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 2 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, 3 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 4 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. 5 “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 6 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 7 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 8 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. 9 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. 10 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 11 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 12 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. 13 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. 14 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. 15 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 16 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. 17 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 18 • 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 19 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. 20
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