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2011 Service Office Seminar. Service Office Website www.vfwilserviceoffice.com.

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Presentation on theme: "2011 Service Office Seminar. Service Office Website www.vfwilserviceoffice.com."— Presentation transcript:

1 2011 Service Office Seminar

2 Service Office Website www.vfwilserviceoffice.com

3 National Policy Changes Post SO Records Post SO Records Post SO Actions Post SO Actions

4 REVIEW VA Claim Backlog VA Claim Backlog PTSD Changes PTSD Changes Agent Orange Changes Agent Orange Changes OIF / OEF Changes OIF / OEF Changes Camp Lejeune Marines Camp Lejeune Marines

5 VA Claim Backlog 12-26-09481,751 12-26-09481,751 12-27-10704,599 12-27-10704,599 6-27-11832,674 6-27-11832,674 7-25-11839,301 7-25-11839,301 8-29-11846,079 8-29-11846,079 9-26-11849,709 9-26-11849,709

6 PTSD Changes Changes in regulation relaxed requirement for veteran to provide evidence of a verifiable stressor – effective July 12, 2010

7 AO Changes New Presumptives New Presumptives Korean Service Korean Service Thailand Service Thailand Service Blue Water Sailors Blue Water Sailors

8 OIF / OEF Changes New Presumptives added to list of disabilities under 38 CFR 3.317

9 Camp Lejeune Marines https://clnr.hqi.usmc.mil/clwater/ https://clnr.hqi.usmc.mil/clwater/index.aspx Register with the Navy research program if on base 1957-1987 Register with the Navy research program if on base 1957-1987 File a claim with the VA File a claim with the VA

10 National Research Council The National Academy of Sciences National Research Council published its Contaminated Water Supplies at Camp Lejeune, Assessing Potential Health Effects, in 2009.

11 This report included a review of studies addressing exposure to Trichloroethylene (TCE), and Tetrachloroethylene or Perchloroethylene (PCE), as well as a mixture of the two, and a discussion of disease manifestations potentially associated with such exposure.

12 Fourteen disease conditions were identified as having limited/suggestive evidence of an association with TCE, PCE, or a solvent mixture exposure. They include: esophageal cancer esophageal cancer lung cancer lung cancer

13 breast cancer breast cancer bladder cancer bladder cancer kidney cancer kidney cancer adult leukemia adult leukemia multiple myeloma multiple myeloma myleodisplasic syndromes myleodisplasic syndromes

14 renal toxicity renal toxicity hepatic steatosis hepatic steatosis female infertility female infertility miscarriage, with exposure during pregnancy miscarriage, with exposure during pregnancy scleroderma scleroderma neurobehavioral effects neurobehavioral effects

15 Public Law 111-275 Changes in VA Program Benefits: Burial & Plot Allowances SMC changes for amputation levels SMC changes for TBI Earlier date for survivors of POW Extends Eligibility for Auto Allowance Increases Auto Allowance

16 Veteran Population 9-30-10 National Total22,658,145 National Total22,658,145 Illinois Total 782,747 Illinois Total 782,747 Illinois Male 725,626 Illinois Male 725,626 IL Gulf War Era 190,079 IL Gulf War Era 190,079 IL Vietnam War Era 251,301 IL Vietnam War Era 251,301 IL Korean War Era 84,132 IL Korean War Era 84,132 IL WW II Era 72,441 IL WW II Era 72,441

17 VA Health Care Benefits

18 VA Facilities VISNs (Regional centers for administrative control) VA Medical Centers (5 in Illinois) Outpatient Clinics Vet Centers

19

20 Eligibility Reform 1985 1997

21 VA Eligibility Reform 1997 - Major improvements in VA Health Care Delivery 1997 - Major improvements in VA Health Care Delivery a. Required an enrollment system for most veterans b. Established a Comprehensive Uniform Benefits Package for veterans c. Simplified application d. Catastrophic Disability Reform d. Catastrophic Disability Reform The most significant piece of legislation to be passed in the history of VA health care The most significant piece of legislation to be passed in the history of VA health care

22 VA Eligibility Reform Improvements as a result of Eligibility Reform Improvements as a result of Eligibility Reform –Veteran Patient Uniform Benefit Package –Same level of VA medical benefits regardless of geographic location –Assures comprehensive, portable health benefits

23 Medical Benefits Package Preventive Care Services Preventive Care ServicesImmunizations Physical Examinations Health Care Assessments Screening Tests Health Education Programs

24 Ambulatory Diagnostic & Treatment Services Ambulatory Diagnostic & Treatment Services ER outpatient care in VA facilities Medical care Surgical care Chiropractic care Mental Health care Bereavement Counseling Substance Abuse Counseling

25 Hospital Diagnostic & Treatment Hospital Diagnostic & Treatment ER inpatient care in VA facilities Medical care Surgical care Mental Health Care Substance Abuse Counseling

26 Medications & Supplies Medications & Supplies Prescription medications Over the counter medications Medical & surgical supplies (Generally they must be prescribed by a VA provider and be available under VAs national formulary)

27 Non VA Prescriptions Generally only veterans with special eligibility, such as veterans receiving NSC A&A or HB benefits, or who are approved by a VA health care facility for Fee Basis are eligible to obtain medications at VA expense.

28 If you see a non-VA provider and want to have prescriptions filled by VA, all of the following criteria must be met: You must be enrolled in VA health care. You must be enrolled in VA health care.

29 You need to have an assigned Primary Care Provider. You need to have an assigned Primary Care Provider. It is your responsibility to provide your VA health care provider with your medical records from your non-VA provider. It is your responsibility to provide your VA health care provider with your medical records from your non-VA provider.

30 Your VA health care provider has to agree with the medication prescribed by your non-VA provider. Your VA health care provider has to agree with the medication prescribed by your non-VA provider. (Your VA health care provider is under no obligation to prescribe a medication recommended by a non-VA provider. )

31 VA Eligibility Reform Veterans rated 50% or more SC and those receiving care for their SC conditions do not need to formally enroll Veterans rated 50% or more SC and those receiving care for their SC conditions do not need to formally enroll All other veterans are required to enroll All other veterans are required to enroll

32 VA Eligibility Reform Based on eligibility and income information, the veteran is placed into one of eight enrollment priority groups Based on eligibility and income information, the veteran is placed into one of eight enrollment priority groups

33 VA Eligibility Reform 1) Veterans rated 50% or more SC 2) Veterans rated 30% or 40% SC

34 3) Veterans rated 10% or 20% SC; Veterans rated 10% or 20% SC; Former POWs; Former POWs; Recipients of Purple Heart; Recipients of Purple Heart; Recipients of the Medal of Honor; Recipients of the Medal of Honor;

35 3) Continued: Veterans discharged from Active Duty due to disability incurred or aggravated inline of duty; Veterans discharged from Active Duty due to disability incurred or aggravated inline of duty; Veterans receiving compensation under 38 USC 1151; Veterans receiving compensation under 38 USC 1151;

36 4) Veterans receiving NSC A&A or NSC Housebound benefits; Veterans receiving NSC A&A or NSC Housebound benefits; or those determined to be Catastrophically Disabled or those determined to be Catastrophically Disabled

37 …permanent severely disabling injury, disorder or disease that compromises the ability to carry out the activities of daily living that requires constant supervision to avoid physical harm to self or others.

38 5) 0% noncompensable SC Veterans whose income and net worth are below threshold; 0% noncompensable SC Veterans whose income and net worth are below threshold; NSC Veterans below income and net worth threshold; NSC Veterans below income and net worth threshold; Veterans receiving NSC Pension; Veterans receiving NSC Pension; Veterans eligible for Medicaid Veterans eligible for Medicaid

39 6) Veterans solely seeking care for a disorder associated with exposure to toxic substance or radiation; Veterans solely seeking care for a disorder associated with exposure to toxic substance or radiation;

40 6) Continued: for a disorder associated with service in the Southwest Asia theater of operations during the Gulf War; for a disorder associated with service in the Southwest Asia theater of operations during the Gulf War;

41 6) Continued: for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998; for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998; 0% SC veterans receiving compensation 0% SC veterans receiving compensation

42 7) Veterans whose income is above the VA Means Test threshold but below the Geographic Means Test threshold who agree to copayments (inpatient copays reduced by 80%)

43 8) Noncompensable 0% SC Veterans; Veterans with gross income above the geographically adjusted income threshold for their resident location by 10% or less and who agree to pay copays.

44 VA Eligibility Reform Enrollment: VA form 10-10EZ Enrollment: VA form 10-10EZ The information is input electronically into the local Vista system & transmitted to the EC for eligibility verification The information is input electronically into the local Vista system & transmitted to the EC for eligibility verification The information is verified against VBA C&P master files, with corrections returned to the EC The information is verified against VBA C&P master files, with corrections returned to the EC The EC transmits the verified data to all facilities having the veteran in their data base the following night The EC transmits the verified data to all facilities having the veteran in their data base the following night

45 VA National Income Thresholds: Groups thru 7 Household Income less than: Free Presrip:Health Care: Vet$11,830$29,402 Vet+1$15,493$35,284 Vet+2$17,513$37,304

46 VA National Income Thresholds: Group 8 Household Income less than: Health Care: Vet$32,342 Vet+1$38,812 Vet+2$41,034

47 VA Eligibility Reform Geographic Means Test Geographic Means Test –Enrollment Priority Group 7 for inpatient care will be those veterans with incomes above the VA MT threshold but below the HUD index for their area –Inpatient co-pay will be 20% of regular co-pay –Outpatient co-pay unchanged

48 VA Eligibility Reform Geographic MT cont: Geographic MT cont: –Enrollment Priority Group 8 for inpatient care will be those veterans with incomes above the VA MT and HUD thresholds –Full co-pay for both inpatient and outpatient

49 Geographical Means Test Refer to State chart by County Handout

50 VA Eligibility Reform Co-payments for health care 0$ Preventative Medicine 0$ Preventative Medicine 15$ Primary Care Visit 15$ Primary Care Visit 50$ Specialty Care Visit 50$ Specialty Care Visit 8$ Groups 2-6 each 30 day supply 8$ Groups 2-6 each 30 day supply 9$ Groups 7-8 each 30 day supply 9$ Groups 7-8 each 30 day supply

51 VA Health Care Enrollment Decisions Annually Its important to remember that VA health care depends primarily on congressional funding, which may affect VAs ability to care for all priority groups. Subsequent appropriations which do not meet the needs to treat all priority groups may require dis-enrollment of some priority groups, therefore encourage veterans to keep any health care insurance they may have.

52 Enrollment Review Annually the VA will require verification of enrollment via VA Form 10-10EZR

53 National Enrollment Enrollment is National, HOWEVER…

54 Billing Health Insurance Companies When applying for medical care, all veterans must provide information pertaining to your health insurance coverage, including your spouses insurance policy. A veterans eligibility for VA health care benefits is not affected by health insurance coverage.

55 Billing Health Insurance Companies The VA will bill private insurance carriers for all non service connected treatment regardless of your priority group. VA is not allowed to bill Medicare or Medicaid.

56 If the full cost of your care is not fully recovered, VA will not collect nor otherwise hold you responsible for the charges not covered by the insurance company. VA will not reimburse or credit co-pays based on collected insurance payments.

57 Special Groups Former POWs Former POWs Purple Heart Recipients Purple Heart Recipients Incarcerated Veterans Incarcerated Veterans Homeless Veterans Homeless Veterans Woman Veterans Woman Veterans

58 Travel Pay Veteran SC 30% or more, or Veteran SC 30% or more, or Treatment of SC disability, or Treatment of SC disability, or Receiving NSC Pension, or Receiving NSC Pension, or Scheduled C&P examination, or Scheduled C&P examination, or Income less than the max VA Pension rate Income less than the max VA Pension rate

59 Travel Pay Rate: $0.41.5 per mile Rate: $0.41.5 per mile Scheduled appointments – round trip Scheduled appointments – round trip Unscheduled appointments may be limited to return mileage only Unscheduled appointments may be limited to return mileage only

60 Travel Pay Deductible: $3.00 each way Deductible: $3.00 each way Deductible: Monthly cap of $18 Deductible: Monthly cap of $18 After monthly cap remaining travel pay THAT month will be paid without further deductible After monthly cap remaining travel pay THAT month will be paid without further deductible

61 Waiver of Travel Deductible In receipt of NSC Pension In receipt of NSC Pension NSC veteran with income less than pension rate NSC veteran with income less than pension rate SC veteran with income less than national means test threshold SC veteran with income less than national means test threshold Veteran traveling for C&P exam Veteran traveling for C&P exam

62 Travel Pay EXAMPLESHandout

63 Fee Basis When the VA cannot provide treatment for a service connected disability or for a condition under VA care they MAY authorize community based fee basis treatment at VA expense.

64 Fee Basis Treatment must have: Prior authorization in writing from the Medical Center of jurisdiction, –name the provider, –the treatment, –the duration and –the authorized fee.

65 It will be the Medical Centers option to authorize community Fee Basis care or to require treatment by another VA facility capable of providing the indicated treatment or surgery.

66 Long Term Care VA Inpatient programs VA Outpatient programs State Veterans Homes

67 Long Term Care Veteran SC 70% or more Veteran SC 60% and is P&T Veteran requires nursing care due to SC disability Veterans who meet income & asset criteria Others on case by case basis

68 Nursing Home Care VA Nursing Care Units Contract Community Nursing Homes State Veterans Home

69 VA Nursing Care Unit Vary between VA facilities! Long term Short term Transitional - stabilization Rehabilitation

70 Contract Nursing Care Availability not uniform! Placement by VA Social Worker. Requires prior VA inpatient status.

71 State Veterans Homes VA subsidizes cost of care by contract. Cost shared by veteran unless placed by VA on contract. Admission policies and resident fees are controlled by the state.

72 Non-Institutional Care Programs Vary Home based primary care Contract home health care Adult Day Health Care Homemaker & Home Health Aide Community Residential Care Respite Care Domiciliary Care

73 Hearing & Vision Aids VA will provide diagnostic audiology and diagnostic and preventative eye care services. VA will MAY provide hearing aids and eyeglasses to veterans on NSC A&A or HB, veterans receiving compensation, are former POW or PH recipient.

74 Dental Care Full Eligibility Veteran has a SC compensable DENTAL disability Veteran has a SC compensable DENTAL disability Veteran is a former POW Veteran is a former POW Veteran is 100% SC rated or SC with IU Veteran is 100% SC rated or SC with IU

75 Dental Care One time dental care following AD of 90 days if applied for within 180 days of discharge from AD

76 Dental Care Needed care for a SC noncompensable dental condition resulting from combat wounds or service trauma.

77 Dental Care Dental care to treat the oral condition that has a direct and material detrimental effect to a service connected medical condition

78 Dental Care Dental care required to make possible, to continue or prevent interruption of a Vocational Rehabilitation program or to secure employment during the period of employment assistance.

79 Dental Care Dental care to treat the oral condition that is determined to complicate a medical condition currently under treatment.

80 Dental Care To a Homeless enrolled veteran under VHA Directive 2007-039 a one time course of dental care determined medically necessary to relieve pain or to assist in gaining employment.

81 Dental Care To a veteran receiving hospital, nursing home or domiciliary care determined to be essential to the management of the medical condition under active treatment.

82 My Healthe Vet VA s online Personal Health Record requires veteran to register online at: www.myhealth.va.gov Future enhancements to the program will require personal authentication at a local VA medical facility.

83 Misc VHA Benefits Automobile Allowance Automobile Allowance Clothing Allowance Clothing Allowance Home Improvement & Structural Alterations (HISA) Grant Home Improvement & Structural Alterations (HISA) Grant

84 Automobile Allowance One lifetime automobile purchase grant One lifetime automobile purchase grant ($11,000 increased to $18,900 10-1-11) Adaptive equipment allowance every four years Adaptive equipment allowance every four years Requires Rating Board decision of loss of use of hand or foot or significant vision impairment of both eyes Requires Rating Board decision of loss of use of hand or foot or significant vision impairment of both eyes

85 Clothing Allowance Annual allowance each August - $716 Annual allowance each August - $716 Veteran with a prescription for a prosthetic or orthopedic appliance due to SC disability Veteran with a prescription for a prosthetic or orthopedic appliance due to SC disability Veteran with a prescription for topical medication for SC skin condition Veteran with a prescription for topical medication for SC skin condition

86 HISA Grant Veteran with disability to provide access to the home or to essential lavatory/sanitary facilities Veteran with disability to provide access to the home or to essential lavatory/sanitary facilities $6,800 for a SC condition $6,800 for a SC condition $6,800 for a NSC condition if veteran is SC 50% of more $6,800 for a NSC condition if veteran is SC 50% of more $2,000 for all other veterans $2,000 for all other veterans

87 Millennium Health Care Act

88 Background of the Millennium Act Emergency Care Benefit Public Law 106-117, the Veterans Millennium Health Care and Benefits Act authorizes the Department of Veterans Affairs (VA), to reimburse claimants for emergent non VA treatment of non service-connected conditions. Under this authority, a veteran must meet certain conditions to be eligible for direct payment of or reimbursement of payment for the emergency medical services.

89 Background of the Millennium Act Emergency Care Benefit This act was established as a safety net for veterans who have no other means of paying a non-VA facility emergency bill. This act was established as a safety net for veterans who have no other means of paying a non-VA facility emergency bill. VA will pay for all medical care necessary to stabilize a emergent condition. Once the veteran can be stabilized and safely transported, VA will arrange for treatment at an appropriate VA facility, if necessary. VA will pay for all medical care necessary to stabilize a emergent condition. Once the veteran can be stabilized and safely transported, VA will arrange for treatment at an appropriate VA facility, if necessary.

90 Eligibility for Benefit This authority establishes VA as a payer of last resort. Therefore, as a payer of last resort, VA can only authorize payment or reimbursement under the following conditions:

91 Veteran is enrolled in the VA Health Care System. Veteran is enrolled in the VA Health Care System. Veteran must have been provided care by a VA clinician or provider within the last 24 months. Veteran must have been provided care by a VA clinician or provider within the last 24 months.

92 Veteran was provided care in a hospital emergency department or similar facility providing emergency care. Veteran was provided care in a hospital emergency department or similar facility providing emergency care. Veteran has no other form of health insurance. Veteran has no other form of health insurance.

93 VA Medical Center of jurisdiction was timely informed (48 hours). VA Medical Center of jurisdiction was timely informed (48 hours). Veteran agrees to transfer to VA facility upon medical stabilization. Veteran agrees to transfer to VA facility upon medical stabilization.

94 Veteran has no coverage under Veteran has no coverage under Medicare, Medicaid, or a state program. Veteran has no coverage under Veteran has no coverage under any other VA programs.

95 Department of Veterans Affairs or other Federal facilities are not feasibly available at time of emergency event. Department of Veterans Affairs or other Federal facilities are not feasibly available at time of emergency event. A reasonable lay person would judge that any delay in medical attention would endanger your health or life. A reasonable lay person would judge that any delay in medical attention would endanger your health or life.

96 The veteran is financially liable to the provider of the emergency treatment for that treatment The veteran is financially liable to the provider of the emergency treatment for that treatment The veteran has no other contractual or legal recourse against a third party. The veteran has no other contractual or legal recourse against a third party.

97 The new rule does not affect veterans who are already covered for non-VA emergency services, for example, veterans receiving fee basis care for a service connected disability.

98 Should the VA determine the emergency care meets the criteria of the Mill Bill, transportation costs from the home to emergency facility may be paid. Should transportation from the emergency facility to a VA approved facility be required, the veteran must meet beneficiary travel regulations.

99 Where Do You Send The Claim? To initiate a claim for emergency treatment a claimant must submit VA Form 10-583 to the Fee Basis unit of the VA medical facility of jurisdiction (defined as the nearest VA medical facility to where the emergency service was provided).

100 Regulatory Time Frames for Submitting Claims To receive payment or reimbursement for emergency services, a claimant must file a claim within 90 days after the latest of the following: (1) The date that the veteran was discharged from the facility that furnished the emergency treatment;

101 (2) The date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or (3) The date the veteran finally exhausted, without success, action to obtain payment or reimbursement for the treatment from a third party

102 Delegation of Authority The Chief of the Health Administration Service or an equivalent official at the VA medical facility of jurisdiction will make all determinations regarding payment or reimbursement under 38 U.S.C. 1725

103 Prudent Lay Person The Fee Service Review Physician or equivalent officer at the VA medical facility of jurisdiction will make determinations regarding the prudent layperson, feasibility of VA facilities and point of stabilization criteria. The Fee Service Review Physician or equivalent officer at the VA medical facility of jurisdiction will make determinations regarding the prudent layperson, feasibility of VA facilities and point of stabilization criteria. An MD concurrence is necessary for all denials. An MD concurrence is necessary for all denials.

104 Reimbursement The non-VA facility will file for reimbursement from the VA. Eligible veterans will not be required to pay any fees should the non-VA facility accept VA payment for the care. If the non- VA facility bills the veteran directly, the veteran should contact his local VA health care facility and a representative will assist in resolving the issue. The non-VA facility will file for reimbursement from the VA. Eligible veterans will not be required to pay any fees should the non-VA facility accept VA payment for the care. If the non- VA facility bills the veteran directly, the veteran should contact his local VA health care facility and a representative will assist in resolving the issue.

105 VA will pay 70 percent of the Medicare fee schedule, or if no schedule, 70% what the VA would normally pay under guidelines which are in compliance with 38 CFR, or VA regulations. VA will pay 70 percent of the Medicare fee schedule, or if no schedule, 70% what the VA would normally pay under guidelines which are in compliance with 38 CFR, or VA regulations.

106 Other Significant Millennium Bill Changes Required VHA to establish chiropractic care policy provided to veterans, which is now in effect Restored eligibility for CHAMPVA surviving spouses who remarry (and lose eligibility) and then later terminate those marriages

107 Caregiver Support Eligible Veterans: Sustained a serious injury on or after 9-11-01 Sustained a serious injury on or after 9-11-01 In need of personal care services die to inability to perform one or more activities of daily living or need protection due to symptoms In need of personal care services die to inability to perform one or more activities of daily living or need protection due to symptoms

108 Veteran must enroll for VA health services Veteran must enroll for VA health services Veteran must apply for Caregiver program Veteran must apply for Caregiver program Approved caregiver will receive specific training Approved caregiver will receive specific training Caregiver will receive monthly stipend based on level of need for assistance Caregiver will receive monthly stipend based on level of need for assistance

109 Caregiver Benefits for Other Era Veterans In home and community based care In home and community based care Respite care Respite care Caregiver education & training Caregiver education & training Caregiver support groups Caregiver support groups Equipment & aids Equipment & aids

110 Medical Benefits for Family Members CHAMPVA CHAMPVA Spina Bifida Program Spina Bifida Program Children of Women Vietnam Veterans Children of Women Vietnam Veterans Bereavement Counseling Bereavement Counseling Services for Caregivers Services for Caregivers

111 Caregivers Caregivers enrolled in VA Caregiver program who do not have other medical insurance coverage may receive CHAMPVA insurance coverage

112 Bereavement Counseling Veteran patients and family members Veteran patients and family members Parents, spouses, children of Armed Forces personnel who died on active duty Parents, spouses, children of Armed Forces personnel who died on active duty Counseling offered by ministry staff or at Vet Centers Counseling offered by ministry staff or at Vet Centers

113 Children of Women Vietnam Veterans Biological children of women veterans who served in Vietnam Biological children of women veterans who served in Vietnam Monetary benefits payable for certain birth defects associated with the mothers service in Vietnam: 38 CFR 3.815 Monetary benefits payable for certain birth defects associated with the mothers service in Vietnam: 38 CFR 3.815

114 Reimbursement for medical care services provided for birth defects on a Fee for Service program for community based treatment. Some preauthorization required

115 Spina Bifida Program Biological children of Vietnam veteran with spina bifida Biological children of Vietnam veteran with spina bifida Monetary benefits paid based on association with veterans service in Vietnam: 38 CFR 3.814 Monetary benefits paid based on association with veterans service in Vietnam: 38 CFR 3.814

116 For qualified beneficiaries comprehensive health care considered medically necessary and appropriate Some preauthorization required

117 CHAMPVA Comprehensive health care program Comprehensive health care program Beneficiary not eligible for TRICARE Beneficiary not eligible for TRICARE Spouse or child of SC P&T veteran Spouse or child of SC P&T veteran Spouse or child of veteran who died from a SC disability Spouse or child of veteran who died from a SC disability Spouse or child of service member who died in the line of duty Spouse or child of service member who died in the line of duty

118 QUESTIONS??

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