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Veterans Benefits 101

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Veterans Benefits 101 William Burrus, President Cliff Guffey, Vice President Joyce Robinson, Research and Education Director Chuck Sundgaard, Instructor – PowerPoint PPT presentation

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Title: Veterans Benefits 101


1
Veterans Benefits101
  • William Burrus, President
  • Cliff Guffey, Vice President
  • Joyce Robinson, Research and Education Director
  • Chuck Sundgaard, Instructor
  • APWU 2008 National Convention
  • Las Vegas, Nevada

2
Introduction
  • 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.

3
Objective
  • Familiarize APWU reps with DVA procedures.
  • Educate membership in need of assistance with
    DVA.
  • Assist members obtain benefits from DVA.

4
What is the VA ?
  • Cabinet level government agency
  • Applies federal law concerning veterans
  • Provides medical treatment to veterans
  • Awards compensation to veterans injured in the
    performance of duty.

5
What does VA offer ?
  • Disability Benefits
  • Educations and Training benefits
  • Vocational Rehab and employment assistance
  • Healthcare
  • Life insurance
  • More

6
Who is Eligible?
  • Veteran
  • Spouse
  • Dependant
  • Surviving spouse or dependant
  • Guard, reserves, regular military service

7
What is the Source ?
  • Title 38 Code of Federal Regulations is the act
    which provides for all of the benefits provided
    by VA

8
We will Focus on 2 different types of benefit
  • 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

9
What does Service Connection mean, why is it
important
  • 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 VAs policy
    of administering the law under a liberal
    interpretation consistent with the facts in each
    case.

10
What is the Criteria to establish Service
Connection
  • Discharge type (first thing researched by VA)
  • Eligibility
  • Medical Diagnoses of current disability
  • Evidence of service occurrence or aggrevation
  • Nexus

11
  • Eligibility requires discharge or released
    from military service under conditions other than
    dishonorable.
  • Honorable discharge (HD)
  • Discharge under honorable conditions (UHC), or
    general discharge (GD)
  • Discharge under other than honorable conditions
    (UOTHC), or undesirable discharge (UD)
  • Bad conduct discharge (BCD) (which can be
    issued by sentence of either a special
    court-martial or a general court-martial) and
  • 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 veterans 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.

12
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.

13
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.

14
Getting Started
  • Like the grievance proceduredocumentation is
    critical
  • Several sources for information
  • Military medical documentation is best
    info,but not the only info acceptable

15
Absolutely Positively
  • Military Service Records (MUST)
  • DD 214 (MUST)
  • Private medical history
  • Marriage certificate / divorce documentation
  • Birth certificates
  • Other evidence that is relevant

16
  • Where/How to get records
  • DD 214 and Medical Records
  • National Personnel Records
  • Room 230 OR
    WWW.archives.gov
  • 9700 Page Blvd
  • St Louis, MO 63132
  • 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.

17
  • The Duty to Assist Veterans
  • VA is required to obtain
  • Claimants 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.

18
  • 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 claimants 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 claimants active
    service but
  • (3) does not contain sufficient medical evidence
    for the VA to make a decision on the claim.

19
  • Claimants 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

20
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

21
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

22
Evidence needed to substantiate a claim
  • VA is required to inform the claimant
  • of the information and evidence not of record
    that is necessary to substantiate the claim
  • of the information and evidence that VA will
    obtain
  • of the information and evidence that the claimant
    must submit
  • (4) to provide any evidence in the claimants
    possession that pertains to the claim.
  • give us everything youve got pertaining to your
    claim(s), or something to that effect.

23
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 service-connected disability
    compensation

24
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.

25
  • 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.

26
  • 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.

27
  • 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.

28
  • How do I file an appeal?
  • No special form is required to begin the
    appeal process. All thats needed is a written
    statement that
  • (1) you disagree with your local VA offices
    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

29
  • DISABILITY PAYMENTS
  • 10
    106.00
  • 20 205.00
  • 30 316.00
  • 40 454.00
  • 50 646.00
  • 60 817.00
  • 70 1029.00
  • 80 1195.00
  • 90 1344.00
  • 100 2239.00
  • Between 30 and 100 there are allowances for
    a spouse and each minor child. The amount
    depends on the disability rating.

30
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.

31
  • PTSD
  • Post-traumatic stress disorder (PTSD) is a
    mental disorder characterized by the American
    Psychiatric Associations 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.

32
UNEMPLOYABLE
  • 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.

33
SERVICE AGGREVATED CONDITION
  • 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.

34
  • 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
    20


35

  • 5256 Knee, ankylosis of

  • Extremely unfavorable, in flexion at an angle of
    45degrees or more 60

  • In flexion between 20degrees and 45degrees
    50

  • In flexion between 10degrees and 20degrees
    40

  • Favorable angle in full extension, or in slight
    flexion between
  • 0degrees and 10degrees
    30

  • 5257 Knee, other impairment of

  • Recurrent subluxation or lateral instability

  • Severe

    30

  • Moderate

    20

36
  • Service Organizations
  • Disabled American Veterans
  • Veterans of Foreign Wars
  • American Legion
  • Paralyzed Veterans of America
  • Many more

37
  • 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
    1-800-697-6947
  • Gulf War Agent Orange Helpline 1-800-749-8387
  • Debt Management1-800-827-0648
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