Transcript Veterans Benefits 101

Introduction
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Not a tool for use with contractual issues
Nothing to do with MSPB or OWCP
A tool for organizing
Help veterans obtain medical assistance
and compensation through department of
veterans affairs.
Objective
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Familiarize APWU reps with DVA
procedures.
Educate membership in need of assistance
with DVA.
Assist members obtain benefits from DVA.
What is the VA ?
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Cabinet level government agency
Applies federal law concerning veterans
Provides medical treatment to veterans
Awards compensation to veterans injured
in the performance of duty.
What does VA offer ?
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Disability Benefits
Educations and Training benefits
Vocational Rehab and employment
assistance
Healthcare
Life insurance
More…
Who is Eligible?
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Veteran
Spouse
Dependant
Surviving spouse or dependant
Guard, reserves, regular military service
What is the Source ?
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Title 38 Code of Federal Regulations is the
act which provides for all of the benefits
provided by VA
We will Focus on 2 different types
of benefit…
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Disability Compensation applies if
veteran is at least 10% disabled as a
result of military service
Disability pension applies if veteran
is a wartime veteran with LIMITED
INCOME, NO LONGER ABLE TO
WORK, OR IS 65 OR OLDER
What does Service Connection
mean, why is it important
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When VA grants service connection:
It acknowledges that a condition/injury is the result of
or has been aggravated by military service
Determinations about service connection will be
based on a review of the entire evidence in the
record, with due consideration to the VA’s policy
of administering the law under a liberal
interpretation consistent with the facts in each
case.
What is the Criteria to establish
Service Connection
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Discharge type (first thing researched by
VA)
Eligibility
Medical Diagnoses of current disability
Evidence of service occurrence or
aggrevation
Nexus
Eligibility requires discharge or released from military service under
conditions other than dishonorable.
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Honorable discharge (HD);
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Discharge under honorable conditions (UHC), or general discharge (GD);
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Discharge under other than honorable conditions (UOTHC), or undesirable
discharge (UD);
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Bad conduct discharge (BCD) (which can be issued by sentence of either a
special court-martial or a general court-martial); and
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Dishonorable discharge (DD) or a dismissal, the latter in the case of an officer
(both are issued only by a general court-martial).
Honorable discharges and discharges under honorable conditions are, with some rare
exceptions, considered by the VA as discharges under “conditions other than
dishonorable” and therefore are sufficient to qualify the claimant as a veteran
under the first part of the eligibility test. Bad conduct discharges from a special
court-martial and discharges under other than honorable conditions may or may not
make a veteran and the veteran’s dependents ineligible for benefits. If a claimant for
benefits has one of these types of discharge, the VA will first adjudicate the issue of
the character of service by making a special “character of service determination,”
based on the facts in each case, to decide whether the veteran was separated from
service under “dishonorable conditions” or “other than dishonorable conditions.
Three Fundamental Requirements to
Obtaining Service-Connected Disability
Compensation
A veteran seeking service-connected disability compensation must
satisfy three fundamental requirements before VA will grant
compensation benefits.
First, there must be a medical diagnosis of current disability.
Second, there must be medical, or in certain circumstances, lay
evidence of in-service occurrence or aggravation of a
disease or injury.
Finally, there must be medical evidence of a link or nexus
between the in-service occurrence or aggravation of a
disease or injury and the current disability.
Existing Disability…
VA requires evidence that the veteran had a
“presently existing disability” on the date that
the veteran filed the claim for compensation
benefits. The U.S. Court of Appeals for the
Federal Circuit and the U.S. Court of Appeals for
Veterans Claims have upheld this “presently
existing disability” requirement. Evidence that a
veteran had a service-related disability at some
point in the past does not satisfy this
requirement.
Getting Started
Like the grievance
procedure…documentation is critical
Several sources for information
Military medical documentation is best
info,but not the only info acceptable
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Military Service Records (MUST)
DD – 214 (MUST)
Private medical history
Marriage certificate / divorce
documentation
Birth certificates
Other evidence that is relevant
Where/How to get records
DD 214 and Medical Records
National Personnel Records
Room 230
9700 Page Blvd
St Louis, MO 63132
OR WWW.archives.gov
Include your name at the time of military
service, social security number, service number
(if different), the approximate dates of service
and branch of service.
Please allow minimum of 6 weeks for
processing.
The Duty to Assist Veterans
VA is required to obtain:
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Claimant’s service medical records,
Relevant medical treatment or examination of the
claimant, either at VA facilities or at the expense of the
VA (i.e., “fee basis treatment”),
Other relevant records” held by a federal department or
agency, that the claimant adequately identifies and
authorizes the VA to obtain.
Duty to Assist in Obtaining Medical Examinations /
Medical Opinions
The VA is to provide a medical examination or opinion
“when such an examination or opinion is necessary to make
a decision on the claim.”
Statutes further provide that a medical examination or opinion shall
be considered necessary to make a decision on a claim if the
evidence of record, taking into consideration all information and lay
or medical evidence (including the claimant’s statements):
(1) contains competent evidence that the claimant has a current
disability, or persistent or recurrent symptoms of disability; and
(2) indicates that the disability or symptoms may be associated with
the claimant’s active service; but
(3) does not contain sufficient medical evidence for the VA to make a
decision on the claim.
Claimant’s Burden
The standard of proof used by the VA in deciding claims
(found in 38 U.S.C.S. § 5107(b)), is a unique standard.
The claimant is not required to demonstrate that he or
she should be granted benefits by even a
“preponderance of the evidence.”
VA can deny the claim only if the preponderance of the
evidence is against the claim. If there is an “approximate
balance of positive and negative evidence regarding any
issue material to the determination of a matter,” the
claimant wins and the claim is granted.
SEE CHART IN HAND OUT PAGES STARTING ON
PAGE 9 FOR MORE DETAILS
Benefit of the Doubt Doctrine
38 C.F.R. pt. 4, the rating schedule:
“When, after careful consideration of all procurable and assembled data
information, a reasonable doubt arises regarding the degree of
disability such doubt will be resolved in favor of the claimant.”
An approximate balance of positive and negative evidence regarding
the merits of a material issue, the claimant will be given the benefit
of the doubt in resolving each of these issues.
It is the defined and consistently applied policy of the Department of
Veterans Affairs to administer the law under a broad interpretation,
consistent, however, with the facts shown in every case. When after
careful consideration of all procurable and assembled data, a
reasonable doubt arises regarding the degree of disability such
doubt will be resolved in favor of the claimant
Now What…
VA has a form 21-526 that can be
completed to initiate a claim. However,
any format may be used so long as:
It is complete
Contains Vets ID such as SSN, Service
number
States a claim
Evidence needed to substantiate a claim
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VA is required to inform the claimant:
of the information and evidence not of record that is
necessary to substantiate the claim;
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of the information and evidence that VA will obtain;
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of the information and evidence that the claimant must
submit;
(4) to provide any evidence in the claimant’s possession
that pertains to the claim.
give us everything you’ve got pertaining to your
claim(s),’ or something to that effect.”
The Rating Process
First, the VA determines if the veteran is eligible to receive VA
benefits, including whether the veteran was discharged or separated
under other than dishonorable conditions.
Second, if the veteran survives the first step, the VA then decides
whether the veteran qualifies for disability compensation under the
rules discussed in this chapter.
Third, if steps one and two are satisfied, the VA then determines the
severity of the disability and assigns a percentage evaluation from 0
to 100 based on the Schedule for Rating Disabilities.
Fourth, the VA sets the effective date for the award of serviceconnected disability compensation
Notice of Disagreement
Written communication expressing
disagreement with an adjudicative
determination by the agency and a desire
to contest the result.
Special wording is not required. Notice of
Disagreement must be in terms which can
be reasonably construed as disagreement
and a desire for appellate review.
Appeals Available
What is an appeal to the Board of Veterans’ Appeals?
An appeal is a request for a review of a VA determination
on a claim for benefits issued by a local VA office.
Who can appeal?
Anyone who has filed a claim for benefits with VA and
has received a determination from a local VA office is
eligible to appeal to the Board of Veterans’ Appeals.
When can I file an appeal?
You may file an appeal up to one year from the
date the local VA office mails you its initial
determination on your claim.
What can I appeal to the Board?
You may appeal any determination issued by a VA
regional office (RO) on a claim for benefits. Some
determinations by VA medical facilities, such as eligibility
for medical treatment, may also be appealed to the
Board.
You may appeal a complete or partial denial of your
claim or you may appeal the level of benefit granted.
For example, if you filed a claim for disability and the
local office awarded you a 10% disability, but you feel
you deserve more than 10%, you may appeal that
determination to the Board.
How do I file an appeal?
No special form is required to begin the appeal
process. All that’s needed is a written statement
that:
(1) you disagree with your local VA office’s claim
determination and
(2) you want to appeal it.
More specific info is available in the VA booklet:
“The Board of Veterans Appeals” and “How do I
appeal”
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DISABILITY PAYMENTS
$106.00
$205.00
$316.00
$454.00
$646.00
$817.00
$1029.00
$1195.00
$1344.00
$2239.00
Between 30 and 100 there are allowances for a spouse and
each minor child. The amount depends on the disability rating.
Commonly filed Claims
AGENT ORANGE
After years of struggles, VA has begun recognizing and helping Vietnam era
vets with conditions presumptively related to Agent Orange (aka herbicdes)
exposure.
A number of pamphlets and programs are available dedicated exclusively
to Agent Orange issues.
Gulf War Veterans
Gulf War veterans who suffer from chronic disabilities resulting from
undiagnosed illnesses, medically unexplained chronic multi-symptom
illnesses (such as chronic fatigue syndrome, fibromyalgia, or irritable bowel
syndrome) that are defined by a cluster of signs or symptoms, and any
diagnosed illness that the Secretary of Veterans Affairs determines warrants
a presumption of service-connection may receive disability compensation.
The undiagnosed illnesses must have appeared either during active duty in
the Southwest Asia Theater of Operations during the Gulf War or to a
degree of at least 10 percent at any time since then through Dec. 31, 2006.
PTSD
Post-traumatic stress disorder (PTSD) is a mental disorder
characterized by the American Psychiatric Association’s Diagnostic
and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV)
as an anxiety disorder. It appears in the VA Schedule for Rating
Disabilities under 38 C.F.R. § 4.130 (2005) as diagnostic code 9411.
UNEMPLOYABLE
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A veteran may be considered as
unemployable upon termination of
employment which was provided on
account of disability, or in which special
consideration was given on account of the
same, when it is satisfactorily shown that
he or she is unable to secure further
employment.
SERVICE AGGREVATED CONDITION
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In cases involving aggravation by active
service, the rating will reflect only the
degree of disability over and above the
degree existing at the time of entrance
into the active service, whether the
particular condition was noted at the time
of entrance into the active service, or it is
determined upon the evidence of record
to have existed at that time.
RATING SCHEDULE EXAMPLE
5056 Ankle replacement (prosthesis).
Prosthetic replacement of ankle joint:
For 1 year following implantation of prosthesis
100
With chronic residuals consisting of severe painful motion
or weakness
40
With intermediate degrees of residual weakness, pain or
limitation of motion rate by analogy to 5270 or 5271.
Minimum rating
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20
5256 Knee, ankylosis of:
Extremely unfavorable, in flexion at an angle of 45[degrees] or more
60
In flexion between 20[degrees] and 45[degrees]
50
In flexion between 10[degrees] and 20[degrees]
40
Favorable angle in full extension, or in slight flexion between
0[degrees] and 10[degrees]
30
5257 Knee, other impairment of:
Recurrent subluxation or lateral instability:
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Severe
30
Moderate
20
Slight
10
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Service Organizations
Disabled American Veterans
Veterans of Foreign Wars
American Legion
Paralyzed Veterans of America
Many more…
Helpful Telephone Numbers
VA Benefits1-800-827-1000
Health Benefits 1-877-222-8387
Education Benefits 1-888-442-4551
Life Insurance 1-800-669-8477
Telecommunication Device for the Deaf (TDD)1-800-829-4833
CHAMPVA 1-800-733-8387 Headstones and Markers 1-800697-6947
Gulf War &Agent Orange Helpline 1-800-749-8387
Debt Management1-800-827-0648