolling in VA healthcare, but it's strongly recommended that you do so in order to receive all the benefits you are entitled to.

Now we'll talk briefly about military exposures and PD risk. When the PADRECCs were first established, Parkinson's was not a service-connected condition. But in 2010, it became a presumptive service-connected condition for veterans who served in the Vietnam era and were exposed to Agent Orange. In May 2021, parkinsonism was added to the list of presumptive conditions associated with Agent Orange. The exposure locations continue to expand, most recently with the PACT Act adding five new locations, which I'll show you on the next slide.

In 2017, VA announced Parkinson's disease as a presumptive service-connected condition for veterans who were stationed at Camp Lejeune during a specific time period, and this is due to the water contamination. It's important to note that parkinsonism has not yet been added to the presumptive condition list.

In 2013, Parkinson's disease and parkinsonism were recognized as secondary conditions to service-connected moderate or severe traumatic brain injury.

The PACT Act and Parkinson's disease expands VA healthcare benefits for veterans exposed to burn pits, Agent Orange and other toxin exposures.

Parkinson's was not added to the list of presumptive conditions for Gulf War and post-9/11 veterans related to burn pit and toxin exposure. For now, we're hoping that will eventually change. The PACT Act expanded Agent Orange presumptive conditions, including by adding the five additional locations where Agent Orange was potentially stored or present.

Gretchen Glenn 00:16:23
If you're a veteran, how do you go about applying for VA service connection if you believe that you fit in one of those criteria for a presumptive condition? To give you a little bit of an understanding of how the Department of Veterans Affairs is set up, the Veterans Health Administration and Veterans Benefits Administration both fall under the umbrella of the Department of Veterans Affairs, but we function quite separately. VHA, or the Veterans Health Administration, is the healthcare system. VBA is the financial benefits side that also includes financial assistance to veterans.

VHA can provide medical support for VBA claims, but determination of claims is done by VBA only. To apply for VA service connection benefits, you'd want to contact the Veterans Benefits Administration by calling their hotline number at 1-800-827-1000. You can visit their website here, or you can connect with a veteran service officer, which is something we strongly encourage veterans to do to help in the disability claim process because it can be complex and confusing. We're going to have Johnny, a VSO, talk to you shortly about the role of a VSO and how they can help you.

Now, just to give you a brief overview of some of the more common benefits that a veteran following at a VA can receive. Just note this is a highlight of VA benefits; it's not an exhaustive list. There might be different eligibility criteria and co-pays for many of these benefits. They can depend on income, service connection status, level of care required and even what VA you follow at.

All veterans are assigned a primary care team. This also includes the inclusion of the pharmacy benefit. A primary care team consists of a doctor, a nurse practitioner, a nurse case manager and oftentimes a social worker. They are really your director of care. We also have very robust mental healthcare services for our veterans. We provide rehab services such as PT, OT, speech, kinesiotherapy and recreational therapy. We also have contracts with many adult day healthcare centers in our communities that can provide increased socialization and supervision during the day, as well as provide some caregiver relief.

We have contracts with home health aide programs to provide assistance with personal care, such as bathing, dressing and grooming; respite care services, again, to give care partners a break; and the home-based primary care program, which is for veterans who have great difficulty or are no longer able to leave their home for care. They will bring the primary care team to you. You have to live within a certain mile radius of a VA medical center to be eligible for this. They have everything from doctors, nurse practitioners, nurses, social workers, pharmacists, psychologists and rehab specialists that can all come to your home if needed.

Gretchen Glenn 00:19:25
Hospice and palliative care can help with goals-of-care conversations, difficult treatment decisions and advance directives, as well as end-of-life care.

Prosthetics equipment, also known as durable medical equipment, can range from anything from button hooks to reachers to stair glides, to walking aids such as walkers, wheelchairs and scooters, and even having grab bars installed into your home. There needs to be a medical justification for the equipment. It oftentimes requires an assessment by a physical or occupational therapist. But we always recommend to our veterans to ask us or your primary care team. If you are in need of any equipment, let us have an assessment done, determine the need, and we can order it for you if we're able. If you purchase it on your own, the VA won't reimburse you for it.

Veterans who are 70% service-connected or more may be eligible for VA nursing home placement or payment at one of our community nursing homes.

Then we have our caregiver support program, which has two levels. There's the general caregiver support program, which is the core program that provides peer support, mentoring, skills training, coaching, telephone groups, online programs and referrals to resources for caregivers of veterans. The second part of that program is a comprehensive program, which offers enhanced clinical support and services for caregivers of eligible veterans who have serious injury or illness and require in-person personal care services, among other various requirements.

Caregivers eligible for this program also receive a monthly stipend to be their veteran's paid caregiver. You can contact the National Caregiver Support Hotline number listed here to learn more about that program and if you're eligible. To learn about any of the resources or benefits that I mentioned above, you can ask to speak to your VA social worker, who can help assess what your needs are, what might be available at your VA, and what you might be eligible for, and help facilitate those referrals.

Gretchen Glenn 00:21:38
How do the PADRECCs and the Parkinson's Foundation Centers of Excellence work together? We do a lot of co-practice. Co-practice really means that veterans who are eligible for movement disorder care at a VA do not need to give up their community neurologist. That's what we refer to as co-practice. The PADRECCs and the Centers of Excellence are really about working together to ensure veterans are receiving the best possible care with access to all eligible benefits. If you have a community neurologist that you have had a relationship with for a long time, we don't expect you or ask you to give up that community neurologist. But we do ask that you pick one person, either the community neurologist or the VA neurologist, to make the medical decisions for you.

That's just for a safety reason. We don't want to have too many hands in the pot messing around with your treatment. If you decide to keep your community neurologist, you just need to come to the VA at least one time a year to receive your VA benefits, such as medications, durable medical equipment, in-home support programs and all of those services I mentioned previously. That goes the same for your primary care provider. If you've had a relationship and followed with a primary care provider for many years, we don't ask you to necessarily give up that provider, but again, you must come to the VA at least one time a year to maintain your benefits.

We do shared fellowship programs with our Centers of Excellence and our university affiliates. For example, at our Philadelphia VA, we have four fellows who rotate, spending half their week with us at the Philadelphia VA and half their time at the University of Pennsylvania. We do a lot of joint patient education programs together.

Our physicians have shared appointments at the university affiliate, many of which are PF Centers of Excellence, and we do a lot of research collaboration. Again, we are interested in working together to ensure that our patients receive the best care possible. We're not interested in taking anybody's patients away from them. It's all about getting the care and the benefits for the patient.

Gretchen Glenn 00:23:47
I know that was a lot of information. Who can help you with that? Who can help sort a lot of that out for you? VA social workers can assess your needs and make you aware of the availability and eligibility of services, and we can help advocate for you.

I always refer to myself as a resource person. If I don't know the answer, at least I can try to help point you in the right direction. If you're receiving care at a VA, you should always ask to speak and make a connection with your VA social worker.

VA veteran service officers can help with applying for or increasing VA disability benefits. This is the service connection benefits. They can help with the process, which can often be complicated and sometimes overwhelming. The VSO can monitor your claim and, again, advocate for you. Johnny is going to talk to you in a little bit about the role of the veteran service officer.

To highlight the partnership between the VA and the Parkinson's Foundation again, which was really formed to improve the health, well-being and quality of life of veterans living with PD, we developed many resources together. There's a veteran-specific webpage, which is Parkinson.org/Veterans, where you can find information on PD and veteran benefits, stories from veterans living with PD, and connections to veteran-specific events such as these webinars. We also have fact sheets, and we have a newly updated Veterans Guide that really goes over all of what I just spoke about today in a little bit more detail and has all the links to the different webpages and contact numbers that might help you in navigating the VA system.

Here's just a listing of additional resources from the Parkinson's Foundation. There is the National Helpline, which we have done some training with on VA and veteran benefits. We work very closely with them, so if a veteran is having a hard time connecting to a VA, the Helpline staff is more than willing to reach out to us, and we'll help problem-solve and try to break down some of those barriers.

I suggest that you check out some of these other valuable resource information from the Parkinson's Foundation.

Gretchen Glenn 00:26:06
Again, this is a list of important contact information. All these slides are going to be shared with you at the end of the presentation, and many of them are the links that were presented in the presentation today to help you navigate through the VA system.

Thank you, everyone. Now I'm going to invite my colleague Emily Hall to join me for our Q&A session.

Emily Hall 00:26:30
Hi, everyone.

Crista Ellis 00:26:33
Welcome back, and thank you, Gretchen, so much for pulling us through how to navigate these benefits with the VA and collaboration with the Parkinson's Foundation, and also highlighting the partnership that does exist and is impactful in supporting our community of veterans who are living with Parkinson's. I appreciate the way that you've outlined this for our community and knowing that we can revisit it again once we post the recording later on.

The first question is from Dan and Donna, and they ask: what types of home modifications can I get support from when the time comes?

Gretchen Glenn 00:27:12
Through the VA specifically, if you're a veteran and you're enrolled in the VA healthcare system, there are grab bars that can be installed into your home; stair glides; ramping, if that's necessary to help getting in and out of the home; and there is a HISA grant, H-I-S-A, which is a one-time lifetime grant that a veteran can apply for that could make the bathroom more accessible. We know getting in and out of the shower and tub can be difficult. You could get a grant. It likely won't pay for all of it, but it could go toward the renovation of a bathroom for putting in a walk-in shower or a roll-in shower.

There is a lot that we can offer. A lot of times, what we would do is send out a physical or occupational therapist to your home to assess your home to determine what modifications would be needed and what type of equipment would be needed. They would contact us, and then we could see what we could get through the VA or if there's a certain grant that could be supportive for that.

Emily Hall 00:28:14
Yeah, and I would definitely agree with consulting with your rehab or therapy team too, because I know here through Richmond, one of the rehab therapists has to put in that referral to prosthetics for the HISA grant, with the medical justification of what's needed. But also, as Gretchen said, it doesn't necessarily always cover everything that you need done. Sometimes what people will do is use that grant and also apply for a community grant.

If you check with your local VA social worker and check in your community if there are different programs. For example, in Virginia, we have Granting Freedom, which is a specific grant for Virginia veterans too. Sometimes people will use that and the HISA grant, and that can cover a lot of the cost.

There are a couple of other disability housing grants that are a little bit more intensive and definitely a lot more difficult to get. That's available on the VA.gov site. They're called disability housing grants. These are applications submitted directly to VBA, the Veterans Benefits Administration. They have a lot of very specific clinical criteria to meet in order to qualify. I would say the HISA grant is typically the best way to go. The other two grants are a lot more difficult.

Crista Ellis 00:29:45
Thanks, Emily, for highlighting that there are grants available to support types of home modifications that Dan and Donna were asking about. I appreciate you both, Gretchen and Emily, for highlighting the types of modifications that could be provided through VA benefits and also giving us another opportunity to explore resources that could further support those home modifications. Bill is asking us: how is research coordinated across the PADRECCs to optimize results?

Emily Hall 00:30:18
I know, and you can correct me if I'm wrong, Gretchen, because this isn't my realm as much, but I believe each PADRECC has a research coordinator, correct?

So they are running their own studies either locally or nationally, and they all communicate with one another. I know the big study that I'm aware of is the Vet-PD research study that they're doing also with the Michael J. Fox Foundation. But I'll let Gretchen speak a little bit more to that too.

Gretchen Glenn 00:30:53
No, you're right.

For each PADRECC, each mission has an associate director attached to it. There is an associate director for research who really oversees the research going on locally. For the ones that are being done more nationally, they do meet, either once a month or bimonthly, and have a research call where all PADRECCs and associated sites who are doing research can come together and discuss what research they're doing and opportunities for maybe collaborating together.

As we mentioned, there have been some collaborative studies, and they're strictly monitored and really are working together. When we are having a national meeting, we do have a biannual network meeting. We're having one next week. That is one of the topics as well: talking about research and the possibility of collaboration in the future. How can we further collaborate together for the research projects for our veteran population?

Crista Ellis 00:31:54
I'll add that optimizing results in research for Parkinson's and veterans requires participation from veterans with Parkinson's. I'll just advocate for participation in clinical research at our PADRECCs and centers across the globe. Thank you for the question, Bill.

Jan is asking, can you talk more about financial considerations for care? What are the income limits?

Gretchen Glenn 00:32:22
For VA specifically?

Crista Ellis 00:32:25
Yeah. When you're considering financial care, financial considerations for VA benefits, are there income limits to receiving the benefits from the VA? Restrictions on income?

Gretchen Glenn 00:32:39
If you're a non-service-connected veteran, to be eligible for VA healthcare, there is an income limit, and I'm not exactly sure what that number is. Do you know, Emily?

Emily Hall 00:32:48
I was looking it up and having trouble finding the link, but everyone's income limits differ based on where they live. I was trying to find the actual website where you can look it up because somebody's income limits as a single person versus a dependent, or living in Virginia versus living in California, are all very different. They do it based on that, and they do change annually.

They look at your income limits and will see if you're eligible for care. In reading the information as well, I know they're trying to lower that a little bit, lowering the income limit because there have been a lot of veterans in the past who have, quote unquote, made too much money to qualify for care. So they're gradually trying to work to lower that income limit so more veterans can use the VA for care, but sometimes that also means that they might have to pay a copay to get care.

The most important thing is just making sure that you're updating your income as much as possible. Try and do it at least annually because that determines a lot of eligibility for different services.

As far as benefits and income and things like that, I know Johnnie is going to be presenting in a little bit, but to my knowledge, there's no income limit when you're applying for a service-connected disability condition. Now, the VA pension is an income-based benefit. In that, they will look at how much money you're making, and that could potentially determine the benefit payout.

Gretchen Glenn 00:34:42
All of it is listed on the website, and you can go to the VA apply for VA healthcare page. It gives you the breakdown on there, and you can actually start plugging in your information to see if you're eligible. I always tell people: just apply and let the VA make the determination if you're eligible or not because there are many factors that play into that. Even if you had a copay for care, even if you were eligible for VA and had a copay, it would be about $20 for primary care and $50 for a specialist.

If you have private insurance on top of that, not Medicare, but private insurance on top of that, they can bill part of that to your private insurance, so it may be less. I just always say, if you're a veteran, apply for VA healthcare. Let them make the determination to see if you're eligible.

Crista Ellis 00:35:36
Thank you, Gretchen. Really appreciate it.

Emily Hall 00:35:39
I've got some links for you all, if you're able to share them too.

Crista Ellis 00:35:44
Absolutely. Thanks for sharing those links, Emily. Feel free, Jan, and anyone who's interested in income considerations, to go ahead and click those links in the chat, and it'll pop open a new tab on your browser for you to browse after our program today.

Our viewer Jonathan shares that they live in the Florida Panhandle. The closest VA center with PD support is four hours away, one way. How is care provided to veterans like me?

Gretchen Glenn 00:36:12
We do a lot of telehealth. We have a lot, even prior to COVID. The VA was one of the leaders in providing telehealth care to veterans who were in more rural areas. If a veteran isn't able to get to us or an associated site, you can ask your primary care provider to reach out to your local site, or you can contact us directly and we can work with you to try to get you connected to have even a video visit with one of our PADRECC or associated sites. We are happy to do that as much as we can.

Crista Ellis 00:36:48
I would agree.

It's a testament to being connected here in the virtual world. We're all doing some form of health education here and empowering yourself to get connected through more support and quality care by way of the World Wide Web. So it is possible.

Thank you for highlighting that.

Gretchen Glenn 00:37:07
We're always looking and spreading awareness across the VA system for other providers in other areas so that we can expand our associated site locations as well.

Emily Hall 00:37:18
Mm-hmm.

Crista Ellis 00:37:20
There are a couple of specific questions in here related to service-connected and non-service-connected. Franz is just asking, what does non-service-connected mean? What are benefits for non-service-connected veterans?

Emily Hall 00:37:33
I know Gretchen touched on this in her presentation, so she can probably say it verbatim now at this point, but it essentially means that that individual veteran does not yet have a rated service-connected disability condition. That can range anywhere from 0% to 100%. I have seen where somebody has had a 0% disability rating before, but that's because that condition they're no longer getting necessarily treatment for. Non-service-connected just means that they don't currently receive, they're not... You can speak on it.

Gretchen Glenn 00:38:13
That's okay.

It's a veteran who's eligible for VA healthcare. However, they don't have an injury or illness that is connected to their service time. The disability rating for a service-connected veteran is related to if you served and if you had an injury or were diagnosed with an illness while serving active duty, or have one of the presumptive service-connected conditions, like Parkinson's related to Agent Orange.

Non-service-connected veterans, so we have a lot of non-service-connected veterans who have Parkinson's disease but were never in an area where they were exposed to Agent Orange, cannot be service connected for their Parkinson's if they were never in an area where Agent Orange was located. But they are still eligible, based on the income limits, to receive care at a VA.

Being service connected not only gets you the disability compensation check each month, which is the monetary benefit, but it also may give you more. You wouldn't have a copay for your care. If there was ever a hold on home health aide, if it was only eligible for a service-connected veteran, you would be eligible for that. For nursing home level of care, if that's needed, you have to have a service-connected rating of 70% or more to be eligible for that.

So being service connected may give you access to additional benefits over somebody who's non-service-connected. But you can still receive medical care as a non-service-connected veteran. You just may have a copay for some of those things. I hope that made sense. It's a confusing process.

Emily Hall 00:39:47
Yeah. That was a really good explanation.

Gretchen Glenn 00:39:50
Thank you.

Crista Ellis 00:39:51
Thank you, Gretchen. That did answer Linda's question specifically on: are nursing home services only available to service-connected veterans? I believe you said yes, only available to service-connected veterans.

Gretchen Glenn 00:40:03
Yes.

Emily Hall 00:40:04
So 70% or higher, specifically, or I think that there are some, yeah, 60% and unemployable, but that gets even more complicated.

Gretchen Glenn 00:40:15
I just say, if you think, just talk to a VA social worker. They can pull up your records, sit down with you, and go over all of this with you on a personal basis.

Emily Hall 00:40:25
That's eligibility through the VA. If you are eligible for Medicaid, like state Medicaid and different things like that, you still have opportunities for long-term care, just not necessarily covered by the VA. In planning for the future and thinking about the future, that's why it's very helpful to try and start pursuing, registering, and applying for things early so that when the time comes, if you do need long-term care, you already have everything kind of in place. You have a plan set up for the future.

Crista Ellis 00:41:04
Thanks, Emily. Our next question comes from Suzanne, and they ask, what's the difference between a VA clinician, a VA social worker, and a veteran service officer?

Gretchen Glenn 00:41:16
A VA clinician, I would think, would be more of your primary care doctor or nurse practitioner, or your movement disorder specialist who's managing your medical care. A VA social worker, that's Emily and me, we do more of the resource coordination, looking at what you might be eligible for through the VA, doing supportive care and disease education, talking about planning for the future and long-term care planning. I like to refer to myself, and I'm sure Emily does as well, as your resource person.

If I don't know the answer, I can at least try to find it for you or point you in the right direction. A veteran service officer works on, and so we work in the medical side, under VHA, the Veterans Health Administration. Veteran service officers fall under the Veterans Benefits Administration, which is the financial benefit piece of the VA. They are really the experts in applying for compensation disability benefits, housing grants, vocational resources for veterans who are newly coming out of the military, accessing their education benefits, etc. That's the veteran service officers, and that's really their area of expertise.

Emily Hall 00:42:35
Mm-hmm.

Crista Ellis 00:42:38
Thanks.

A question I think is really important to ask as we think about additional services provided through the VA: who do we contact for occupational therapy or physical therapy services through the VA? This question comes from Paula.

Emily Hall 00:42:55
I would say start with your local VA clinic because your primary care can definitely request that. Now, if you want to try and have someone that's a little bit more Parkinson's specific or maybe certified in some of those different programs like LSVT BIG, even for speech therapy, like SPEAK OUT!, PWR! Moves, all of that.

If you can't really find it locally, a lot of the PADRECCs, I know specifically for Richmond, all of our therapists actually do telehealth too. I know, as crazy as that might sound, thinking about physical therapy done via telehealth. But for certain patients, it does work really well. Sometimes what they can even do is a couple sessions of education or ordering specific equipment. Because the great thing about telehealth, if you're talking to an occupational therapist, is they're automatically beamed into your house. They can see what you need, they can look at you, take measurements of doorways, and help order specific pieces of equipment and things you might need.

If you're having trouble locally, start with your primary care provider. But if you are connected to a PADRECC center, trying to find someone who's a little bit more specialized with Parkinson's might work in your favor.

Gretchen Glenn 00:44:18
If you can't get it through your local VA, then your primary care doctor through the VA could see about getting it through VA Community Care, which is if a VA can't provide it, we can provide that care through a contracted provider in the community that might be closer. Or if you live three hours away from a PADRECC that has somebody that can do LSVT BIG, but you have a rehab that's two miles down the street from you, if we have a contract with them, you might be able to go get that care closer to home than traveling three hours, which is not reasonable.

Bottom line, talk to your primary care provider. If you're hooked into a PADRECC, talk to your PADRECC or associated site about therapy, and they'll help get you connected and get you started.

Crista Ellis 00:45:16
Thanks, Emily. Thank you, Gretchen.

One of our anonymous viewers is asking, there are accredited and non-accredited VSOs. How do we know the difference?

Emily Hall 00:45:27
I bet Johnnie will be able to tell you for certain. But if anyone ever tries to say you need to pay them to apply for a benefit, or sometimes I've talked to another service officer before, there are some people who will have them apply, but then somewhere in the agreement it says if they're awarded the benefit, they give a certain percentage of their benefit to that person. Those are not people that you want to utilize.

Unfortunately, because of the PACT Act expansion and just the nature of the VA and these benefits, a lot of people target veterans and try to get a little bit of money. The VSOs that are accredited, you can find them on this website as well. I'll try and find the link. I definitely prefer, or refer to, your state VSOs very often, but there are a lot of other ones through Disabled Veterans, American Legion, and those as well.

Sometimes if people apply and they're denied, they might immediately seek legal representation, but then you would have to pay those fees too. If you work through some of these VSOs, and like Johnnie will probably talk about as well, they actually have a legal team that works with them that can help through the appeals process. If anyone ever tries to ask for money for you to apply for benefits, don't go with them. You can find someone. It is a free service. It is free for you all. Just remember that.

Gretchen Glenn 00:47:20
A veteran should never have to pay for applying for benefits.

Emily Hall 00:47:25
Mm-hmm. Bottom line.

Gretchen Glenn 00:47:28
Bottom line.

Crista Ellis 00:47:29
Thanks, Emily, for explaining that and Gretchen for simplifying it.

We have time for two more questions. Brittany is a social worker who works with Parkinson's patients, and they are curious if it would be best for her to refer patients wondering if they're eligible for VA benefits to a VSO or the Parkinson's Foundation Helpline just to streamline the process for them.

Emily Hall 00:47:54
Honestly, I think a VSO would probably be a little bit easier because that way it would just cut down the communication line and then you can go straight to the source. So that would be my recommendation.

Gretchen Glenn 00:48:08
Same.

Crista Ellis 00:48:10
I agree.

Our last question for this portion of the Q&A comes from Louis, and they ask, are there any disabilities that the VA recognizes that's connected with the cause of Parkinson's? I believe you alluded to some of this in your presentation, Gretchen.

Gretchen Glenn 00:48:29
We don't know 100% what causes Parkinson's. That's the biggest problem. The toxin exposure, there was some research that was done, and it wasn't big, but it was enough for the VA to say we can't say that Agent Orange or the water contamination didn't cause Parkinson's. So we're going to put it on the presumptive service-connected list.

That's a hard question to answer because we don't really know the direct cause of Parkinson's disease. What we do know is that it is on the presumptive list for Vietnam-era veterans who were exposed to Agent Orange or were in one of those locations where Agent Orange was considered stored, or if you worked on certain airplanes. That's Parkinson's and parkinsonism.

For veterans who were the Marines who were stationed at Camp Lejeune during a specific time period who may have been exposed to the water contamination, it's presumed if you were there for 30 consecutive days during those certain years that you were exposed to the contaminated water. Parkinson's disease is on the presumptive list for that, not parkinsonism, just Parkinson's disease currently. But it took many years for them to add parkinsonism to Agent Orange, so I'm hopeful that one day parkinsonism will be added to Camp Lejeune as well and maybe even expanded further.

It's not considered presumptive for burn pits, which is what we have a lot of veterans asking about because the Gulf War veterans are now coming into that age of diagnosis of Parkinson's disease, and that's a lot of what people were exposed to: the burn pits. It's not there yet, but hopefully with continued research we'll get there. That's my hope anyway.

Emily Hall 00:50:20
Yeah. I was going to say just continue to keep your eye on the news and things coming out because, like she said, parkinsonism was just added a few years ago. I think they're going to continue to look at different areas where people served, what things were there in terms of toxins or exposures, and then maybe start making some more research connections in the future.

Gretchen Glenn 00:50:49
There are environmental health examinations that you can register with. Each VA, if you contact your VA's environmental health coordinator, I believe is the name, you can get your name in a registry so that if down the line it comes up that maybe you're service connected, you have that examination already in the system and it can maybe help with making a retroactive claim.

Crista Ellis 00:51:21
Thank you, Gretchen.

Gretchen Glenn 00:51:23
I always say, if you think your parkinsonism or Parkinson's was related to your service connection, or you think that there was a possibility that you were in an area where Agent Orange was present, just apply. Let VBA make that determination. It is a process, but it might be a process that works out for you in the future.

Crista Ellis 00:51:47
Thank you, Gretchen.

Gretchen Glenn 00:51:49
Thank you.

Crista Ellis 00:51:50
Thank you for sharing your valuable time and expertise with us today. If you had a question that was not answered, please reach out to the Helpline by calling 1-800-4PD-INFO or emailing our Helpline at Helpline@Parkinson.org. I hope everyone has gained new insights and feels empowered to apply this knowledge to enhance your quality of care and strengthen your connections.

Now we'll move into the second half of today's programming, where we will be provided with an overview of VA disability benefits. Johnnie retired from the Army in March 2016 after 24 years of dedicated service. She began her journey with the Virginia Department of Veterans Services in September 2018 as a veteran service administrator and was promoted to veteran service representative in March 2019. Throughout her career, Johnnie has been committed to assisting departing active-duty service members, veterans, and surviving spouses in securing the compensation and pension benefits they deserve. Johnnie, we're truly grateful for your time and expertise today. Thank you for being here.

Johnnie Bourque 00:52:55
Hi. Thank you for having me. I do appreciate this. I learned a lot from Miss Gretchen and Miss Emily. Thank you.

I am a veteran service representative for the state of Virginia. Next slide, please.

Crista Ellis 00:53:17
Okay.

Johnnie Bourque 00:53:19
What is a veteran representative? What do we do? We help file claims for veterans and their family members, and we also help file claims for departing service members. We will have access to your VA file once we do the representation form, and then we can actually review decision letters that the VA gives you. That's one piece.

Someone asked about an accredited VSO in the last piece. An accredited VSO will have access to your VA file, and yes, they will not charge you money. We do not charge money at all.

We as VSRs can communicate with the VA on your behalf. If you have a question and you don't want to speak to a VA representative, we can call on your behalf and ask that question and get the answer for you.

We provide free services for veterans and their family members. We also have to complete training and pass an accreditation test. That's one way to make us accredited. It's roughly a 120-question test, and we do have to pass it to receive our accreditation through the VA itself.

Our VSRs work with American Legion, Disabled American Veterans, VFWs, AMVETS, Wounded Warrior, and those all have VSOs and VSRs. Each state by law is required to have either a state-level VSO or county-level VSO. That is mandatory, that is law. Every state has a veteran service representative, an organization assigned to that state, whether it's state level or county level.

Our purpose is designed to compensate veterans for diminished work capacity as a result of a disability that occurred in military service. The condition that you are trying to claim has to have happened while we were on active duty or be well documented in your military medical records. But in this case, Parkinson's due to Camp Lejeune water contamination or Agent Orange exposure is presumed.

It is presumptive. I don't want to say it's automatic, but it's kind of automatic, especially if you were boots on the ground in Vietnam and in the locations designated by the VA. You must be a veteran. You must provide a DD 214 to be eligible.

The requirements are related to in-service injury, illness, or hazardous exposure. Disability compensations can open doors to additional benefits such as healthcare, as Miss Emily and Miss Gretchen spoke of earlier, and also the caregiver support programs and stuff like that.

Johnnie Bourque 00:56:43
There is no time limit to file a claim after service. We still have veterans today that are Vietnam veterans who are filing. We even have some that are a little bit before Vietnam who are still filing claims, and the VA is processing them. There is no time limit whatsoever.

When you come to us, to a VSR, we will complete all the paperwork for you. You will sign the documentation. You will give us your supporting documentation. For Parkinson's, I should say for any presumptive of Agent Orange or Camp Lejeune, you need a current diagnosis of that condition, whether it's Parkinson's, hypertension, et cetera. A current diagnosis is all you need for a presumptive. You do not need a nexus letter.

Disability ratings are based on the current severity of that condition that you have. It is by law, 38 CFR Part 4, where the rating schedules are given.

Like it was spoken of earlier, the ratings are zero to 100%. Even if you have a rating of zero, you can receive treatment from the VA. If it does get worse, you can request an increase.

Ratings are monthly compensation for the rest of your life. Age is not considered in the worsening of the disabilities. Please keep that in mind.

Payments are tax-free, assigned based on your combined rating, and paid for the rest of your life. Next slide, please.

Disability compensation requirements for service connection: an in-service event and/or your exposure, a current diagnosed disability, and a nexus. If you're not applying for a presumptive condition due to Camp Lejeune or Agent Orange, you do need a nexus. If you are filing for a presumptive, you do not need a nexus. You just need that current diagnosis.

Johnnie Bourque 00:59:15
Parkinson's is a neurological condition, convulsion disorders, diagnostic code 8004. This diagnostic code automatically is a minimum of 30% for that condition. But it does not take into account the symptoms associated with it. So the majority of the time, Parkinson's is rated at 30%. But once we know Parkinson's always gets worse, you start to get your symptoms, and as you get more symptoms, you file for those symptoms. That will be on the next slide. Next slide, please.

The symptoms of Parkinson's, we have this little slideshow. We file Parkinson's itself, and then, say a couple of months later or a little bit later, okay, you're now having symptoms of Parkinson's. You're having the depression, you're having the constipation, the difficulty speaking, the excessive salivation or the tremors.

If you want to file for those conditions, you go back to your doctor, your neurologist, I believe it is, the doctor you see for your Parkinson's. You say, “Okay, doc, I'm service connected for Parkinson's, but now I'm showing more of the symptoms: the constipation, the tremors, the difficulty speaking, difficulty feeding myself, difficulty swallowing.” Have your doctor write up another letter, another memo, saying, “I am treating Mr. Veteran. He is diagnosed with Parkinson's disease. He now has symptoms of Parkinson's,” and have your doctor list those symptoms: depression, anxiety, whatever it may be. You take that memo back to your veteran service representative, and your veteran representative can do another claim for you saying, “He now has,” we call it residuals, “residuals of service-connected Parkinson's, whether it's constipation, tremors, depression.”

We would list all that on the 526EZ that we fill out for you, and then we would submit that with the memo from your doctor stating that he now has these symptoms, and that will add to your 30%. So that 30% that was just for Parkinson's is now possibly up to 100% because you've added all those other symptoms, and it adds to your rating disability.

Now, the rating disabilities of the VA, I really don't want to get into it, but if you are service connected with the VA, you know 10 plus 10 with the VA equals 19. So it's not math. It's not straight math.

I can't really explain it because I'm not an engineer, but we know how to read our rating disability chart, and then we can kind of explain why 90 plus 10 equals 91 and not 90 plus 10 equals 100. But that's a whole different story. I just wanted to put that out there. These are our references. For the VSO, I do have the same as Ms. Emily had: VA.gov, “Get help from an accredited representative,” “Find a rep.”

There is a little search bar. You can type your state, like “New York VA rep” or “VA New York VSO,” and then New York will pop up. So you can do it that way. Or you can click the link right there, and then it'll bring up your state and the representative near you.

Okay. I know that was very fast. I do apologize. But what are your questions?

Crista Ellis 01:03:34
Thanks so much, Johnnie. I appreciate it. I know it's challenging to navigate conversations and receiving benefits through the VA, and so grateful that there are people like you who are helping our community receive the benefits that they so deserve because of their service to the country. So thank you for doing what you do, and know that it's really appreciated and certainly acknowledged by the Parkinson's Foundation.

Johnnie Bourque 01:04:03
Thank you. Thank you.

Crista Ellis 01:04:05
I'm curious. One of our viewers, Brittany, is asking what's the best way to locate a VSO near you? I think you touched on it just now with that link. So simply Googling a VSO near whichever city, what would be the best way that you would recommend, Johnnie?

Johnnie Bourque 01:04:22
If you want to make sure it's accredited, you would want to use the VA.gov website. There is a little search bar at the top with a magnifying glass. That's where you would want to type in VSO and your state, and then that would populate right there. We would know the VA has already vetted them. And then, of course, we don't charge.

Crista Ellis 01:04:50
Thank you, Johnnie.

I did just receive a question that seems very specific to this particular individual's circumstances, and I would recommend to this individual, who writes that they're an 11-year active-duty U.S. Navy veteran, to contact their VSO, just thinking about if there's any hope for their situation to have a closer evaluation of being connected to their injuries and limitations.

I'm not going to read the whole question to you, Johnnie, because it is very specific and I believe outside of both of our practices to address and the objective of today's webinar. So I really appreciate your patience with me, my friend, and want to direct you to the resources that are most helpful for your question.

Does anyone else have any questions related to being connected with a veteran service representative or officer while we have Johnnie here to support our navigation and receiving benefits?

We'll just pause for a moment, Johnnie, while people write in.

Gwen, I see your question about cognitive challenges associated with Parkinson's disease. I'll invite you, Gwen, to tune into our mental health webinar, where we will dive deeper into the mental health implications of Parkinson's disease, and that program will be in February. We also have lots of resources related to general Parkinson's information and education on our website.

Johnnie Bourque 01:06:25
The VA does—I'm sorry. The VA does service connect for cognitive conditions when it comes to Parkinson's.

Crista Ellis 01:06:35
That's really helpful to know. Thank you for sharing that, Johnnie. One of our viewers is asking, “Should I put a claim in if I'm already at 90% service connected for mental health and sleep apnea?” Is that something you can address, Johnnie?

Johnnie Bourque 01:06:49
Yes, ma'am.

First, for behavioral health, if you had those conditions while on active duty or if you were in combat, the VA may service connect the behavioral health. The sleep apnea is a little more tricky because everyone has sleep apnea, but our advice is if you did not have it in service, and you were diagnosed way later, you never went to medical and you didn't complain of sleep issues, more likely than not, the VA may not service connect.

If you are service connected for behavioral health and your psychiatrist is willing to write a nexus for your sleep apnea secondary to your service-connected behavioral health, you can try that way. But the VA is, I don't want to say picky, but they scrub sleep apnea claims a little bit more than a regular claim, if that makes sense.

Crista Ellis 01:07:55
What would you recommend to our friend here who's inquiring about sleep apnea? Where would they turn to get some answers about that?

Johnnie Bourque 01:08:02
Get your sleep test. Get your current sleep test. Get your strong nexus letter from your doctor that you see for sleep apnea. You can write your statement on sleep apnea. If you were married or had a roommate or something and you still speak with them, they can write a statement on your behalf too.

It's just that strong nexus letter that you will need from your doctor that states more likely than not, your current diagnosis of sleep apnea is related to your military service.

Crista Ellis 01:08:36
Jane is writing in, “I'm still confused about benefits for non-service-related Parkinson's. Where do we start?”

Johnnie Bourque 01:08:46
So they are not service connected? Sorry. Am I understanding they are not service connected for Parkinson's?

Crista Ellis 01:08:54
They don't describe themselves as being service connected or not, but confused about the benefits related to being non-service connected.

Johnnie Bourque 01:09:05
Non-service connected, like Ms. Emily and Ms. Gretchen spoke of earlier, you can receive health care. You may have a small copay. But as for receiving money on a monthly basis from VA, you will not receive that. That's for service connected only.

Crista Ellis 01:09:26
Thank you for sharing, Johnnie. Appreciate you clarifying that.

James is asking us, “How can we find out what PD symptoms have been used to assign our current rating and what our current rating is?”

Johnnie Bourque 01:09:42
You would contact the 1-800 number or your VSO. Your VSO would have access to your VA file and can see exactly, so your Parkinson's 30%, the tremors are 10% or whatever it may be. Your VSR can look at your VA file and tell you exactly what your percentages are for.

Crista Ellis 01:10:07
It's very helpful. Thank you.

We'll be able to offer that phone number at the end of the program. You'll all receive resources and a link to a full white paper of resources and links to connect to. Thank you, Emily, for continuing to drop some resources in the chat as well.

Johnnie, one of our viewers, David, is asking what benefits are available for spouses of veterans.

Johnnie Bourque 01:10:32
As long as the veteran is alive, for VA purposes, they will go to the veteran. And depending on your rating, I should say that too. If you're 100% P&T, then your spouse may be able to get VA health care. But that depends on your rating.

Once the veteran passes, and if the veteran passes from a service-connected disability, as long as that is listed on the death certificate, the surviving spouse will then be eligible for what's called Dependency and Indemnity Compensation, DIC. But his service-connected issue has to be on the death certificate, or he has to be rated at 100% P&T for 10-plus years.

Crista Ellis 01:11:33
Thank you for outlining those benefits for us, Johnnie. I know it can be a little bit confusing, which is why people like Johnnie are here to serve us and answer these questions on a more personal level. So I strongly encourage each of you to find your VSO nearby and start that dialogue with someone who's able to support you through navigating these questions, the systems, and being connected with the services that you deserve.

We have another question. I'm not sure who asked this one, but why is it not feasible anymore to obtain a copy of one's DD 214 at CVSOs? What options are there now for doing this?

Johnnie Bourque 01:12:24
So if you're trying to gain your DD 214, you can go to archives.gov. G-O-V. Do not go to archives.com because .com will charge you. So please go to archives.gov. But if your VSR has a copy of your DD 214, I know we can, for the state of Virginia. I can't speak for other states. If we have a copy of your DD 214, we can give it to you, of course. Or go to archives.gov.

Crista Ellis 01:13:00
Archives.gov. Thank you. Can you say what a DD 214 is?

Johnnie Bourque 01:13:06
It's your discharge paperwork that you receive once you're out of the service. It tells you your time in service, your rank and your character of discharge. It says your awards and stuff like that. For Vietnam vets, it's important that they have the Vietnam Service Medal, the Vietnam—there's another Vietnam citation on there too. That's how the VA knows, oh, they were in Vietnam. So, yes.

Crista Ellis 01:13:40
Johnnie, are you aware if a service member of the Navy, six years active duty, are there any benefits for hospice?

Johnnie Bourque 01:13:54
I would have Ms. Emily or Ms. Gretchen answer that because that's more health care. Possibly? I apologize.

Crista Ellis 01:14:04
Not at all. I appreciate your ability to acknowledge where you don't have the answers. Gretchen, I see you're here. So, do we know if there are benefits related to hospice?

Gretchen Glenn 01:14:15
There are. If you're eligible for VA health care and you receive VA health care, we do have hospice teams through the hospital. Many VAs, not all, but many VAs have hospice units, oftentimes at their nursing home. That's where we have ours in Philadelphia. There is also an option to have hospice covered from the VA if you're at home too, but you have to get all that authorized through your primary care team or, if you're affiliated with a PADRECC, it has to all get approved through the VA before they'll start paying for it.

If that's a question, talk to your VA health care provider. They'll connect you most likely with a social worker and possibly the palliative and hospice team at your VA to determine if you're eligible for it. But it is part of the benefit.

Crista Ellis 01:15:12
Feel free to stay on, Gretchen. We have an interesting question that I think would be curious to ask out loud. One of our viewers is sharing, “My partner's service record does not reflect any service because he was on top secret assignments. Can the VSO gain access to those secret assignments? He's been unable to obtain benefits for his Parkinson's, which he believes is connected to those assignments.”

Gretchen Glenn 01:15:44
That's a tough one that we hear a lot.

Johnnie Bourque 01:15:47
Yes. Not that I can think of. Maybe they're declassified by now, so maybe he can contact his branch of service, because I'm sure they have something on record if it's declassified by now. But as for public, no. It has to be declassified. Not that I know of.

Gretchen Glenn 01:16:12
It is a challenge that we've heard. You're not alone. I've heard this challenge before, and unfortunately, it sounds like Johnnie and I don't have a good way to direct you except to keep trying.

Crista Ellis 01:16:27
Keep trying. Yeah. Go ahead, Johnnie.

Johnnie Bourque 01:16:33
If they maybe received an award or something that says, hey, you were in Vietnam, or something that states that they were in Vietnam or the location, maybe. Even if it's not a DD 214, that's proof right there of some sort. Possibly.

Crista Ellis 01:16:53
I love your optimism.

Gretchen Glenn 01:16:57
You've got to get creative sometimes and just try. That's what we say. You just have to work with us, work with the veteran service officers to just brainstorm together. We're your advocates, and we'll try our best. We can't always make it happen, but we'll certainly try.

Crista Ellis 01:17:16
Yeah.

I am just really quickly looking through the open questions right now to see if there's one that's relevant to today's subject. If you're asking for more specific information, I highly recommend you reach out to the Parkinson's Foundation Helpline, and they'll be able to guide you with your specific questions and resources that can support you.

All right, here's one. Got it. Glenn asks, “Do I still need to pay Medicare premiums if I have 100% service-connected disability and receive all care through the VA?”

Gretchen Glenn 01:18:03
My suggestion is always to keep Medicare Part A because you don't pay for that. If you call 911, 911 is going to take you to your closest hospital emergency room. They're not going to transport you to the VA. So if you don't have Medicare Part A, you're going to get stuck with that bill if you don't have any insurance. And we can't guarantee, if it's not related to one of your service-connected conditions, if the VA is going to necessarily pick up the cost of that hospitalization or the ambulance ride or anything like that. So I always recommend that you at least keep A.

B, it's kind of up to you. If you chose to want to get a second opinion at some point, the VA does not necessarily have to agree to covering that second opinion if we provide the care at our hospital or at the VA. So if you wanted a second opinion and the VA wouldn't send you out for it because we already have the specialists here, you would then have to pay for that outpatient care that would fall under B. But I'm curious if Emily and Johnnie have anything differently that they say.

Emily Hall 01:19:17
I definitely think it's, I mean, like Gretchen said, it's not required. If you're 100% disabled and you get everything through the VA, you're not required to keep Part B. I just, as someone who also works at a community hospital and sees a lot of veterans who come through those doors as well, it opens up a lot more flexibility and options as far as community care, or if you needed to have short-term rehab done at a facility that is close to your house versus trekking to the VA.

I think sometimes it's nice for having a little bit more as far as options. Now, some of these Medicare Advantage plans, which I could go on a long rant about, sometimes the costs, the premiums are really, really high. I think it's about weighing your options on that and seeing whether or not you feel like that plan is right for you. Because again, if there are specific programs within that that you utilize, that's great, or providers that you see with it, that's great. But most of those programs are usually a little bit more costly.

If you are 100%, you have that dental eligibility, which a lot of times people will pick those Medicare Advantage plans because they have dental in there. But if you're 100%, you can use dental through the VA, which I think is a really big benefit, honestly.

Crista Ellis 01:21:00
All right, my friends and community, thank you all so much for sharing your time with us today. A big thank you to Johnnie for generously sharing your expertise. I hope everyone has walked away with fresh perspectives and feels motivated to use this knowledge to improve your care and deepen your connections.

A message that I'm receiving from today is keep trying, keep asking. You don't know the answer unless you ask the question. So continue to poke and prod and nudge your community members who are supporting you through navigating the VA system. Continue calling the Parkinson's Foundation Helpline. Send us emails. Ask the questions. Keep trying.

Today's webinar and the entire Veterans Webinar Series is presented with support from the Don and Lorraine Freeberg Foundation. We want to take this moment to thank the Freeberg Foundation for helping to make these programs possible.

Join us for the second program of our Veterans Webinar Series, Care Partners of Veterans with PD, on December 12. This program provides essential guidance for care partners of veterans living with Parkinson's disease. You will gain insights into effective strategies for navigating evolving roles and accessing beneficial support services. Join us to deepen your understanding of the comprehensive care services and caregiver resources provided by the VA and the Parkinson's Foundation. You can find more information and register for the program on our webpage at Parkinson.org/Veterans.

In the same vein of providing resources for care partners, join us this November for our Care Partner Summit Webinar Series, designed specifically for those supporting someone with Parkinson's. Whether you're new to the role or have been caring for a while, these webinars will offer valuable strategies for managing Parkinson's, maintaining strong relationships, and navigating daily challenges with confidence. Our expert panelists, people who are living with and impacted by Parkinson's disease, will offer you practical tools to support you every step of the way. We are hosting three webinars throughout the month of November. You can sign up for all three of them or one that speaks to you the most. Again, you can scan that QR code on the screen or visit our webpage at Parkinson.org/Summit.

The Parkinson's Foundation wants to hear from you through our PD Story page. The Foundation shares stories written by anyone in the Parkinson's disease community. These stories help bring awareness to this life-changing disease and help to inspire others. As a veteran or a loved one caring for someone with Parkinson's disease, your experience is unique. We encourage you to submit your PD story and share your experience with others in the community. You can visit Parkinson.org/PDStories.

Don't forget to visit our webpage and explore the resources offered by the Parkinson's Foundation that can support your navigation of living with Parkinson's as a veteran. That website is Parkinson.org/Veterans.

If you had a question today that was not answered, please reach out to our Helpline by calling 1-800-4-PD-INFO or emailing Helpline@Parkinson.org. You can use that same contact information to order our free resources, educational book series and our Hospital Safety Guide. We thank you for joining us today and hope to see you again soon. Be well and keep trying.