Today I received my findings from the PEB. They were not what I had expected (UNFIT, 0% DOD, 100% VA P&T). I'd like to gain some knowledge about CHAMPVA, since I will not receive Tricare upon separation. Are there any folks out there who have used CHAMPVA? I've downloaded everything CHAMPVA has, but unclear what the actual cost for a family of 5 would be. I've never been great at reading between the lines on insurance policies.
CHAMPVA Deep Dive
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Jason Perry
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I personally have no experience using CHAMPVA, so hopefully others with direct experience will chime in.
However, with a 0% DoD rating, I wanted to make sure that it was actually a 0% rating for an unfitting condition OR if it was deemed non-compensable because the PEB stated that your unfitting condition Existed Prior to Service and was not Service Aggravated.
Can you confirm the situation? It matters for the appeal options (likely a VARR vice challenging the EPTS issue). I have come across a high volume of EPTS cases that I am confident are being decided indirectly.
However, with a 0% DoD rating, I wanted to make sure that it was actually a 0% rating for an unfitting condition OR if it was deemed non-compensable because the PEB stated that your unfitting condition Existed Prior to Service and was not Service Aggravated.
Can you confirm the situation? It matters for the appeal options (likely a VARR vice challenging the EPTS issue). I have come across a high volume of EPTS cases that I am confident are being decided indirectly.
It's a 0% rating for an unfitting condition (tbi) which occurred in a combat zone. The VA lumped all MH together (70%) which reduced my tbi rating to 0%
Wow! I have a feeling that if you consult a good attorney that you have decent chance of getting that changed. Getting a zero percent unfitting rating is an oxymoron for most situations. I bet you could request a FPEB and get mental health added as unfitting to bump up from 0% to 70%. A 70% rating for mental health is by definition unfitting lol since work impairment is alleged.
I probably could, or they could just find me fit and I'd depart with nothing. I've been fighting this battle for almost a year. From what I hear the formal PEBs are at a stand still. Before that, they were taking 4-6 months.
Your case is unique. Definitely talk to an attorney. You may not have to get to a Formal. When you submit for a FPEB your attorney can include a written appeal. If your evidence is compelling many times they will grant your request and cancel your Formal and send you an updated form to sign.
My dads widow uses champva and it’s pretty comparable to tricare. There are dental and vision benefits you can also enroll in and add on. One of the best though is meds by mail”, a family member takes some expensive drugs and getting them through champva meds by mail the copay is far get cheaper saving her hundreds of dollars a month as compared to going to a local pharmacy.
@johnbgately Any thoughts on this?
That's good to hear! Thank you for the feedback. It's so hard to find true info on it. Do you know the out of pocket cost for her every year?
That would be nice!
I can confirm that that the written appeal sent with your FPEB packet can result with the board granting your request without having a to go through the FPEB. This happened in my situation. Like @Provis said, with an attorney you probably have a good chance of getting this changed. Most of us on here know the feeling of just wanting the whole process to be done as quickly as possible, but just by reading your comments, future healthcare is more important than money and trust me when I say that Tricare with a medical retirement is absolutely better than any other healthcare you will have for yourself and your family. I have had to have three surgeries since I was retired and just knowing there is no bill, no delay and it’s a surgeon I chose makes that extra time I kept fighting worth it.
If you haven’t talked to the Soldiers council MEB attorney yet, go talk to them and quickly—they are free. Consider hiring a private attorney, the money spent now will hopefully save you time and money later. I have no idea how much it cost to take out two of my organs that grew worse because of worsening GI issues after I retired because I have Tricare and paid nothing—it is probably in the tens of thousand of dollars. Now imagine yourself, wife or child in a similar situation and a bill shows up—it’s worth the time and money right now to get it correct.
Sorry for the long lecture, but I know to many people that just either got out with a ton of medical problems and are suffering right now because of no or terrible healthcare coverage or they rushed their MEB/PEB and now claim they got “screwed”. The Army does not care about you and they will give you the lowest bid and see if you take it. Don’t let yourself get screwed over, you not fighting this is hurting no one but yourself.
My wife has a ton of medical issues. It's really for her that I'm looking into everything before I make a decision. Is the soldiers council MEB attorney for Marines also? I'm speaking with mine on Monday. Him and I sort of brainstormed the possibility that this would happen. If I remember correctly, he stated that I could always accept and request a one time VA reconsideration and it should bump it up. I'm not quite sure how accurate that is because it has been a few months since we spoke and it wasn't the top priority of the conversation.
Honestly, I appreciate the lecture. This is why I created this thread. Thank you.
Yes its the same type attorney but just with a different name. The links below is some Navy/Marine info, but it sounds like you are already on top of it. I hope this goes in your favor, we are always here to assist.
Disability Evaluation System
The Navy Judge Advocate General’s Corps provides solutions, from a military perspective, to legal issues involving military operations, organization, and personnel, wherever and whenever such solutions are required, with primary focus on operations, accountability, Sailor legal readiness, and...
A good attorney will want to employ a strategy where you have more than one way to achieve your goal if possible. I would try to get another condition added as unfitting AND do a VARR. If you concur and do a VARR and it comes back the same you are out of luck.
Sorry, I missed this question while dealing with USAF FPEBs on Friday. If you are working with a Code 16 attorney at the Navy Yard- the Navy's formal hearing attorneys- you are undoubtedly already gaming out your strategy. It is hard for us to speculate on the merits of going to an FPEB without reviewing your TRIM file. Still, Provis is correct- the Navy panel has been stipulating in many cases as of late- stipulating means an on-the-record decision. The key to deciding the next step is to review how likely you will be found Fit and what conditions may logically be possible to add at an FPEB. If there is a risk of being found fit, you may simply proceed with a VARR. To play it safe, you can always request an FPEB, retract that election, and proceed with a VARR if that is the better way to go. FYI, most hearings are now being scheduled out eight weeks or less now, not 4-6 months. The lengthy period is waiting for the IPEB findings. That wait is over, and now you are on a much shorter clock
Thanks for the info! That sounds encouraging. The PEBLO told me that they are 4-6 months but that they are at a stand still and expect to be longer than that here soon.
The VA formulary is very different than express scripts (DoD contract). I see that as a big downside of going VA.
Charlie,
Champva can work outside the formulary. My stepmother is on otezla very expensive and was costing her 350 per month copay through Walmart pharmacy. Now that she does champva meds by mail she pays like 60 I think I’ll have to ask her.
Va and Champva are completely different champva is much more like tricare and meds by mail is exactly like express scripts.
Was the $350 copay while she was using CHAMPVA?
Nevermind. I just reread your post. Basically, it sounds like if I go with CHAMPVA for my family they would have to use express scripts to reduce cost?