Benefits

Question:

I'm rated at 80% disabled by the VA payable at 100% and receive free medical care through my local VA clinic. My spouse receives free ChampVA. My 60th birthday is in a few months and at that time my Army Reserve retirement pay will kick in. But also, at that time, she will be ineligible for ChampVA. Will I also be ineligible for VA medical? Will we both have to switch to Tricare Select or Tricare for Life?

Jim's Reply:

I don't know. This is the very first time I've run into the retired Army Reserve retirement pay system and I'll congratulate them on having made it incredibly complex. There are more nuances. twists and turns than most and that's saying a lot.
 

I'd urge you to find someone local to you, perhaps even on a local military base, who knows of any recent changes to the complex rules and regs that support your health care and your retirement. 
 

I've looked over a number of documents like  https://ec.militarytimes.com/guard-reserve-handbook/retirement/other-benefits/   and it's pretty clear that you start Tricare at age 60 and that's a good thing...you get to choose your doctors and so on. But losing her CHAMPVA may or may not be all that positive since overall that's pretty good insurance. I have to assume she will also get Tricare but I don't know how the decisions for different varieties of Tricare will work.
 

I'm afraid this is one of those life events that will probably cause some stress due to so many unanswered questions and variables as you proceed. That's the bad news. The great news is that you have what is likely the best health care insurance options available in America today and that's a very good thing. Good luck!

Question:

Hi Jim, last we spoke about my VA Primary Care Dr. stopping my pain meds. I wrote a letter to him with my hospital report that contained an explanation. Lo and behold, he reinstated my pain meds. He is a very compassionate doctor. My new  question is...I need a walk in tub because my balance is very bad. I filled out a grant form 26-4555. Where is the best place in VA to send this form? Of course I will send it certified mail. Hope you are doing OK. Thanks.

Jim's Reply:

It's good to hear from you! That makes me very happy...it's been a long while since we tackled your challenging RVN claim. Your service was the kind of stuff Ian Fleming would have loved.
 

You're fortunate to have a compassionate primary care provider. Far too many won't even talk about opiate pain therapy these days. The overreaction and full pendulum swing in response to the opioid crisis has hurt a lot of people. As usual in our history, treating substance use and abuse issues as revolving door criminal proceedings rather than a health care problem solves nothing and the drug crisis in America is at a new peak...or low. Some physicians seem to be returning to their senses about chronic opioid pain management and I'm glad you found one.
 

Your VA has managed to mismanage incoming documents to an absurd point. The form tells us, "This application should be submitted to the VA regional office where your claim file is located or this form can be completed online by visiting www.ebenefits.va.gov", and that doesn't seem correct. Other VA broadcasts tell us that all paper must come through Janesville to be scanned and uploaded to the system. If you mail routine claims related stuff to your RO it's sent to Janesville to be scanned.
 

If it were me, I'd go to eBenefits and complete the form on line. The eBenefits site presents its own unique set of challenges but the fact is that if you can get that done, your form is instantly in the system and ready to get started on.
 

Feeling just a bit stressed and not sure about this? Mail a copy via certified mail...​

V A Claims Intake Center
PO BOX 4444
JANESVILLE, WI
53547- 4444

And fax  a copy...
Toll Free Fax:
844-531-7818

And if you have the address of your regional office handy, mail them a copy too. Yes. The Shotgun Approach is alive and well. Sometimes only old school works.
 

What happens next?
 

Your papers will find their way to a desk and someone will process it all and then in the distant future I'll read another obscure VAOIG report about how veterans abuse the system by sending in repetitive and redundant copies of paperwork.
 

Yes, really. VA never fails to entertain.
 

Good luck sir.

Question:

Hello Jim, I hope that you can answer this question or send me in the right direction. Is there a law that states that if Combat Related Special Compensation (CRSC) entitlement exceeds retirement pay then you are only entitled to have your retirement pay tax free and not the full amount of CRSC. I understand that I'm only allowed to receive CRSC or retirement pay. My CRSC rating is 100%.

Jim's Reply:

Each individual tax situation is so different that I hesitate to try and answer your questions. I'll let you in on a family secret though...I've used the same CPA firm for almost 20 years. I don't use a CPA because I run a big business or have a lot of money, I use a CPA because like you, I sometimes have tough tax questions. And for what it's worth, I'm not talking about a seasonal "tax preparer" with a booth in K-Mart, I mean a real CPA.
 

There are times that it pays to get an expert on the task. I could send you to various web sites where you could muddle around finding different answers but you've probably already done that.
 

If you'll ask around in your region you'll discover a small business that houses a couple of CPAs who have some experience with veterans finances and you'll learn PDQ that their fee is well worth it. I know I've avoided a lot of traps by having a pro take care of it.
 

CPAs usually charge by the amount of work they put into your tax returns and if you're like me without a ton of income, debt or cash flow, you may find the service to be a real bargain. And your questions will be reliably answered by a pro.
 

Good luck!

Question:

In 2015 I had a massive heart attack, 9 week's later I had surgery for 5 bypass. I was granted 60 percent, and am currently at 80 percent. This month I had a defibrillator put in my chest to control my heart rate. Should I try to get 100 percent for the defibrillator?

Jim's Reply:

You're a Vietnam veteran with an agent orange IHD rating. It sounds as if your rating has been lowballed from the start. Sixty then eighty percent for what your heart is going through really isn't near enough.
 

VA is notorious for fudging the seriousness of a heart attack and subsequent damage to the muscle of the heart. They use obscure and obtuse methodology to determine the functional strength of the muscle and that usually is a gross understatement of the overall condition of the heart and the patient. I have yet to see an accurate rating for IHD.
 

In any case, if you had a pacemaker, an AICD or any other cardiac rhythm or pump assist device implanted, your rating should be adjusted to 100% from the date of implant and maybe then some. If you have other ratings that total up to 60% along with the 100% for the AICD, you should get the SMC housebound benefit.
 

You will have to keep applying for increases until VA gets it right. Good luck.

Question:

Hi Jim, like you I am a Vietnam Era Veteran. I served in the USAF from 1967-71, honorably discharged. I am now a sick old man (aren't we all) and I am retired. Among more than my fair share of maladies, I have lost my hearing in one ear and am losing in the other. The VA will do nothing for me, in fact they wouldn't even vaccinate me for COVID even though they had vaccine, when nobody else did. I have never asked the VA for any health care, or much of anything else. Now, I need hearing aids and they are insanely expensive. Any ideas? I could also use some help paying for all the medications I take, Part D of Medicare is pretty pathetic. But my most immediate need is hearing aids. 

Jim's Reply:

Many of us of our era were told we had health care benefits for life. That was true if we registered in the VA system early on and stayed active by seeing a VA doctor every now and then. A lot of folks didn't bother because they had civilian insurance and in those days avoiding VA care was a good way to stay healthy.
 

Then came the most recent era of wars and in 2006-2007 the rules changed. No longer were we promised forever care, there were rules. If you were RVN era and hadn't registered and didn't have a VA rated disability, or you weren't retired etc., you were out of luck. That sounds like you, doesn't it?
 

The next generations of warriors have each faced changes to eligibility for VA health care and to be honest it's a challenge to keep up with who is eligible for what.
 

At this point you have a good option. Apply for a hearing related disability rating. Hearing loss and tinnitus is the #1 rated disability in our world. We have all been exposed to acoustic trauma that has harmed our hearing over time. You'll be examined for the degree of hearing loss and you'll be given the opportunity to tell VA why you believe your hearing loss is connected to your military experience.
 

Once you have a rated disabling condition, you'll be able to access the full offering of VA health care. Depending on your rating there may be some minor copays but nothing burdensome.
 

It's a pain to have to do this but this is the way it works. Good luck!

Question:

My wife uses ChampVA for insurance but will be eligible for Medicare when she turns 65 along with Medicare Part D for prescription drugs. There is a monthly premium for Medicare Part D, but other than that how would you compare Part D drug coverage versus the ChampVA meds by mail program?

Jim's Reply:

My wife crossed that line a couple years ago and it get's confusing. First up, it's my experience that Part D can be costly whereas CHAMPVA gets the meds to her for free or with a very low copay. 
 

https://www.va.gov/COMMUNITYCARE/docs/pubfiles/brochures/MbM_brochure.pdf 
 

Overall my wife is pleased with her Meds By Mail program, it works well for her. She and I have a habit of carefully looking over any Medicare offering that costs extra. Often enough if you take the $$$ that you'd pay the premium with and tuck it away and use it to pay cash for extras, you'll be ahead. Many of these Medicare supplements restrict you to a group of providers who may not be as convenient as you'd like so read that fine print.
 

If you'll spend more time than you wanted to and get to know CHAMPVA, you'll likely discover that when combined with her basic Medicare benefit she'll have very good health care insurance. The trick to using it all effectively is to ask questions of providers up front, before you need the health care. Every doctors office has an insurance specialist who will be grateful for you to come in ahead of time to talk about billing. The same applies to your local pharmacy, they're a wealth of info about who covers what and when.
 

You have your VA care and Medicare and CHAMPVA in your family. That puts you in the best insured group in America today. Learn the rules that apply in your region and you're way ahead. Good luck!

Question:

It appears that the VA is being more critical of IMO/Nexus letters. In the past it use to be, "More Likely than Not" was enough to get an approval of your claim. Do you know what the VA is looking for? Can you provide an example of an accepted Nexus letter that the VA will accept? I'm in the process of obtaining an IMO/Nexus and would like to avoid any pitfall. Are you in a position to call the VA and actually ask them for guidance on what they will accept now? About 3 years ago I submitted what I thought was a very good Nexus. The VA threw that out in the blink of an eye. That claim is sitting with the BVA. I just want to be in a better position to provide the VA with the evidence they require. Thank you.

Jim's Reply:

Plugging in a phrase like, "More likely than not" isn't nearly enough. The statement would have to be supported by science and made by a qualified individual. For example, a podiatrist shouldn't opine about heart disease for your IMO. I haven't seen any particular shift in what VA accepts as an IMO.
 

Call the VA and ask them for advice? That's a new one on me. But no, the VA doesn't help you to win your claim by offering personalized advice.
 

Since I don't know where you're getting your support from, the best I can offer is that experience counts. The doctor should have a deep understanding of what VA needs to hear and must have to support your claim. Asking your family doctor to provide an IMO is usually a waste of time.
 

The 2002 edition of The Clinicians Guide is the tool I use most often to develop what I think VA must have in the record for you to prevail. If you'll study that guide and tie those principles to your claimed conditions in The Schedule, you should have a winner.
 

I'll remind you that sometimes we don't win because we don't have a well grounded claim no matter how much we believe in our cause. There's only so much that wordsmithing can do to help and legit IMO doctors won't fudge anything to help you.
 

In the end, if you want a great IMO these are the folks who can help https://www.vawatchdog.org/imo-ime-medical-opinions-exams.html   Good luck.

Question:

If you have P&T 90% rating should you try for 100%. I have heard that they can lower your rating when you ask for a higher rating. I asked for a higher rating and am afraid that it will reduced. How often do they check if you don't try to get a higher rating?

Jim's Reply:

No, you shouldn't "try" for a higher rating. You're correct that you have to be careful what you ask for and that once you get this started, you can actually lose benefits.
 

If you're at 90% and you're unable to work, the TDIU benefit is the way to go https://www.vawatchdog.org/tdiu-unemployability.html 
 

Before you do anything, have a look here https://www.vawatchdog.org/how-to-increase-an-existing-benefit--.html 
 

Do your homework and decide how you can win before you try to increase to 100%. Good luck.

Question:

Once I returned home from Vietnam, was I supposed to file for Veterans Benefits especially because of the Agent Orange exposure?

Jim's Reply:

If you returned home and developed a disabling condition that you could attribute to any activity during your active service, you could file a claim for disability benefits. You can still do that, no problem. Agent orange has a specific set of disabling conditions (the presumptive list) and those that are recognized will make filing a claim simpler.
 

Beyond disability ratings benefits your biggest benefits are education, health care and home loans. You don't file for those in the way you file for disability benefits. The benefits are there to use so you simply go get an education or register for health care. If you haven't used any benefits, I suggest you go to your nearest VA health care facility and apply for care. Good luck.

Question:

Read your mail every day and enjoy it. I have asked you questions on several occasions and the answers have been spot on. Thank you for the time you take to answer our questions, here goes:
 

1. Do you know the ballpark price for a veteran to be buried in a national cemetery? Say Montevallo here outside of Birmingham.
    
2. Is the spouse also eligible, I retired from the Air Force after 20+ years

Thanks, John

Jim's Reply:

Thanks for your kind words. I enjoy answering the questions posed to me...I'm glad to hear it helps.
 

If you're eligible, burial and perpetual care costs you nothing out of pocket and your funeral home costs will be very low. I urge vets to go to the closest national cemetery they may want to use and speak with the staff there. National cemetery staff are friendly and open to helping you determine how they may help. See the links I've provided below.
 

I also advise vets to choose a funeral home today and make arrangements with them. Interviewing them now and choosing the director you like is a great step to get out of the way now. Your funeral home director will be in charge of all arrangements and they can be a terrific asset. They have all the connections and numbers to VA since that's how they get paid...that's always a great motivator. The funeral director can be a great friend at a bad time.
 

Your spouse is eligible to be buried along side you in most circumstances. Check eligibility requirements here https://www.va.gov/burials-memorials/eligibility/
 

Don't forget about probate...you need your will and so on updated. If you believe that your spouse will be eligible for DIC benefits you should talk about that now and start the paperwork for her to complete. See here: https://www.vawatchdog.org/dic---survivor-benefits.html 
 

Looking at your chosen cemetery it appears they have sites available for burial and cremated remains. https://www.cem.va.gov/cems/nchp/alabama.asp  This is a beautiful choice for you.
 

If you're interred in a national cemetery you'll soon be a part of the new VA legacy project here  https://www.vlm.cem.va.gov/   
 

There you have it...good luck sir. Promise to do your very best to not use this benefit until you absolutely must!