1. Introduction to VA Pension and Survivor Benefits
Philadelphia Pension Management Center
Department of Veterans Affairs
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2. Pension entitlement 4 Things that need to be considered
Military service requirement
Income/Net Worth requirement
Disability Status
Dependency

3. Military Service Type of discharge requirement
Wartime service requirement
Minimum service requirement

4. Military Service Type of Discharge
Honorable - OK
Under honorable conditions (general) - OK
Under other than honorable conditions – VA determination required
Dishonorable – not OK (in most circumstances)

5. Military Service Wartime Service (one day minimum)
Gulf War - August 2, 1990 to the present
Vietnam Era - August 5, 1964 through May 7, For The period beginning on February 28, 1961 through August 4, 1964 is also considered wartime for Veterans who served in-country in Vietnam during this time.
Korean Conflict - June 27, 1950 through January 31, 1955
World War II - December 7, 1941 through December 31,  
World War I - April 6, 1917, through November 11, 1918

6. Military Service Minimum Service
For all wartime periods before the Gulf War Era, a minimum of 90 days is required.
For the Gulf War Era, the minimum service requirement is 24 months or the full period for which the Veteran was called to Active Duty.

7. Income/Net Worth Regular Pension Pension With Housebound
2017 VA Pension annual/monthly income limits
Regular Pension
Pension With Housebound
Pension with Aid and Attendance
Veteran, no dependents
(Surviving Spouse)
$12,907/$1,075
($8,656/$721)
$15,773/$1,314
($10,580/$881)
$21,531/$1,794
($13,836/$1,153)
Vet with one dependent
$16,902/$1,408
($11,330/$944)
$19,770/$1,647
($13,249/$1,104)
$25,525/$2,127
($16,506/$1,375)
A claimant’s Net Worth is considered when determining entitlement to VA Pension (not the rate of VA Pension)
While there is no specific dollar amount that can be designated as ‘excessive’ VA is required to make a formal determination as to whether net worth is excessive in all cases where the total household net worth is more than $80,
If a claimant's assets are large enough that the claimant could use those assets to pay living expenses for a reasonable period of time, net worth is considered a bar

8. Income
Most all income is countable, with the major exception being needs-based benefits.
If a claimant’s household income exceeds the prescribed limit, then VA Pension is not payable.
If a claimant’s household income does not exceed the prescribed limit, then the VA Pension rate will make up the difference between the claimant’s income and the income limit.

9. Income Expenses
Medical expenses reduce countable income on a dollar for dollar basis after consideration of a deductible.
Deductible also depends on the claimant and their dependents and ranges from approximately $ to approximately $ yearly.

10. Upfront Verification of Income
IRS and SSA will provide VA with application income information for pension applicants.
PMC will use this information to verify the income of applicants for original Veterans and survivors pension claims.
In the future upfront verification will be expanded to include additional pension end products.

11. Benefits of Upfront Verification
Reduce the potential for fraud and vulnerability to abuse.
Reduce or eliminate improper payments caused by the failure to verify a claimants income at the time the PMC determines entitlement to benefits.
Prevent complex, time-consuming, and untimely income verification matching and due process procedures required to suspend or terminate an award.
Reduce debt management workload.

12. Medical Expense Overview
All expenses related to medical care can be considered. Examples include
Prescriptions
Over the counter medications
Doctor/dental/hospital visits and tests
Medical transportation
Medical insurance (including Medicare Part B, Part D and private medical insurance
At-Home care, nursing home care and assisted living care
Press release 12/20/12

13. Claiming Assisted Living Facility or Nursing Home Fees
Be specific as to dates paid for irregular amounts AND indicate regular recurring monthly or daily amounts.
Provide full contact details for a person at the facility we can call to verify information.
Tell them we may be calling!
For nursing home, if Medicaid is assisting, include VAF and be specific as to patient paid amount.

14. Claiming Home Caregiver Fees
Additional documentation is required the first time
fees are claimed per provider.
Every time a new provider is used, documentation must be submitted in full.
Type of documentation acceptable:
receipted bill,
statement on the provider's letterhead,
computer summary, OR
A ledger or bank statement

15. Accepting RLF Fees
Room and Board expenses from an RLF are acceptable if:
The individual’s physician states in writing that the claimant must reside in that facility and separately contract for custodial care with a third-party provider. Or…
The facility provides the individual with custodial care in the form of assistance with two or more activities of daily living.

16. What are Custodial Care and Activities of daily living?
Custodial Care: “assisting a person with activities of daily living”
Activities of Daily living: “items of basic self-care which include; bathing or showering, dressing, eating, getting in or out of bed or a chair, and toileting”
To accept fees facility must provide at least 2 of the above services

17. Income Example Single Veteran rated for Aid and Attendance.
Only income is $ monthly ($7, annually) from Social Security.
VA Pension income limit = $21,531.00
Income limit – income = Annual Pension rate
$21,531 - $7,248 = $14,283.00
$14, / 12 months = $1, monthly

18. Income Example Single Veteran rated for Aid and Attendance.
Only income is $ monthly ($7, annually) from Social Security.
Medical expenses of $1, yearly.
Income – medical expenses + deductible
$7,248 - $1,294 + $645 = $6,599.00
VA Pension income limit = $21,531.00
Income limit – income = Annual Pension rate
$21,531 - $6,599 = $14,932.00
$14, / 12 monthly = $1, monthly

19. Net Worth
A claimant’s Net Worth is considered when determining entitlement to VA Pension.
Definition - Net worth means the market value, less mortgages or other encumbrances, of all real and personal property owned by the claimant and/or spouse, except the claimant's single-family dwelling and reasonable personal effects

20. Net Worth VA Pension is…
Intended to afford beneficiaries a minimum level of security
Not intended to protect substantial assets or build up the beneficiary's estate for the benefit of heirs
We consider it is reasonable, under all circumstances, for the claimant to consume some of his/her estate for maintenance when considering the pension claim.

21. Net Worth
There is no specific dollar amount that can be designated as excessive net worth. What constitutes excessive net worth is a question of fact for resolution after consideration of the facts and circumstances in each case. A number of variables must be taken into consideration in making a net worth determination. Factors to be considered include the following:
income from other sources
family expenses
claimant's life expectancy
convertibility into cash of the assets involved

22. Upfront Verification of Net Worth
Coming In the Near Future
Final Rule at AO73
Net Worth Limits and Asset Transfers

23. Disability Status 3 levels
Basic Pension level
Housebound level
Aid and attendance level

24. Disability Status P&T Status - Administratively
Permanent and total status is conceded if the Veteran is…
Age 65 or older
Deemed disabled by the Social Security Administration
A Patient in a nursing home
This is considered an Administrative grant of P&T

25. Disability Status P&T Status – By Rating
Medical evidence should adequately describe the claimant’s health, provide a diagnosis, and provide enough information to evaluate their conditions. The medical evidence must provide the level of disability for all medical conditions, the severity of these medical conditions, and the limitations of the medical conditions.

26. Disability Status
May be required to schedule an exam for the Veteran for the following:
General P&T status (basic pension)
SMP status

27. Disability Status Housebound Status
Both Veterans and surviving spouses must be rated to be considered Housebound.
Medical evidence must demonstrate that the claimant is basically confined to the home and is unable to leave without assistance due to a medical or mental condition. A single disability rated at 100% must be of record (for Veterans), or the evidence must enable such an evaluation to be granted.

28. Disability Status Aid and Attendance (A&A) Status - Administratively
Aid and attendance status is conceded if the Veteran or surviving spouse is…
A Patient in a extended care facility that is licensed by a State to provide skilled or intermediate-level nursing care or
A Patient in a nursing home care unit in a State Veterans' Home or
A Patient in a Department of Veterans Affairs Nursing Home Care Unit
This is considered an Administrative grant of A&A

29. Disability Status Aid and Attendance (A&A) Status – By Rating
Medical evidence must demonstrate that the veteran needs assistance with the activities of daily living because of specific physical or mental impairments. For Veterans, single disability rated at 100% NSC must be of record or the evidence must enable such an evaluation to be granted.

30. Dependency Status
The rules for establishing a child or spouse for VA Pension purposes are more or less the same as establishing a child or spouse for VA Compensation.
However, there are some special rules regarding whether a spouse can be added to a Veteran’s Pension award.

31. Dependency Status

32. Dependency Status Dependency requirements (surviving spouse)
Married to the Veteran at the time of death for at least one year
Lived continuously with the Veteran (exceptions being separation due to reasons other than marital discord)
Unremarried

34. Dependency Status Dependency requirements (surviving child)
Be under the age of 18
Be between the ages of 18 and 23 and attending school
Be permanently incapable of self support due to disability which occurred prior to the age of 18

35. DIC benefits
DIC benefits are not based on income or net worth. Rather, they are payable if a Veteran’s death was
in-service or,
related to service (AKA service-connected) or,
if the Veteran was seriously disabled from service connected conditions for an extended period of time prior to death.

36. DIC benefits Presumptive Service Connection
Some conditions will be considered to have been incurred in or aggravated by service even though there is no evidence of such disease during the period of service. These are known as presumptive conditions.
There are many diseases and disabilities which are considered presumptively service-connected for Veterans, provided they meet other requirements, such as type of service.
If a Veteran was to pass away as a result of one of these conditions, service-connected death would be established.

37. DIC Some DIC Payments Now Automated 100% S/C for 10 years or more
IU for 10 years or more
and have a dependent spouse on their award
SBP and Non-Concurrent Payments
VAF EZ VA Obligated to Address the Claimant’s Entitlement to DIC, Survivor’s Pension and Accrued Benefits.

38. VA Burial benefits
One time stipend payable to the person who paid the funeral costs associated with the death of a Veteran.
If a spouse is listed on the veteran’s VA benefits award, an automated burial benefit payment will be made to the spouse when the veteran’s award is stopped.

39. Recent Pension Rule Changes
Burial Automation
Upon the processing of a First Notice of Death (FNOD), if the Veteran was in receipt of Comp/Pension benefits, VA will automate either the $300 basic NSC burial allowance or the $2000 basic SC burial allowance.
Does not mean claimants will no longer file… Does not automate transportation, plot allowance, or additional NSC burial for VAMC deaths.

40. Burial Automation Receipts/itemized funeral bills no longer required.
Funeral Homes are no longer proper claimant for claims received on or after July 7th 2014 (except for unclaimed Veterans)
“First to File” – VA no longer dividing burial payments. Benefit paid to the first person who files and is found entitled.
If automated payment is made to the surviving spouse, and we receive an application from another eligible claimant for additional benefits, if it is determined they paid the expenses, the additional benefits can be paid.

41. WHO SHOULD FILE A BURIAL CLAIM
- VA will pay the first living person to file a claim of those listed below:
(1) The veteran's surviving spouse;
(2) The survivor of a legal union between the deceased veteran and the survivor;
(3) The veteran's children, regardless of age;
(4) The veteran's parents or the surviving parent
(5) The executor or administrator of the deceased veteran's estate.

43. Recent Pension Rule Changes
HUB promulgation Teams
Fiduciary HUBS will now do:
Final findings of incompetency
Prepare and schedule field examinations.
Release withheld funds.

44. Forms for Pension/DIC Claims
For pension claims: VA encourages the use of the VA Form EZ; however, the VA Form and VA Form are also acceptable for pension claims. For DIC and survivor benefits: VA encourages the use of the VA Form EZ; however, the VA Form and VA Form are also acceptable for DIC and survivor benefits.

45. Address to SMS Portal
Scanning Contractor for Claims and Responses to Development:
Department of Veterans Affairs
Pension Intake Center
ATTN: Philadelphia Pension Center
PO Box 5206
Janesville, WI
FAX
Not FTI or IVM Responses
Will be scanned into VBMS

46. Special Access to: Philadelphia PMC Advocacy Team
Special Inquiry Phone Queue:
Special Fax Number:
VSO Addresses:
Fiduciary Hub
(888)
Special PO Box:
PO Box 42910
Philadelphia, PA 19101