Presentation on theme: "Milwaukee VA Pension Management Center Presentation October 3, 2013 Lisa Kelto | Rating Coach."— Presentation transcript:
Milwaukee VA Pension Management Center Presentation October 3, 2013 Lisa Kelto | Rating Coach
Todays Agenda Current status of workload General Information –Submitting claims –Contacting the PMC –General Tips –Accessing VAs manual FDC update DIC update Veteran Pension Survivor Pension Additional Topics –Reverse Mortgage –Trusts
Average Days Pending as of 09/23/2013
Submitting a Claim Milwaukee PMC Address Department of Veterans Affairs Pension Management Center PO Box Milwaukee, WI OR Virtual VA Fax number
Contacting the PMC – Non-Priority Issues By Phone: There is no direct phone line within the Milwaukee PMC for general information calls. Calls are taken at the national call center: # By –Responses will not include personally identifiable information (PII) if you are not encrypted.
VSO Contact Number for Priority One Claims The Milwaukee PMC has a direct line FOR VSOs to inquire about the current status of expedited claims. We consider the following to be Priority One Claims requiring expedited processing: –Medal of Honor –Homeless –Terminal illness –POW, GWOT, SI/VSI –Severe Financial hardship The number is: This number is answered by employees on our Advocacy Team which also processes these priority claims. Please do not use this number for any other status inquiries or general questions.
General Tips to Help Speed Up Claims Process Send claims directly to the PMC. Sending the claim to the RO delays the processing. (Dual claims go to the RO.) Help us identify and establish the proper claimant –Veterans and survivors names are listed and correct –Social security numbers are listed and correct (Claim number if known) –Service number and dates of service Ensure the application/forms and any s are properly signed by the claimant (or an X/thumbprint with 2 witness names and addresses). Ensure the application/forms are complete. Do not leave blank boxes - enter 0 or none. Net worth over $80K? Submit a completed VAF-8049.
How do you access VAs manual? The VA has an internet based manual available for you to review at any time – WARMS (Web Automated Reference Material System):
Fully Developed Claims (FDC) Update
What are Fully Developed Claims? Claims submitted on VA EZ forms: EZ (Live Pension) or EZ (DIC and Survivor Pension). Receipt of an EZ application packet allows VA to make a quicker decision because the claimant has received the 5103 notice rights (previous VCAA) as part of the application and certifies that they have submitted all evidence necessary to decide the claim. VA will gather all federal records that the Veteran identifies, like those from VA Medical Centers and the Social Security Administration. This allows VSRs to start processing these claims without development for missing information, which speeds the decision making part of the process considerably. Occasionally, claims will be excluded from the FDC program and will be processed as usual with development.
FDC Common (and avoidable) reasons for immediate denials of FDC claims: –Income sections are incomplete or blank. –No death certificate attached. –Marital information is missing or incomplete.
FDC Other issues that can slow the FDC process down: –Verification of service (DD214) not submitted. –Applications returned for improper signature. –Development is needed because $5,000 or greater is reported in net worth and no interest is reported. –Development is needed because net worth is reported at $80,000 or greater and no VAF is received. –We need the claims file which is located at the home regional office or in a federal archive.
DIC Progress File Date Number Claims Pending Number Claims Pending > 125 Days Average Days to Complete FYTD 10/31/2012 4,2271, /30/2012 4,1391, /31/2012 4,1351, /31/2013 3,9671, /28/2013 3,8531, /30/2013 3,2961, /30/2013 3, /31/2013 2, /29/2013 2, /31/2013 2, /31/2013 2,
DIC Overview DIC is a monthly payment made to a surviving spouse, child or parent. It can be payable in the following situations: –Death in service –Cause of death is service-connected –Veteran was permanently and totally disabled (SC) for 10 years prior to death (38 USC 1318) –Cause of death is related to treatment by the VA (38 USC 1151) –Even if the claimant did not specifically claim DIC, we need to review the file for presumptive entitlement.
Nehmer Claims Nehmer is a court order that allows us to pay retroactive benefits in certain situations when veteran had a condition (or died of a condition) that is presumptively service- connected (SC) when the veteran was exposed to Agent Orange. Vietnam (RVN) service must be verified. We can use the DD 214 to Verify RVN service: The comment section shows Vietnam service dates You see USARV The veteran received the Combat Infantryman Badge (CIB) It lists an APO/FPO box that is found on the Vietnam APO & FPO Listings
VETERAN PENSION (NON-SERVICE CONNECTED LIVE PENSION)
VAF Tips Make sure the disability section on the front is answered as NONE if only filing for pension. This section is to claim S/C conditions and will cause a delay if completed and only pension is being claimed. The income sections ask for monthly income. If you report any amount, it will be annualized. Example…if you report the annual figure for interest…specify so VA does not multiply by 12 Make sure all sections are answered with a statement, amount, None or N/A
Veteran Pension 5 Hurdles to Granting Veteran Pension 1. Service 2. Disability (non-service-connected) 3. Income 4. Net Worth 5. Dependency
Veteran Pension Service Requirement Duty entry date prior to : At least 1 day active duty during wartime period, and 90 days active military service, or Active service with discharge for service connected disability Duty entry date after : At least 1 day active duty during wartime period, and 24 months active military service, or Served full period to which he/she was called or ordered to active duty See exceptions to minimum active duty requirement in M21- 1MR, III.ii.6.4.c.M21- 1MR, III.ii.6.4.c
Veteran Pension (Service Requirement) Must have discharge of: –honorable, –under honorable conditions, or –general with no evidence of misconduct.
Veteran Pension Disability Requirement A veteran may be granted pension presumptively if he/she is: –Age 65 or older, or –A patient in a nursing home, or –Disabled for the purposes of Social Security Disability (SSD) or Supplement Security Income (SSI) benefits. If the veteran does not qualify presumptively, non-service-connected pension must be granted by rating.
Veteran Pension Income Requirement Pension payments are based on income. A claim for pension must be disallowed if countable income exceeds the applicable income limit.
Veteran Pension Net Worth Requirement Pension entitlement is based on need and that need does not exist if a claimant's estate is of such size that he or she could use it for living expenses. The basic issue in evaluating net worth is whether or not the claimants financial resources are sufficient to meet the claimants basic needs without assistance from VA. M21-1MR, V.iii.1.J M21-1MR, V.iii.1.J
Veteran Pension Dependency Requirement A claimant in receipt of VA pension benefits is required to report his/her dependents. Having a dependent on the award increases the MAPR, but can also affect income as we generally must count the dependent's income/NW. M21-1MR, V.iii.1.F.37 and M21-1MR, III.iii.5 M21-1MR, V.iii.1.F.37 M21-1MR, III.iii.5
Veteran Pension (Dependent Requirement) Dependents for pension benefits: –Spouse –Children (biological, step, or adopted) Minor (under 18) School child (18-23 and attending school) Helpless (became permanently incapable of self-support prior to age 18)
Veteran Pension Special Monthly Pension SMP is a VA benefit program which increases the claimants Maximum Annual Pension Rate (MAPR). –Aid and Attendance (A&A) is paid because a person, due to mental or physical disability, requires the regular aid and attendance of another person in conducting the basic activities of daily living. –Housebound (HB) allowance is paid because a person, due to a mental or physical disability, is very limited in his/her ability to leave home
Veteran Pension Liberalizing Law If the veteran is granted pension benefits and he/she would have met one of the presumptive requirements on , the date the law was enacted, we may be able to grant benefits effective one year prior to the effective date of pension.
SURVIVOR PENSION (Death Pension)
Survivor Pension Qualifying Military Service For death pension, the veterans military service must meet the same requirements as those for disability pension (see M21- 1MR, III.ii.6.7.d).
Survivor Pension Eligibility requirements 1. Veteran had qualifying military service 2. Legal surviving spouse or child of the veteran 3. Income / net worth within allowable limits It does not matter if the veteran was entitled to pension in his/her own right. There is no disability requirement for a widow (unless he/she is claiming SMP).
Survivor Pension Proper Claimant We must have a complete marital history of record in order to establish the surviving spouses relationship to the veteran. Per FL 13-04, we can now establish a surviving spouse without marital history if he/she was already established on the veterans award. –However, we will need to enquire further if continuous cohabitation or remarriage are an issue. M21-1MR, III.iii.5.E When the surviving spouse was not already an established dependent, he/she must give us a full marital history. If the surviving spouse does not know the veterans marital history and it is not already of record, an administrative decision is needed to determine whether the marriage can be deemed valid for VA purposes.
Survivor Pension Marriage Dates Requirement 38 CFR 3.54 states that benefits may not be paid to the surviving spouse unless one of the following requirements is met: 38 CFR 3.54 –The claimant was married to the veteran one year or more before the veterans death, –A child was born of the marriage or prior to the marriage, or –The claimant was married to the veteran before the specified delimiting dates (see M21-1MR, III.iii.5.E.22.a)
Survivor Pension Dependents In order to establish dependents on a surviving spouses award or to receive benefits in their own right, children must be unmarried and: –Minor (under 18) –School children (between 18 and 23) –Helpless Can be: –Biological –Adopted –Stepchild (must have been a member of the veterans household at the time of death) If the child was not previously claimed by the veteran, we need proof of relationship. Also need DOB, place of birth, and SSN 38 CFR 3.57, M21-1MR, III.iii.5.F and H
Survivor Pension Proof of Death Death Certificate, or alternative document that provides proof of the veterans death, is required in order to award benefits. –M21-MR, IV.iii.1.1.g –38 CFR 3.211
Survivor Pension Income The claimants income must be below the appropriate Maximum Annual Pension Rate (MAPR) for survivor pension benefits. Veterans life insurance proceeds are no longer considered countable income.
Survivor Pension Last Expenses We can use last expenses paid by the claimant to reduce countable income for a period of 12 months. Last expenses = burial expenses, last illness expenses, or just debts. We will deduct any amount received for VA burial benefits from the last expense total. We do not need an itemized statement from the funeral home nor do we need to verify with the funeral home that the last expenses were paid UNLESS a burial claim has been filed.
Survivor Pension Effective date Effective date is the first of the month of the veterans death, if the claim is received within one year from the date of death (otherwise, DOC). Benefits are payable the first of the month after death. The initial year period begins with the veterans date of death.
Survivor Pension Special Monthly Pension Like veterans, widows can increase their MAPR if they are entitled to A/A or Housebound. A/A can be granted presumptively if he/she is a patient in a nursing home. We also reduce widows and children to the $90 Medicaid rate, when applicable.
Accrued Benefits Accrued benefits are benefits due to the beneficiary but not paid prior to death. Accrued benefits can be paid for periodic monetary benefits by the VA (such as pension, DIC, compensation). Accrued cannot be paid for non-periodic benefits (such as MOD or burial). If something was pending, but we would have denied right away (i.e. excess income, no wartime service, etc.), you can deny accrued. If nothing pending, still need quick review to make sure no accrued payable (i.e. COLA never paid, etc.).
Accrued Benefits Eligibility Eligibility for accrued benefits is based on a line of succession established by law: Based on Relationship 1. Surviving spouse 2. Child(ren) – equal shares 3. Parent(s) – equal shares If no one is eligible based on relationship, we will consider benefits based on reimbursement. This means we can pay the person who bore the expenses of last illness or burial.
Accrued Substitution of Claimant Previously, accrued benefits were only payable based on the evidence that was in file at the time of the veterans death. Per FL 10-30, a claimant who is eligible for accrued benefits can now submit additional evidence in support of the claim. Development of the claim pending at death may be required Substitution of claimant only applies to claims or appeals pending at death (undecided). The original claimant must have died on or after 10/10/08. A request to be substituted must be received within one year of the claimants death.
Additional Topics Reverse Mortgage –Considered a type of loan. –A reverse mortgage is not countable income. –Do not count loans to a claimant as long as the claimant incurs a legally binding obligation to repay the loan. –Do not count funds received from a reverse mortgage. A reverse mortgage is considered a home equity loan that must be repaid when the homeowner no longer lives in the home. –Note: Loans must be distinguished from gifts. A gift disguised as a loan is countable. –Manual reference: M21-1MR, V.iii.1.I.58.m
Additional Topics Trusts –In order for a trust to reduce a claimants net worth, the claimant has to show that he or she has given up all rights to the asset/property, to include income from it. –We will ask for a copy of the trust documents. –We may also inquire further if monthly expenses exceed income when they no longer have the net worth to account for it. –Manual reference: M21-1MR, V.iii.1.I.65.a