Veterans Benefits 101

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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

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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.

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Objective

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

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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.

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What does VA offer ?

• Disability Benefits
• Educations and Training benefits
• Vocational Rehab and employment assistance
• Healthcare
• Life insurance
• More

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Who is Eligible?

• Veteran
• Spouse
• Dependant
• Surviving spouse or dependant
• Guard, reserves, regular military service

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What is the Source ?

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

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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

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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.

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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

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• 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.

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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.

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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.

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Getting Started

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

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Absolutely Positively

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

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• 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.

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• 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.

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• 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.

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• 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

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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

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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

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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.

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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

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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.

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• 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.

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• 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.

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• 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.

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• 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

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• 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.

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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.

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• 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.

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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.

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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.

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• 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
• 
  

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• 
  
• 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

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

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• 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