Guide to Veterans Pensions

Guide to Veterans
Pensions
Contents
Introduction.............................................................................................2
Who Qualifies for Veterans Improved Pension Benefits?........................3
What You Need to Know about Veterans Improved Pension Benefits....4
Types of Improved Pension Benefits................................................4
Additional Eligibility Requirements..................................................5
How to Apply....................................................................................8
What You Need to Know about Aid & Attendance and Housebound
Benefits...................................................................................................8
Eligibility Requirements for Aid & Attendance.................................9
Eligibility Requirements for Housebound Benefits.........................10
Applying for Additional Benefits....................................................10
Potential Obstacles to Receiving Benefits.............................................11
Financial Eligibility Obstacles.........................................................12
Medical Eligibility Obstacles...........................................................13
How to Give Yourself the Best Chance of Receiving Full Benefits.........15
Appendix A............................................................................................16
Appendix B............................................................................................17
Appendix C............................................................................................18
Introduction
As a US veteran, you probably already know that there are
a number of specific federal benefits available to those
who have served in the military. However, what you may
be less familiar with is how to determine your eligibility
and apply for these benefits, especially those that are
need-based or related to disabilities.
Many veterans today are living without the benefits that
they should be receiving either because they are unaware
that they have a right to the benefits or because their
claim or appeal is stuck in the Veteran Administration’s
infamous backlog of paperwork.
If you are one of the veterans who is entitled to disability
or need-based benefits but isn’t currently receiving them,
this guide is designed to help. Don’t assume you are not
eligible, part of the job of a veterans law attorney is to
make sure you are eligible or help you become eligible.
The goal is to familiarize you with some of the benefits
available, explain the eligibility requirements in a clear
way, and show you how you can give yourself the best
chance of receiving benefits.
It should not, however, be considered legal advice—if
you’re planning to apply for benefits or are navigating the
appeals process after the VA has denied your claim, your
best bet at receiving a positive outcome is to consult with
an experienced veterans attorney as soon as possible.
Don’t miss out on the compensation that you need and
deserve because of a complex application process or
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minor application error. Read on to learn more about the
Improved Pension benefit (which includes the Housebound
and Aid & Attendance benefits).
Who Qualifies for Veterans Improved Pension
Benefits?
For the purpose of benefit eligibility determination, the VA
defines a veteran as anyone who served in active military
service and was released or discharged under conditions
other than dishonorable.
Improved pension benefits have some added qualifications
that a veteran must fulfill:
1) The veteran must have served 90 days or more of
active military service with at least 1 day during
wartime (See Appendix A for the official periods of
wartime.)
2) Have “low monthly income” and;
3) Have “nominal assets”
What You Need to Know about Veterans
Improved Pension Benefits
Veterans improved pension benefits are sometimes
confused with veterans disability compensation, or they
are believed to be the same thing. In reality, there is a
distinct difference between the two categories of benefits.
Unlike disability compensation, improved pension can
be paid to disabled veterans whose disability was NOT
incurred or aggravated in the line of active service. Rather,
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the disability may have been incurred after the veteran
completed their service and the benefits are need-based.
So if you complete your tour of service and return home
only to get into a car accident and lose the use of your
legs, the law says that you qualify for veterans improved
pension benefits.
Types of Improved Pension Benefits
Veterans Improved Pension is a monthly financial
supplement for disabled veterans and their families when
the family’s income is below a certain limit. That limit is set
by Congress, can change from year to year, and is based
in part on the number of people in the household and
also the amount of medical expenses in the household.
The amount an eligible veteran receives each month is
the difference between Congress’s financial cap and their
own annual income. For example, if the cap that year
is $16,000/yr and the veteran’s income after medical
expenses are deducted is $2,000/yr, that veteran would be
entitled to a $14,000 veterans pension for that year.
Survivors Pension is only paid to a surviving spouse after
the death of their partner if they do not remarry and if
their partner already qualified for Veterans Pension (even
if they weren’t receiving a pension). The child of someone
who received Veterans Pension can also qualify, but only
if he or she is under the age of 18, under the age of 23
and attending a VA-approved school, or incapable of
supporting his- or herself due to a disability. The surviving
family will not be eligible for Survivors Pension if their
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circumstances change and their household income exceeds
the limit set by Congress.
Additional Eligibility Requirements
As you can probably already tell, the eligibility
requirements for pension benefits are quite strict, and
it takes some careful accounting to determine if you are
already eligible or if you need to do some planning to
make you eligible.
Nominal Assets
There is no hard and fast rule about how much you can
have in assets and still receive a pension. The VA takes
a look at all the factors including income, assets, and
expenses when making a determination. However, your
chances of getting approved on the initial application are
much more certain if countable assets for a single person
are around $40,000 or $80,000 for a married couple.
Remember, not all assets are countable by the VA so you
might already be eligible. Even if you are not immediately
eligible, there are several ways to turn countable assets
into non-countable assets. If you think you have too many
assets, consult a veterans attorney for advice on how to
make yourself eligible for VA benefits.
Low Monthly Income
Don’t assume ineligibility based solely on your income, this
calculation has a lot of factors and is pretty complicated so
it’s likely you’re overestimating your countable income.
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“Countable income” includes most sources of income
(such as earnings, interest on annuities, and disability and
retirement payments), but you may discover that you have
a few exceptions if you go over all of your income sources
with your lawyer. If you have unreimbursed medical
expenses, you may also be able to lower your “countable
income.” Unreimbursed medical expenses for the VA
are probably different than what you are used to for tax
purposes, they are much broader, so it’s worthwhile to
consult with an attorney. See Appendix B for a list of some
of the most common medical deductions.
The VA also has a special provision for long-term care costs
that allows veterans with ongoing medical expenses, such
as paying for nursing home care or in-home care, to reduce
their “countable income” by their projected medical care
expenses for the next 12 months. This is an important
provision to recognize because it allows many veterans
who otherwise wouldn’t be eligible for Pension benefits to
qualify. You will need to submit appropriate evidence, such
as copies of medical bills, to determine your eligibility.
In addition to the financial and service requirements, there
are several other requirements you will need to meet to
qualify for a Veterans Improved Pension. You will have to
be one of the following:
•
•
•
•
•
65 or older
Totally or permanently disabled
A resident in a nursing home receiving skilled care
Receiving Social Security Disability Insurance (SSDI)
Receiving Supplemental Security Income
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Remember, you just have to meet one of the above
eligibility requirements, not all of them.
How to Apply
If you believe that you are eligible to receive Veterans
Improved Pension, you will need to fill out an Application
for Pension, which you can download from the VA website
or get from your local regional benefit office. You’ll need
to include copies of any documents that will support your
claim to eligibility. See Appendix C for a sample checklist
of documents you will likely need to complete your
application. This should not be considered an exhaustive
list, but it should help get you started.
Once you’ve completed the form, you can mail your
application to the local regional benefit office or drop it off
in person.
What You Need to Know about Aid &
Attendance and Housebound Benefits
Many veterans who are eligible for disability compensation
actually continue to work and live as comfortable of a
life as possible. However, there is another category of
disability compensation that is specifically for those
veterans who are housebound and/or require a caregiver
due to their disability.
Aid & Attendance and Housebound are both benefits
that are added on top of Veterans Pension—that is, a
veteran must first be eligible for a monthly pension before
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determining if they can receive additional supplemental
income from A&A or Housebound.
Eligibility Requirements for Aid & Attendance
In addition to meeting the requirements for Pension,
a veteran will need to meet ONE of the following
requirements to qualify for A&A benefits:
• The veteran requires the assistance of another
person to complete basic daily functions
• The veteran’s disabilities require that he or she
remain in bed
• The veteran is a patient in a nursing home due to
mental or physical incapacity
• The veteran is blind or near blind (has corrected
visual acuity of 5/200 or less)
Eligibility Requirements for Housebound
Benefits
Housebound benefits are similar to A&A benefits, but
there are a few key differences when it comes to eligibility:
• The veteran does not need to be completely
bedridden, but they may qualify if their permanent
disability is rated as 100% disabling and they are
largely confined to their immediate premises
• The veteran has one permanent disability rated
at 100% disabling and another rated at least 60%
disabling
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It’s important to note that a veteran cannot receive both
Housebound benefits and A&A benefits at the same
time, although he or she could hypothetically switch from
one form of benefits to the other if the circumstances
surrounding their disability changed.
Applying for Additional Benefits
Aid & Attendance and Housebound benefits are often
overlooked either because a veteran and his or her family
are not aware of this monthly financial supplement or are
not aware that they qualify.
For example, a veteran might not realize that they can
subtract their medical expenses from their annual income
when determining eligibility or that the benefits can help
cover family members in certain situations.
It’s worth applying if you believe you qualify, especially if
you have a veterans attorney go over your application with
you to make sure you are not missing certain deductions or
other details that could help your case.
If you are already receiving Pension benefits and want to
apply for either Aid & Attendance or Housebound, you
should file a request with the regional VA office that has
jurisdiction over your Pension claim. You’ll need to include
concrete evidence of your eligibility, such as a doctor’s
evaluation stating that your disability prevents you from
leaving your home. You should also submit documentation
of your day-to-day activities to show when you need
attendance.
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Potential Obstacles to Receiving Benefits
Ideally, the process of applying for and receiving veterans
benefits should go smoothly, allowing you to get the
health care and financial support you need in a reasonable
amount of time. Unfortunately, that’s not always what
veterans experience.
The Veterans Administration has come under fire in
recent years for having a backlog of benefits applications,
resulting in veterans waiting an average of 300 days—and
sometimes even longer—to receive their benefits in 2013.
Sadly, this backlog isn’t the only roadblock to benefits for
some veterans who should qualify. Incorrectly filling out
a form or failing to submit the proper evidence can result
in the VA outright denying your claim. In other cases, the
mistake may be on the VA’s side, and you’ll have to work
with your attorney to prove that you actually do qualify.
Here are a few of the common obstacles that veterans face
when applying for disability benefits. Review these issues
to help you avoid them in your own application.
Financial Eligibility Obstacles
Veterans who were injured during active service
do not have to worry about financial eligibility for
disability benefits because they can qualify for Disability
Compensation, but those veterans who became disabled
after their service will have to financially qualify for
Pension benefits. Here are a few things that sometimes get
in the way for disabled veterans applying for Pension.
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Veteran’s household income. As mentioned previously, a
veteran who is applying for Pension benefits cannot have
a household income (adjusted for unreimbursed medical
expenses) exceeding the Maximum Allowable Pension Rate
(MAPR) for their pension income category.
However, even if you are over the MAPR, you may be able
to work with a veterans attorney to show that your health
care expenses reduce your monthly income to the point
that you qualify.
Assets can be counted as income. Some veterans don’t
realize when they apply for Pension benefits that any
assets or investments that could easily be converted
to money will be included as part of their “countable
income.” Unfortunately, this puts some veterans over the
MAPR even if their actual monthly income does not.
Remember, if you calculate your income and it doesn’t
initially seem like you will qualify for Pension or Aid &
Attendance, talk to an attorney to see if it is possible to
maneuver assets or deduct medical expenses to make
you eligible. Don’t risk draining your family’s income and
savings for medical care if you can qualify for Pension and
Aid & Attendance now.
Medical Eligibility Obstacles
Insufficient medical evidence. This is one of the biggest
roadblocks to veterans applying for benefits, whether
they are applying for Disability Compensation or Pension.
It is imperative that veterans submit concrete medical
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evidence, including hospital records and doctors’
evaluations, proving:
• They have a disability with symptoms severe
enough to receive a rating on the VA’s scale
• Their disability inhibits their ability to complete
basic daily tasks and they need the assistance of a
caregiver (for those applying for Aid & Attendance)
• Their disability inhibits their ability to leave the
immediate premises (for those applying for
Housebound)
• Their disability began during or was exacerbated by
active service (for those applying for basic Disability
Compensation)
Veterans who plan to apply for disability benefits should
make sure they are seeking regular medical treatment
rather than “toughing it out,” as they will need this record
to show that their disability is an ongoing problem.
Veterans should also talk to their doctor to ensure that
he or she is providing an evaluation that is as detailed as
possible. A veterans attorney will frequently work with
a doctor and advise them what medical conditions are
necessary in order to apply for these benefits, so that the
form is properly filled out.
Veterans don’t recognize that their medical need for
home care may make them eligible for Aid & Attendance.
This problem stems from a common misconception about
how Aid & Attendance works and may be preventing many
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qualified veterans from getting the improved Pension
benefits they need. Some veterans mistakenly believe that
they are only eligible for Aid & Attendance if they live in
a nursing home or other senior care facility and may be
struggling to pay for in-home care as a result.
In reality, veterans who receive Pension benefits can
qualify for Aid & Attendance if they hire someone to assist
them in their home—they will just need to work closely
with their doctor and sign a caregiver agreement to prove
eligibility.
If the VA denies your claim due to a medical eligibility issue
and you think they’ve made a mistake, you will need to
file an appeal. Your veterans attorney can help you find
evidence to make the strongest possible case for your right
to benefits.
How to Give Yourself the Best Chance of
Receiving Full Benefits
No veteran wants to file an appeal for a denied claim,
because the appeals process can lengthen the already
drawn-out process of qualifying for benefits. The best
case scenario is to file a claim initially, have it processed in
a reasonable amount of time, and receive your monthly
benefits. You obviously can’t control what the VA does on
their end in terms of the time spent processing your claim,
but there are things you can do to give your claim a better
chance of being approved in a shorter amount of time.
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Submit all available evidence with claim. Your claim
will be easiest to process if you submit all the available
evidence you have at one time, rather than sending it
piece by piece. Documents that you should send include:
• Medical records (whether you have been treated at
a VA facility, private facility, or both)
• Service discharge or separation papers
• Service treatment records (if you have them)
Tell the VA where to find all evidence that’s not readily
available to you. If there are certain documents that you
are unable to submit at the time you file your claim, such
as medical records from a private health care provider who
treated you when you lived in another state, make sure
you clearly explain to the VA where they can find these
records. Since the VA is already backlogged with disability
claims, they are unlikely to look favorably upon anyone
who makes them take the time to hunt for important
information.
File a Fully Developed Claim (FDC). The FDC is an optional
process the VA developed in an effort to speed up claims
processing. When you submit an FDC, you’re essentially
telling the VA that you have included all available evidence
and will not need to submit any more evidence at a later
date—so just make sure you include everything that can
help your case. If you do decide to go this route, consider
talking with an attorney before you submit an FDC because
you don’t want to accidentally leave something out when
you’re giving up the ability to turn it in at a later date.
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Get an up-to-date medical exam OR submit the DBQ.
The VA will most likely want you to get a medical exam to
update your records or, as an alternative, submit the DBQ
(which your doctor will need to sign). Documenting your
disability using a DBQ will satisfy the need for an exam and
move your claim along to the next stage of processing.
Following these suggestions when applying for disability
benefits should go a long way towards streamlining the
process, but unfortunately, the VA does still sometimes
wrongfully deny claims, whether it’s due to a clerical error,
a misunderstanding on the DBQ you provided, or another
issue.
If you believe that your claim has been wrongfully denied,
or if you just want assistance completing your claim
in the hopes of eliminating errors, contact a veterans
disability attorney today. Your attorney should have ample
experience handling disability claims and appeals, so you
can rest assured that you’re doing everything you can to
ensure that you receive the benefits you deserve.
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Appendix A
Official periods of war
The Mexican Border: May 9, 1916 to April 5, 1917
World War I: April 6, 1917-November 11, 1918 (or April 1,
1920 for those who served in Russia)
World War II: December 7, 1941-December 31, 1946
Korean Conflict: June 27, 1950-January 31, 1955
Vietnam War: August 5, 1964-May 7, 1975 (February 28,
1961 for those who served in Vietnam)
Persian Gulf War: August 2, 1990-present day
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Appendix B
Sample documents needed to complete an
application for benefits
c Discharge/Separation Papers (DD-214) of the Veteran
c Copy of Marriage Certificates, current & past
marriages of both Veteran and current spouse.
c Copy of Death Certificate (surviving spouse only)
c Copy of current Social Security award Letter
c Net Worth information: bank accounts, CDs, Trusts,
Stocks, Bonds, Annuities, etc.
c Proof of Income from social security, pensions,
retirement, interest income from investments,
annuities, etc.
c Proof of insurance premiums, medications, medical bills
or any other medical expenses that are not reimbursed
by insurance, Medicare, or Medicaid.
c Physician statement or if in a nursing home, the Nursing
Home Status Statement.
c Banking information for direct deposit of monthly
payments
c Employment history (does not apply if over 65)
c List of doctors and hospitals visited in the last year.
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Appendix C
Below is a list of allowable medical deductions when
applying for VA Benefits.
Common Allowable Medical Expenses
• Abdominal supports
• Hospital Expenses
• Acupuncture services
• Insulin treatment
• Ambulance hire
• Insurance premiums, for medical
use only
• Anesthetist
• Arch supports
• Artificial limbs and teeth
• Back support
• Braces
• Cardiographs
• Chiropodist
• Chiropractor
• Convalescent home (formedical
treatment only)
• Crutches
• Dental services, for example,
cleaning, x-ray, filling teeth
• Dentures
• Dermatologist
• Drugs, prescription and
nonprescription
• Invalid chair
• Lab tests
• Lip reading lessons designed to
overcome a disability
• Lodging incurred in conjunction
with out-of-town travel for
treatment (to be determined on a
facts-found basis)
• Medicare Part B premiums
• Neurologist
• Nursing services for medical
care, including nurse’s board paid
by claimant
• Occupational therapist
• Ophthalmologist
• Optician
• Optometrist
• Gynecologist
• Oral surgery
• Hearing aids and batteries
• Osteopath, licensed
• Home health services
• Pediatrician
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• Physical examinations
• Splints
• Physician
• Surgeon
• Physical therapy
• Telephone/teletype special
communications equipment for
the deaf
• Podiatrist
• Psychiatrist
• Psychoanalyst
• Psychologist
• Psychotherapy
• Radium therapy
• Sacroiliac belt
• Seeing-Eye dog & maintenance
• Speech Therapist
• Transportation expenses for
medical purposes (plus, parking
and tolls or actual fares for taxi,
buses)
• Vaccines
• Wheelchairs
• Whirlpool baths for medical
purposes
• X-rays
Other Allowable Medical Deductions
• Meals on Wheels
• Medical Alert
• Fees for In-Home Attendants providing medical,
nursing or personal care for a disabled person rated
Aid & Attendance or Housebound.
Ø
Examples of Medical Services: physical therapy,
administration of injections, placement of
indwelling catheters, and the changing of sterile
dressings.
Ø
Examples of Nursing Services: assisting an
individual with bathing, dressing, feeding him/
herself, and other activities of daily living.
ØExamples of personal care: cooking and
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housecleaning for the disabled person.
• Vitamin or Food Supplements and Herbal
Remedies, if directed by a physician. Proof must be
shown of physician’s instruction to purchase them.
• Adaptive Equipment: Mechanical and electronic
devices that compensate for disabilities are
deductible medical expenses to the extent that
they represent expenses that would not normally
be incurred by nondisabled persons.
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