VBR/CSO Quarterly Training June 2012 Thomas Meadows TDVA Training Officer 615-441-3384 or firstname.lastname@example.org
Welcome to the VBR/CSO Quarterly Training presented by the TN Department of Veterans Affairs
FULLY DEVELOPED CLAIMS • The Fully Developed Claims (FDC) Program is the fastest way of getting your compensation or pension claim processed. • Participation in the FDC Program allows for faster claims processing while preserving great quality of service and your right to appeal a decision.
Claim must be a rating related claim for live compensation • Original • Secondary • Increased service connected claims • Application form 21-526 EZ to include Fully Developed Claim Certification • VA forms available at www.va.gov/vaforms or on Vetra/Spec • You must submit all relevant private medical records for the disabilities you are claiming.
You must identify any treatment records from a Federal Facility such as VA Medical Center, Outpatient Clinic, or Community Based Outpatient Clinic (CBOC) • For Guard and Reserve members you must submit any and all Service, Treatment, and Personnel Records in the custody of your Unit(s). • Medical can be in the form of letters from Physicians, Hospital records, or Disability Benefit Questionnaires. (DBQ’S) Located in Vetra/ Spec or VA site: http://www.va.gov/vaforms/search_action.asp?FormNo=21-0960&tkey=&Action=Search
If claiming dependents, must complete VA form 21-686c • The evidence must show injury in service, or a disease that began in service or was aggravated by service. • You must have a current physical or mental disability related to service. • A relationship or NEXUS must be established between claimed disabilities and an injury, disease, symptoms, or event in military service.
PRESUMPTIVES 3.309: Example Agent orange, POW, and Radiation. • What if you don’t have all the evidence? • File an informal Claim Letter or a 21-4138; must include a statement in the form of a letter: • “I intend to apply for compensation benefits under the FDC Program. This statement is to preserve my effective date for entitlement to benefits. I am in the process of assembling my claim package for submission”.
NSC PENSION • Criteria: • NSC Pension Claims • 21-527EZ Original Claims • Fully Developed Claim Certification Form must be completed. • All necessary income and net worth in formation must be submitted • All private medical must be submitted. • Need for DBQ(see compensation instructions)
Names and addresses of Federal facilities where you receive treatment to include dates of treatment • 21 2680 If Claiming Aid and Attendance 21 0779 If in a Nursing Home • Guard and Reserve records • Dependents 21-686c • What the evidence must show: • 90 Days service one of Wartime • 24 Month Active Duty Requirement 9-8-80 Enlisted 10 16 81 Officers
Permanent and Total Disability Single 60% or Combined 70% one disability being 40% or more. • Over 65 • Patient in a Nursing Home for long term care • Receiving Disability SS or SSI • Exception 3.321 B • Your Net Worth and Income must be within limits.
APPORTIONMENT OF VA BENEFITS CFR 3.450-3.461 • All or any part of the pension or, compensation, payable on account of any veteran may be apportioned. • If the veteran is not residing with his or her spouse • If the veteran’s children are not residing with the veteran and the veteran is not reasonably contributing to the spouse or children’s support.
In death cases where children of the veteran are not residing with the veterans spouse then an apportionment may be made. • In incarceration cases. • Must have application for apportionment. • Improved Pension • Dependency and Indemnity Compensation
3.458 VETERAN’S BENEFITS NOT APPORTIONABLE • Veteran's benefits will not be apportioned: • Where the total benefit payable to the disabled person does not permit payment of a reasonable amount to any apportionee. Example vets less than 30%. • Where the spouse of the disabled person has been found guilty of conjugal infidelity by a court having proper jurisdiction.
For purported or legal spouse of the veteran if it has been determined that he or she has lived with another person and held herself or himself out openly to the public to be the spouse of such other person, • For a child that has been legally adopted by another person, except the additional compensation payable for the child. • Until the estranged spouse of a veteran files claim for an apportioned share. If there are any children of the veteran not in his or her custody an apportionment will not be authorized unless and until a claim for an apportioned share is filed on their behalf.
No apportionment will be made when a fiduciary has been appointed and the fiduciary is providing for dependents. • Procedure: • Upon receipt of request for an apportionment the VA will develop the income and expenses of both the veteran and dependents. VA Form 21-0788 • Sixty day due process will be given both parties. • Formal decision made. • Shorter appeal period on apportionments.
INCARCERATED VETERANS COMPENSATION • Any person specified in paragraph (c) of this section who is incarcerated in a Federal, State or local penal institution in excess of 60 days for conviction of a felony will not be paid compensation or dependency and indemnity compensation (DIC) in excess of the amount specified in paragraph (d) of this section.
Beginning on the 61st day of incarceration. VA will inform a person whose benefits are subject to this reduction of the rights of the person's dependents to an apportionment while the person is incarcerated. • In addition, VA will also notify the person's dependents of their right to an apportionment if the VA is aware of their existence and can obtain their addresses. • Compensation or DIC is not payable on behalf of a veteran or dependent for any period during which he or she is a fugitive felon.
Applicability-The provisions of this section are applicable to the following persons: • A person serving a period of incarceration after September 30, 1980 (regardless of when the felony was committed). • Amount payable during incarceration —(1) Veteran rated 20 percent or more. Reduced to 10% rate / $127.00 • (2) Veteran rated less than 20 percent. A veteran shall receive one-half the rate of compensation payable / $63.50.
Apportionment —Compensation. All or part of the compensation not paid to an incarcerated veteran may be apportioned to the veteran's spouse, child or children and dependent parents on the basis of individual need. In determining individual need consideration shall be given to such factors as the apportionee claimant's income and living expenses, the amount of compensation available to be apportioned, the needs and living expenses of other apportionee claimants as well as any special needs, if any, of all apportionee claimants.
DIC. All or part of the DIC not paid to an incarcerated surviving spouse maybe paid to children. • These apportionments shall be made on the basis of individual need giving consideration to the factors previously mentioned. • Effective dates: An apportionment under this section shall be effective the date of reduction of payments made to the incarcerated person, if an informal claim is received within 1 year after notice to the incarcerated person. Otherwise, payments may not be made for any period prior to the date of receipt of a new claim.
Incarcerated dependent: No apportionment may be made to or on behalf of any person who is incarcerated. • Notice to dependent for whom apportionment granted. A dependent for whom an apportionment is granted under this section shall be informed that the apportionment is subject to immediate discontinuance upon the incarcerated person's release or participation in a work release or halfway house program.
Resumption upon release- The released person's award shall be resumed the date of release from incarceration if the Department of Veterans Affairs receives notice of release within 1 year following release; otherwise the award shall be resumed the date of receipt of notice of release. • Retroactive awards: Whenever compensation or DIC is awarded to an incarcerated person any amounts due for periods prior to date of reduction under this section shall be paid to the incarcerated person.
Conviction overturned on appeal: If a conviction is overturned on appeal, any compensation or DIC withheld under this section as a result of incarceration for such conviction (less the amount of any apportionment) shall be restored to the beneficiary. • Fugitive felons: Compensation is not payable on behalf of a veteran for any period during which he or she is a fugitive felon. Compensation or DIC is not payable on behalf of a dependent of a veteran for any period during which the veteran or the dependent is a fugitive felon.
For purposes of this section, the term fugitive felon means a person who is a fugitive by reason of: Fleeing to avoid prosecution, or custody or confinement after conviction, for an offense, or an attempt to commit an offense, which is a felony under the laws of the place from which the person flees; or Violating a condition of probation or parole imposed for commission of a felony under Federal or State law.
INCARCERATED VETERANS PENSION • If any individual to or for whom pension is being paid, is imprisoned in a Federal, State or local penal institution as the result of conviction of a felony or misdemeanor, such pension payments will be discontinued effective on the 61st day of imprisonment following conviction.
The payee will be informed of his or her rights and the rights of dependents to payments while he or she is imprisoned as well as the conditions under which payments to him or to her may be resumed on his or her release from imprisonment. However, no apportionment will be made if the veteran or the dependent is a fugitive felon. • Disability pension - Payment may be made to the spouse, child or children of a veteran disqualified under this section:
(1) If the veteran continues to be eligible. • (2) If the annual income of the spouse or child is such that death pension would be payable • (3) At the rate payable under the death pension law or the rate which the veteran was receiving at the time of imprisonment, whichever is less. • (4) Payable from the day following the date of discontinuance of payments to the veteran, subject to payments made to the veteran over the same period, if an informal claim is received within 1 year.
Death pension - Payment may be made to a child or children where a surviving spouse or child is disqualified under this section: • (1) If surviving spouse is disqualified payment may be made to child or children at the rate of death pension payable if there were no such surviving spouse; or • (2) If a child is disqualified, to a surviving spouse or other child or children at the rate of death pension payable if there were no such child, and
(3) From the day following the date of discontinuance of payments to the disqualified person, subject to payments made to that person over the same period if evidence of income is received within 1 year. • (4) The income limitation applicable to eligible persons will be that which would apply if the imprisoned person did not exist.
Resumption of pension upon release from incarceration - Pension will be resumed as of the day of release if notice (which constitutes an informal claim) is received within 1 year following release; otherwise resumption will be effective the date of receipt of such notice. • Fugitive felons- Pension is not payable on behalf of a veteran for any period during which he or she is a fugitive felon. Pension or death pension is not payable on behalf of a dependent of a veteran for any period during which the veteran or the dependent is a fugitive felon.
Handout #4: Incarcerated Veterans Double click to open
AUTOMOBILE GRANT • Financial assistance in the purchase of one automobile and adaptive equipment • Inferred issue for VA rating board • APPLICATION: 21 4502 no time limit to apply. • May apply while on Active Duty • 10-1394 R for adaptive equipment
Auto grant currently $18,900 one time grant • Do not purchase or contract for vehicle until approval is received from VA • ELIGIBILITY: • Loss or permanent loss of use of one or both feet • Loss or permanent loss of use of one or both hands • Blindness both eyes 20/200
May receive adaptive equipment for a fusion of one or both knees or one or both hips • Adaptive equipment may be approved for no more than 2 vehicles in a four year period • Specific questions about adaptive equipment should be referred to VAMC prosthetics department
Handout #5: Automobile & Special Adaptive Equipment Grants Double click to open
HOME MODIFICATIONS PROGRAM • VA has three main grant programs to assist disabled veterans and service members with necessary home modifications. • Specially Adapted Housing (SAH) Grant 26-4555 • Special Home Adaptation (SHA) Grant • Home Improvements and Structural Alterations (HISA) Grant 10-0103
What Is a Specially Adapted Housing (SAH) Grant? The SAH Grant is designed to help provide a barrier-free living environment that affords the individual a level of independent living they may not otherwise enjoy, such as creating a wheelchair accessible home. Veterans and service members with specific service-connected disabilities may be entitled to a grant for the purpose of constructing or modifying a home to meet their adaptive needs. This grant is currently limited to $63,780.
The SAH grant is available to veterans who are and service members who will be entitled to disability compensation for permanent and total disability due to: • Loss or loss of use of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or • Blindness in both eyes, having only light perception, plus loss or loss of use of one lower extremity, or
Loss or loss of use of one lower extremity together with (1) residuals of organic disease or injury, or (2) the loss or loss of use of one upper extremity, which so affects the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair or, • Loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbow, or • A severe burn injury (as so determined)
What Is a Special Home Adaptation (SHA) Grant? The SHA grant is for modifying an existing home to meet adaptive needs, such as assistance with mobility throughout the home. Veterans and service members with specific service-connected disabilities may be entitled to this type of grant. The grant is currently limited to $12,756. A temporary grant may be available to veterans and service members who are/will be temporarily residing in a home owned by a family member.
The SHA grant is available to veterans and service members who will be entitled to disability compensation for permanent and total disability due to: • Blindness in both eyes with 5/200 visual acuity or less or, • The anatomical loss or loss of use of both hands or extremities below the elbow, or • A severe burn injury (as so determined).
What Is a Home Improvements and Structural Alterations (HISA) Grant? Under the HISA program, veterans may receive assistance for any home improvement necessary for the continuation of treatment or for disability access to the home and essential lavatory and sanitary facilities. A HISA grant is available to veterans who have received a medical determination indicating that improvements and structural alterations are necessary or appropriate for the effective and economical treatment of their disability. A veteran may receive both a HISA grant and either a SHA or SAH grant.
The HISA program is available for both service-connected veterans and non service-connected veterans. • Home improvement benefits up to $4,100 may be provided to service-connected veterans • Home improvement benefits up to $1,200 may be provided to nonservice-connected veterans.
HOW CAN I APPLY FOR SAH, SHA or HISA GRANTS? • You can apply for the SAH and SHA grants by completing VA Form 26-4555, Veterans Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant, and submitting it to your local VA regional office. • You can apply for a HISA grant by completed VA Form 10-0103, Veterans Application for Assistance in Acquiring Home Improvement and Structural Alterations, and submitting it to your local VA medical center.
CLOTHING ALLOWANCE • Annual payment made to veterans who meet certain criteria. • Loss or loss of use of one hand or foot. • Service connected disabilities that require use of one qualifying prosthetic or orthopedic appliance (including but not limited to a wheelchair) which tends to wear or tear clothing.
Veteran uses medication for skin condition which causes irreparable damage to the veteran’s garments. • Two clothing allowances. • Payable in late August or early September of each year. • August 1 anniversary date. • Application form 10-8678. • Processed by VAMC closest to vets residence. • Amount payable $742.00 • Withholding for incarceration 1/365th for each day beyond 61st day of incarceration.