Benefits

Question:

Hello, I am an IHSS provider for my son. My father is a veteran. He's 86 and needs help grocery shopping, cooking, and cleaning. I also take him to doctor appointments. I have been doing all of this because I am his daughter but it's taking a financial toll on me. Would I be able to be my father's provider? Please advise. Thank you.

Jim's Reply:

Thank you so much for your concerns about your veteran father. You've just made my Saturday a lot better!
 

You may be eligible https://www.va.gov/family-member-benefits/comprehensive-assistance-for-family-caregivers/ 
 

I have to advise you that this program has experienced a lot more turmoil and bad press than most VA programs and that's saying a lot. Caregivers have been approved, had the approval clawed back, been approved again and now the rules are changing and everyone has to reapply. Even for VA this is a terrific mess.
 

However, it seems you've had some experience with bureaucracy so you're somewhat prepared to face VA. The best advice I can offer is that when you apply, do it so well they have no choice but to award you the benefit. Every minute detail is important and the more info you provide, the better. If asked for medical records, hand over more than asked for. If asked for a doctor's opinion, get 2 or 3.
 

You get the idea, you want your first application to be so perfect and with so much information they'll have no choice but to approve you. It's worth the effort, the appeals process here is draconian at best.
 

Give your dad a salute from me. Good luck.

Question:

I have CHAMPVA insurance as a secondary insurance--my primary is united healthcare medicare solutions which is PPO. I have had 2 doctors' offices say they are not in the CHAMPVA network. One just said we don't take that insurance. Can they refuse a military insurance?? Since I am paying a copay, can I get reimbursed for it on a claim form with a receipt from the doctors office?? Thank you in advance for your help.

Jim's Reply:

A medical practice is a business like any other and can refuse any insurance, even Medicare. CHAMPVA isn't 'military' insurance, that would be Tricare. Many practices will only accept limited private insurance or even cash in 'boutique' specialty practices. 
 

Health insurance is confusing at best and I always advise people that what you need is what you're comfortable with and what you can afford. I'm not a believer in Medicare supplemental policies and have never subscribed to one. They're often restrictive and expensive and rather than pay for a supplemental, I save the money and put it aside for out of pocket expenses. If you're visiting physicians in a PPO it's possible they only accept very limited insurance coverage from outside the PPO and because of their business structure they can't deal with any other insurers.
 

My wife uses CHAMPVA which is now the secondary payer to her Medicare. I use Part A & B more often than I use my VA  care as it's just more convenient to me. I pay any copays out of pocket and haven't found that to be burdensome. I also use the VA Community Care Program when I can but that's an uphill climb most of the time.
 

I also usually advise that when you want to use CHAMPVA that you have an appointment with the doctor's insurance and billing people before you try to see the doctor. Many physicians believe they know about their insurance and billing policies and they don't. If they accept Medicare for them to accept CHAMPVA is a no brainer and they just need to learn how. Most offices are happy to see any payment that is equal or near equal to Medicare and once they're set up with CHAMPVA there are few issues.
 

To be honest I don't see any reimbursement for a copay coming your way. I would have guessed that's what the supplemental is for? You could call the CHAMPVA folks and ask...it can't hurt.
 

Like I said earlier, your insurance choices will depend on what you are comfortable with. I think CHAMPVA is great health insurance but it does take a little extra effort and a lot of patience to get it right. Good luck.

Question:

Hi I am caregiver to my mother who currently receives VA Aid and Attendance benefits and Housebound allowance. We live in California we have applied for Medi-cal and were approved. We also applied for IHSS and were approved with a share of cost. The share of cost is because Medi-cal is including the part of this VA aid & Attendance / housebound allowance as income. I don't think that IHSS is correct, how can I show them they are wrong? Thank you.

Jim's Reply:

Every means tested benefit that I'm aware of views all income as just that - income. After all it's real money that is coming in to the household. 
 

This is a common misunderstanding when we speak of any VA income because VA income is tax exempt. The confusion is understandable and frequent...a lot of folks write to me with similar misunderstandings. Tax exempt doesn't mean the money is exempt from other policies.
 

A couple of the ways this comes up is in divorce court where the divorcing vet thinks his disability pay is exempt from child support or alimony or when a veterans pension is reduced because of some small windfall the year before. They're always surprised to learn that all VA income is counted as what it is...incoming money.
 

In the end I'm afraid we aren't going to be able to show them the error of their ways. Good luck.

Question:

Hello Jim, I currently serve as a fiduciary to my brother whom is a 100% disabled veteran. I’m also a financial professional with 30 years of financial industry experience where I’ve held various executive level positions in project management, sales and Client service, managing public and institutional clients. I also have a bachelors degree in Business Management and I have held series 7 and 63 licenses. I’ve really come to enjoy performing my fiduciary duties and have learned a lot since I was appointed. My question is I’m extremely interested in helping other veterans who need help managing their assets. Is it possible me for to become a professional fiduciary for the veterans?

Jim's Reply:

Become a VA fidu? You bet that's possible. Click here.
 

But I have to warn you that the VA fidu program isn't highly regarded. An old friend has this to say: The VA Fiduciary Program: A Wretched Hive of Scum and Villainry.
 

That actually describes it pretty well. I've been an advocate for a long time and dealing with the Fidu program is one of the more frustrating processes I've encountered at VA. I hope you may be able to join in and bring some clarity to what it is they're trying to do.
 

Thank you for your interests in veterans and for taking care of your brother.
 

Good luck.

Question:

Hi Jim - I recently filed a claim for MST related PTSD and Hypothyroidism. I attended my C&P exams and thought both providers were professional and thorough (surprise). I had my first exam for PTSD and the second was for Hypothyroidism. The VA lost my medical records but luckily I provided enough information in my separation exam that I was granted C&P exams (I believe that is why). My primary care provider also wrote a very detailed letter supporting my diagnosis and providing an opinion. My question is - a few days after my exam for hypothyroidism the VA scheduled another exam for "behavioral health and a DBQ for Mental Disorder except PTSD and Eating Disorders". Why would they schedule another mental health exam so soon? It has only been 4 weeks since my PTSD exam. I thought it was strange so I searched the internet and found you. Thank you so much for your time and thank you for taking the time to answer so many questions.

Jim's Reply:

I can't accurately explain why VA does what it does most of the time. This is one of those times. I'm really happy to hear that your examiners were professional in their actions. I recall my own series of exams and 1 of maybe 6 was concerned enough to do the task correctly.
 

We know that VA practices overkill when it comes to C & P exams. The fact is that most C & P exams aren't at all necessary. VA has a process called ACE that should be the first step and never is.
 

I've always thought that this is because the companies doing C & P exams are owned by former (retired) VA executives. The contracting company is paid by the exam so the more the merrier. Yeah, that's pretty cynical of me isn't it? We can hope I'm wrong but this is VA we're talking about so anything is possible.
 

Another reason is the VA propensity to practice CYA at every step. Overkill in data collection is the word of the day, every day.
 

If a rater is responsible for marching your file through the process of adjudication that person wants the file to be as complete as possible prior to the moment of the final decision. If any possible data is left out, whether it is actually necessary or just repetitive, the person monitoring the process will be criticized.
 

I can't tell you just why it is that you have another exam scheduled. What I can leave you with is that no matter how onerous or silly the process may seem, never miss a scheduled C & P exam. Don't reschedule if it's not convenient...find a way to be there. If you miss an exam VA is likely to default to a denial.
 

Always be prepared with copies of any documents that may be helpful but recognize that the examiner isn't required to receive them. Never try to secretly record the encounter with your phone but do make mental notes of anything that seems out of place and them make written notes so you won't forget. If your claim is denied for any reason, the blame is usually traced by to an inadequate C & P exam during appeal.
 

Finally...read this document so you know a lot of what the examiner knows when you enter the room. Good luck!

Question:

Sir I was diagnosed with thyroid cancer in 2006 and had entire thyroid removed. I retired in 2010 and was given a 10% VA rating. The cancer was never in remission since my body had antibodies still present. Just went in and had a modified neck dissection in Dec 2021. My question is should the rating been 100% since retirement since the cancer was not in remission? I just completed a VA claim appointment for the neck dissection. What is normally the outcome? Thank you.

Jim's Reply:

There are no 'normal' or average outcomes in the VA claims system. Not only is every case different down to the most minute detail, the system of adjudication is rife with mistakes and errors that produce wrongful decisions that require appeal.
 

If you'd like to look for cases similar to yours you can search outcomes at the Board of Veterans Appeals. You'll see the search engine there and you can insert key words to pull up cases like yours. This doesn't guarantee a favorable outcome to you as BVA cases do not establish precedent. If you find a case that has prevailed you will more or less have to duplicate that pathway.
 

If I understand you correctly, the answer will be no. If you had a rating of 10% in 2006 and sometime between then and now the conditions worsened, VA could not have known that until you filed a claim for an increase or appealed the rating you were awarded. Had you appealed that rating within one year of it being awarded, you may have won an increase...or not.
 

Good luck sir.

Question:

Hello Jim, I am 100% Permanent Disabled living in Germany. I also have Tricare. Am I insured for all Medical Care ? Also do I still have a co-pay if I am 100% Permanent Disabled. Thank you.

Jim's Reply:

You're in luck. The VA runs a robust Foreign Medical Program https://www.va.gov/COMMUNITYCARE/programs/veterans/fmp/index.asp
 

Keep in mind that once you have registered for the FMP, the pandemic has everyone backed up. Be patient and persistent as you go through the motions with your VA and I think you'll be happy with your health care.
 

I served 2 years at 98th General Hospital Neubrucke/Nahe many years ago. You've made a good choice...Germany is a wonderful country. Good luck.

Question:

I had to have a valve replacement, the doctor at the VA hospital gave me a choice to have it done at the VA hospital or go to a community hospital only 4 miles from my home. He said that the VA would still take car of it. Well, I got the referral ok'd and had it done. Now the VA has rejected the bills because addresses were wrong. They never said anything to me and the doctors people went to my supplemental Humana. Now I'm getting notices from bill collectors. Is this the VA's responsibility?

Jim's Reply:

VA physicians don't have the authority to authorize such things. I'm not sure what you mean by, "the doctors people went to my supplement Humana"? 
 

It sounds as if maybe you have a Humana insurance policy and the civilian hospital got that policy number and they're billing Humana.
 

You have a very serious problem. I'd advise that you open a conversation with a veterans law attorney or your Congressional Representative as soon as you can to get some help. 
 

Whether or not this is VA responsibility isn't clear to me. A valve replacement isn't usually a service connected condition so even if you have it done at a VA hospital, if you have a private insurance, VA will bill that insurance for payment. 
 

Good luck sir.

Question:

Hey Jim, you do an amazing job for Veterans. My question, I have prostate cancer, metastasis bone (so far). I filed claim recently. I'm assuming I'll get a 100% rating (Vietnam-boots on ground). Will they only give me a temporary 100% disability, or can they give me permanent and total? There is no cure and life expectancy range "not good"! If they give me temporary should I turn around and request total and permanent rating of 100%? DAV is helping me, kinda, but when I ask questions, they become defensive. I have an inquiring mind! Thanks.

Jim's Reply:

Your VA has always viewed service connected cancer ratings as temporary. Somehow they're convinced that every veteran will have every cancer treated successfully and within a few months life will return to normal.
 

You can't, "turn around and request total and permanent". There is no path for that request and all doing such a thing would do is to delay adjudication of your claim. That's actually not such a bad thing because all that a 100% P & T rating would do is to give your spouse some health care options and your children could use it for college. I'll assume your children are no longer dependents living at home and your spouse is likely already set with health care like Medicare.
 

So far as your chosen representative not answering your questions and becoming defensive, well...that annoys me. There is no reason for them to have an attitude and I hear this all too often. I fired them as my representatives many years ago. The BVA issues an annual report that includes who are the most successful representatives, you're welcome to do some research for yourself here https://www.bva.va.gov/chairman_annual_rpts.asp
 

As long as you have a detectable cancer you'll be rated at 100% but it will be a temporary rating. Good luck sir.

Question:

As a Vet rated 100% disabled by the VA (not P&T or TDIU), how much can I make per year?

Jim's Reply:

It sounds as if you have a temporary rating for a condition that isn't determined to be static. You'll have a future exam scheduled to determine what your overall permanent rating will be.
 

While you wait for that future exam, there are no restrictions on the amount of work you can do or the amount of money you can earn.
 

I'm a champion of veterans returning to the workforce as soon as they can after an injury or illness. I believe that productive work of almost any sort is healing and good for us. 
 

Go for it and make a lot of money! Good luck!