Benefits

Question:

I am having active surveillance and watchful waiting for service-connected prostate cancer. Can they reduce my benefit from 100% to 20%?

Jim's Reply:

If you have been diagnosed with an agent orange related prostate cancer and you have had no treatment, your rating should remain at 100% disabled as a temporary rating. Only if and when you elect to have some sort of treatment would that 100% rating fall.
 

This is the VA we're dealing with so mistakes are made. They will frequently see that you took an aspirin and credit that as treatment for your cancer and reduce the rating. Yes, really...it happens every day.
 

If that happens to you, you should appeal as soon as you can get to it. Be aware that it happens all too often and then repeats. Good luck sir.

Question:

This question is in reference to dependent children pay status. My dependent child will turn 18 yrs old during this school year (2022-2023). Upon turning 18, what happens to the dependent status? Will the VA stop paying for the dependent child? Will the VA "automatically" start paying at the over 18 yrs old rate as described in the pay chart? I understand that nothing is automatic with the VA, and just leaving things up to the VA is probably not the best idea. Therefore, do you have any input and/or recommendations/suggestions. Thank you!

Jim's Reply:

You'll need to complete the VA Form 21-674 and return it to keep your child on your benefits until the child completes the school year.

Question:

If I am currently TDIU, can I make as much money as I want at a job so long as I don't work 12 consecutive months? Also, does my age play a role not having TDIU taken away (I am 69). Thanks!

Jim's Reply:

No. You are not allowed to earn more than the federal poverty limit in any 12 month period. Your VA is tracking your income by monitoring your IRS and SSA accounts. If you accept employment that earns you more than the limit, you'll soon receive a VA Form 21-4140 asking that you explain why you're earning that money when you're rated as unemployable?
 

VA can and will reduce the TDIU benefit back to the underlying rating if VA determines you're able to work.
 

No, your age doesn't have any effect on your TDIU benefit. In the end the TDIU benefit is exactly the same as any 100% schedular benefit other than the fact that you're rating is dependent on you being unemployable.
 

Good luck sir.

Question:

I am getting 30% disability for ischemic heart disease due to Agent Orange. Just found out that I will have triple bypass surgery in 8 to 10 days. Rep. said I would get 100% for 3 months and then I would be reevaluated. Is there any history on what percent a vet gets after triple bypass surgery? Thanks in advance.

Jim's Reply:

After you have surgery for your service-connected Ischemic Heart Disease (IHD) you'll be awarded a 100% rating for a period of time as you recuperate. The recuperative time is roughly 3-6 months or so and will depend a lot on how well you're recovering and when they can schedule you for a post-op C & P exam. 
 

Your IHD rating is determined by how well your heart is functioning, not by how many or what kind of procedures and surgeries you may endure. Your heart function is usually determined by METS or Metabolic Equivalents and if your heart is functioning much the same after surgery as it was before, your 30% rating won't change.
 

Many vets are surprised to learn that even if they undergo a couple of heart caths, then angioplasty and stenting 2 or 3 times and eventually heart bypass surgery, they can end up with a 30% rating because after all that, their heart works pretty well.
 

So...I wish you a very successful intervention and all the best for your heart! As odd as this sounds, a 0% rating would be the best outcome of all.
 

Good luck sir.

Question:

Jim, Are VA VRE Educational benefit payments counted as income?

Jim's Reply:

Yes, by most entities they would be. How income is defined will depend on the agency that is making the rules.

Question:

I am 81 years old. I served in the U.S. Navy from 1958 to 1969 and was medically retired at that time for Epilepsy. I was stationed in Saigon, Vietnam from 1964 to 1965. Now have following disabilities:

• 40% = prostate residues Agent Orange;
• 20% = Diabetes 2 Agent Orange;  and
• 10% = epilepsy

I now have severe COPD, chronic hypoxic respiratory failure, etc. I cannot connect this as happening while I was in the Navy. Is there anyway I can file a disability claim for respiratory problems?

Jim's Reply:

Yes, you may file for a respiratory rating. Sailors, Navy vets and others who served on board ships or in repair facilities and even training stations were exposed to chemical agents like asbestos in ways most of us never dreamed of. The tight quarters and reconditioned air supply while confined to a sailing vessel of any sort raised the chances of exposure to noxious chemicals.
 

That you didn't suffer ill effects while you were active duty isn't at all unusual with these sorts of injuries. Cancers like mesothelioma can take decades to develop after exposure to asbestos and much the same is true of other HAZMAT exposures that you encountered as you fulfilled your duties.
 

Were I you, I'd first try to recall and then document the sorts of things you were exposed to...like asbestos, a #1 culprit in lung disease. Research ships logs and so on for as much as you can gather, then talk to your doctors about whether or not your current conditions may have been caused from exposures back in the day.
 

Once you've done your homework, file the claim. Good luck sir.

Question:

I am 100% P&T, all service connected. My award letter even states 100% P&T service connected. Now, VA is charging my private insurance and I did not give them my insurance info. I questioned it, but was told by the VA that they could do that. I showed the medical center my letter and they said VA told them, "if they have private insurance charge them." Why is that?

Jim's Reply:

VA has the authority to bill your private insurance for any non-service connected care you may receive. For example, if you're operated on for an inguinal hernia that isn't rated as service connected, you won't be billed but your private insurance will be.
 

We're dealing with VA here so we can assume mistakes will be made and they are. If there is ever a question about what to do, it's easier for the person inputting data to default to billing your private insurance company.
 

Over the years that I've been answering this and similar questions, I've often suggested that vets get in touch with their insurer to see if they are interested and to my surprise, they aren't. So far as your insurance company is concerned, if you received treatment and they received proper paperwork, they pay up as they should.
 

Whether or not this is appropriate is a question for your Congressional representatives, the folks who make the laws. To be honest though, were I you this is one of those things I wouldn't worry about since you won't be able to change it. Good luck sir.

Question:

I'm working with a veteran that is TDIU PT on an extra schedular basis. Has been for years. His combined rating is 50%. He applied for the PCAFC and was promptly denied due to his rating not being 70% or more. Is there a work around for this? Normally, those veterans receiving TDIU would, by default, qualify to apply for the program due to the eligibility criteria for TDIU. I have scoured the regs and VHA directives and have gotten zilch. Speaking to the Caregiver Support line and the VAMC caregiver people is like talking to a wall because they don't have the same critical thinking skills that VSOs have when it comes to the appeals process. To them it's black and white and I think it's partially because they don't understand TDIU or what P&T actually means. As for meeting the ADLs, he definitely meets them but just cannot get past the initial eligibility criteria for the PCAFC. Is he dead in the water?

Jim's Reply:

'Dead in the water'? Hardly. 
 

When you tell me, "I'm working with a veteran", it would help if I knew in what capacity you are representing the veteran? Are you an attorney or VSO? How is it that you're representing this vet?
 

You've turned up an entirely new problem, at least in my experience. You're correct that your contacts don't understand the TDIU rating, much less an extraschedular TDIU rating and they are always committed to the black and white of the regulation that they see. They generally feel that they have no authority to get around what they're reading and they're correct, if they were to approve what you're asking without permission from far above their pay grade, they know they'd be in trouble.

Searching The Federal Register and looking over the history of this convoluted PCAFC process tells me that the exclusion of the extraschedular rated veteran is an oversight, not all that surprising since few people understand TDIU ratings and even fewer understand the extraschedular process.
 

So, how do we escalate this to a proper authority? We have choices and the choice I suggest is to follow the approved process and appeal to the BVA by sending a completed VA Form 10182 to:

Board of Veterans’ Appeals
P.O. Box 27063
Washington, DC 20038
 

If you're comfortable writing an appeal to the Board of Veterans Appeals I'd suggest you go for it, the sooner the better. You can research PCAFC decisions by the BVA by using the BVA search tool. 
 

Good luck!

Question:

Hello Jim. I was awarded TDIU several years ago, but I was recently awarded an increase to 100% scheduler for major depression. Does my TDIU fall off while keeping my new rating, and if so, would I be able to find some form of self-employment or passive income for myself later on if possible?

Jim's Reply:

You are correct. The TDIU rated vet who is awarded an increased schedular rating to 100% loses the employment restrictions that are in place for the TDIU vet. You are allowed to seek and hold any sort of employment you're able to. Good luck!

Question:

Hello. I am a Permanent 100% VA Service Connected Individual. I have been enrolled in the "VA Choice - Community Care Program" since 2019. It has been FANTASTIC to me. My Question for you is - Do you feel that I should keep my Medicare Part B and continue to pay the $1,800 annual deductible? Would you kindly provide me with your feelings one way or the other? Thank you.

Jim's Reply:

Whether or not we need additional insurance is a personal issue that must consider our tolerance for maybe needing it and not having it and being forced to pay some bills out of pocket. 
 

I use my Medicare more often than I use VA care simply because it's more convenient for me. The VA Community Care Program has been a giant failure for most, myself included. You're the only person ever to tell me that you're actually using it successfully. 
 

I can't depend on any VA specialty care as I am 2 to 3 hours away from a VA facility. My VA primary care doctor is about an hour away and he's a great guy but he's in a small clinic in a strip mall with limited resources. My Medicare Part B is a lifesaver for me.
 

If you're comfortable that you won't need your Part B, you can cancel it and save a few bucks. If you should change your mind, renewing it will come with penalties so think carefully.
 

Good luck!