Lisa Kelto-VA Pension Management Center Presentation

Report
Milwaukee VA Pension
Management Center
Presentation
October 3, 2013
Lisa Kelto | Rating Coach
Today’s Agenda
 Current status of workload
 General Information
–
–
–
–
Submitting claims
Contacting the PMC
General Tips
Accessing VA’s manual
 FDC update
 DIC update
 Veteran Pension
 Survivor Pension
 Additional Topics
– Reverse Mortgage
– Trusts
Average Days Pending
as of 09/23/2013
General Information
Submitting a
Claim
Milwaukee PMC Address
Department of Veterans Affairs
Pension Management Center
PO Box 342000
Milwaukee, WI 53234-9907
OR
Virtual VA Fax number
414-902-9470
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: #877294-6380.
 By e-mail:
[email protected]
– 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:
414-902-5062
 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
– Veteran’s and survivor’s 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 21-4142s are
properly signed by the claimant (or an X/thumbprint
with 2 witness names and addresses).
 Ensure the application/forms are complete.
leave blank boxes - enter “0” or “none”.
Do not
 Net worth over $80K? Submit a completed VAF-8049.
How do you access VA’s manual?
 The VA has an internet based manual available for
you to review at any time – WARMS (Web
Automated Reference Material System):
http://www.benefits.va.gov/WARMS/Site_Map.asp
Fully Developed Claims
(FDC) Update
FDC
FDC
What are Fully Developed Claims?
 Claims submitted on VA EZ forms: 21-527EZ (“Live”
Pension) or 21-534EZ (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 21-8049 is received.
– We need the claims file which is located at the home
regional office or in a federal archive.
DIC Update
DIC Progress
Number Claims
File Date
Pending
4,227
10/31/2012
4,139
11/30/2012
4,135
12/31/2012
3,967
01/31/2013
3,853
02/28/2013
3,296
03/30/2013
3,093
04/30/2013
2,705
05/31/2013
2,332
06/29/2013
2,277
07/31/2013
2,266
08/31/2013
Number Claims
Pending > 125
Days
1,310
1,278
1,402
1,440
1,398
1,097
902
628
398
407
420
Average Days to
Complete FYTD
149.1
149.0
149.0
148.8
149.1
141.4
137.9
134.3
130.8
126.8
123.6
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 serviceconnected (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 21-526 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.
2.
3.
4.
5.
Service
Disability (non-service-connected)
Income
Net Worth
Dependency
Veteran Pension
Service Requirement
Duty entry date prior to 9-7-1980:
 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 9-7-1980:
 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 M211MR, 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 claimant’s financial resources are
sufficient to meet the claimant’s basic needs
without assistance from VA.
 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
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
claimant’s 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 09-17-2001, 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 veteran’s military
service must meet the same requirements
as those for disability pension (see M211MR, III.ii.6.7.d).
Survivor Pension
Eligibility requirements
1.
2.
3.
Veteran had qualifying military service
Legal surviving spouse or child of the
veteran
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 spouse’s 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 veteran’s award.
– However, we will need to enquire further if continuous
cohabitation or remarriage are an issue.
 M21-1MR, III.iii.5.E.26-29
 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 veteran’s 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:
– The claimant was married to the veteran one
year or more before the veteran’s 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 spouse’s
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 veteran’s
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 veteran’s death, is required
in order to award benefits.
– M21-MR, IV.iii.1.1.g
– 38 CFR 3.211
Survivor Pension
Income
 The claimant’s income must be below the
appropriate Maximum Annual Pension Rate
(MAPR) for survivor pension benefits.
 Veteran’s 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
veteran’s 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 veteran’s
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 widow’s 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 veteran’s 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 claimant’s 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 claimant’s 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
The Milwaukee
VA Pension Center
Staff and Employees
Thank You for Your
Cooperation and Service!
Questions

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