Benefits

Question:

I've had ChampVA for a little over a year now. I recently went to a doctor. (Don't go very often). The doctor say they accept assignment. ChampVA is my primary insurance. Doctor did blood work and sent to a lab. Bills all came back that I had to pay. I'm getting different stories from every office I contact. One office said coding may be wrong. Not sure what to do now. Spoke to the doctor and she said she will take a look at it. Of course, I have no idea if she will. Thanks.

Jim's Reply:

CHAMPVA is great health insurance when it works well for you. Getting it to work well for you can be an exercise in frustration. CHAMPVA seems to be running in the 1990s and their computer equipment and telephone lines just aren't up to snuff.
 

You have to deal with CHAMPVA directly via phone and fax. You have to be patient and persistent and be prepared to spend hours on the phone. Generally if you don't get the answer you need, call back again and talk with another person.
 

My wife has used CHAMPVA for over a decade and we've had frustrations aplenty. We've learned to deal directly with the staff in the doctors office who do insurance billing and we aren't hesitant about tying them up to be sure our bills are properly paid.
 

If you'll work hard to stay ahead of it, you'll eventually get settled into the routine you need for success in the future. Good luck.

Question:

My brother is 100% disabled with PTSD from Viet Nam. I helped him get VA disability and Social Security. I also do his taxes and other paperwork. It is all overwhelming for him. He has decided at age 75 to get Medicare Plan B. I don't know where I go to fill out an application. I do not want to get a bunch of supplemental health insurance representatives bothering him or me. Do I contact SSA or VA or Medicare?

Jim's Reply:

Medicare is divided into a number of differing plans, A, B, etc. Medicare Part A is more or less required and it is 'free' in that there is no actual payment due when you receive Part A along with retirement or SSDI benefits. All those other letters are elective and require that you either elect to purchase the service at the first opportunity provided to you or you wait for a future special enrollment period and apply then.
 

You can read more and learn how to apply here https://www.ssa.gov/benefits/medicare/ 
 

The bad news is that there will be a penalty of about a 10% increase in the cost of the plan for every year that he delayed enrolling. Suddenly Part B is much less of a bargain. His payment may run as much as 50% higher than it would have originally.
 

If you'll have a look here https://www.vawatchdog.org/social-security-and-medicare-benefits.html you'll learn that many vets don't need Part B as well as more about what happens when we delay signing up.
 

I signed up for Part B because I'm a good ways from my VA facility and like my local doctors. I pay copays which I wouldn't have at VA but it's worth it for me. After this long time without Part B, if I were you I'd think hard about whether it's a good use of the available funds? If he's been without it this long, will it be a great investment? These are tough decisions and require a lot of thought.
 

Thank you for taking care of your veteran brother. I know it's a challenge at times but every veteran on the planet, myself included, salutes you for your love. Good luck.

Question:

Can a disabled veteran refuse a general blood work at the va clinic/hospital? (Non drug related)

Jim's Reply:

Refuse lab testing? Sure you can.
 

It doesn't matter if you're dodging a drug screen or just don't want your blood drawn for whatever the reason, you won't lose any benefits because you aren't getting the full range of health care provided for you by the VA. Even if a drug screen popped as positive, no benefits will be lost.
 

In reality though, if you're going to decline lab testing there really isn't much reason to continue to see a care provider. Your provider can't offer you much, if anything, without the results of the usual panel of blood work and testing. Those blood and urine tests are a window into the mechanics of how your system is running and without that your provider is blind.
 

If you plan to refuse lab work as recommended by your primary care provider, I'd suggest that you simply decline any future health care appointments in the system and make room for a vet who wants the full compliment of care. Good luck!

Question:

What Agent Orange related heart issues would require a pacemaker implant?

Jim's Reply:

Only one heart related issue is approved as presumptive for agent orange. IHD - Ischemic Heart Disease - refers to the condition where the arteries that supply fresh blood to the heart muscle itself are obstructed. In the civilian community this is most often called Coronary Artery Disease or CAD.
 

Your heart is a 4 chambered pump that is electrically powered and controlled. The pump is the muscle of the heart itself and controlling how the pump works there's a wide network of nerve fibers imbedded throughout the muscle of the heart. An electrical impulse is generated at a starting point in the heart muscle and it fires a timed stimulus across the heart resulting in a single heartbeat...repeat as needed.
 

A patient who has IHD may have heart attacks that cause scarring in the heart muscle and then an irregular heartbeat. The irregular heartbeat may be too fast, too slow or just erratic. A pacemaker or an Automatic Implantable Cardiac Defibrillator (AICD) may be implanted to control the rate and rhythm of the heart.
 

Think of it as having had a storm hit that interrupted the electrical grid to your neighborhood. Your power may be sketchy, somewhat erratic or worst case...it can go out completely. A pacer is like FP & L coming to the rescue and setting up a new grid.
 

Ask your doctor to document to your record that your pacemaker is required due to damage to the heart from IHD resulting in electrical malfunctions. 
 

Good luck sir.

Question:

Jim, I am a Disabled Veteran and got approved for TDUI Permanent and Total 4 years ago. However, when I first stopped working 2 years prior I gave money (basically invested) to someone to start a business. I wasn't making any income from that so it was recommended I apply for TDUI. Now the business is doing quite well. Will I be able to draw owners dividends from all the profits? Or would I have to sell my percentage to get some of the funds to improve my quality of life? I could also call and have them put me back at 90 percent if that is another possibility?

Jim's Reply:

First up...we never ever call VA and offer to give up a benefit. Never. Your honesty and attempt to do the right thing will always backfire on you. Another rule that goes in tandem with this, never ever volunteer any information that wasn't directly and specifically asked of you. Even then, think your answers through very carefully.
 

You remember that time in basic when you volunteered for something? Just don't.
 

You can't call anyone at VA and ask this kind of a question. Having said all that there is only one sure fire way to know how VA will manage your particular circumstance...you go ahead and take your profits as you'd like and you report all your income transactions to the IRS when you file your income taxes.
 

As all this is going on VA is monitoring your SSA and your IRS account...you're TDIU and shouldn't have an income of over the federal poverty limit and if you do, you'll receive notice from VA to complete a VA Form 21-4140 to explain your income. At that point you'll learn about all the varieties of income you may earn through various ways and you'll be able to explain your working/economic position to VA.
 

If VA determines that your income violates the TDIU rules, your rating is likely to fall back to the base rate you had prior to the TDIU rating. If your income should fall again in the future and you become eligible for TDIU, you'll go though the application process again.
 

As you can see this entire process may take years to complete...don't get in a hurry, allow the process to work. This isn't an uncommon occurrence at your VA and as so often the case, the way to get a complex question answered correctly is to start the paperwork and/or allow the process to proceed and adjudicate it as usual.
 

Good luck!

Question:

Hello Jim, I am a Vietnam Vet with a combined VA Disability Rating of 40%  — 10% for tinnitus and 30% for IHD. I have had hypothyroidism for many years. In addition, I was diagnosed with Sleep Apnea about 7 years ago. I would like to file a VA Disability Claim for Sleep Apnea secondary to service connected (Agent Orange presumptive) hypothyroidism. Can I file claim now or do I have to wait until I am approved for my December, 2020 Hypothyroidism VA Claim? Thanks.

Jim's Reply:

The rules would say that you can't file a claim as secondary to a condition that you don't have.
 

However, since we're sure you'll be awarded the hypothyroidism presumptive benefit, you can go ahead and file the OSA claim now and it'll all come together eventually. Good luck!

Question:

I was diagnosed with prostate cancer in 2015 with a PSA of 12.7 confirmed by a prostate biopsy. This is fully medically documented at the VA hospital. Can I file for 100% VA pension and can I file for back pay from the time of first diagnosis?

Jim's Reply:

Prostate cancer in the Vietnam veteran is presumptive so if that's you, when you file you'll receive a benefit. You won't be filing for pension, you'll file for disability. No...retro pay is determined by the date of your filing for the benefit, not the date of diagnosis. If you've had treatment your service connected benefit will be less than 100%. Good luck.

Question:

After years suffering with PTSD with sleep apnea without anything being in my STR records for fear of ridicule. How can I get service connection?

Jim's Reply:

Service connection of a disability requires that the veteran claimant provide some basis for the claim. You tell me that there is nothing in your STR about PTSD or OSA and that makes your claim more challenging.
 

However, many of us who didn't avail ourselves of medical care while we were active duty will find that within the first year we're out we have all kinds of evidence generated at VA exams, private care doctors and so on. If you have sought health care in the first year after your exit from active duty, that is seen as a solid connection to your active service. 
 

The more of this kind of documentation you have the better. If you're past the first year after discharge, your task becomes more difficult as time passes. If you've waited a decade to seek compensation for service connected conditions and you have zero evidence of why VA should do that, your challenge becomes near impossible.
 

I know of mental health claims for PTSD based on sexual assault that was never reported and those claims were won after clinical psychologists agreed that symptoms were appropriate for an event having happened but those are few and far between. 
 

If you believe that you have enough after service evidence of treatment to support your claim you should proceed to file with what you've got. If and when you're denied you can retain a veterans law attorney to help you appeal and you won't have any out of pocket expenses. Good luck.

Question:

Hello Jim, question about putting in a claim for SSDI, I'm 100% P&T. Any concerns if I file a claim with SSA? Can it or would it affect my VA rating? I had to fight to get the 100% rating and don't want to wake the sleeping dog if it could reduce my rating.

Jim's Reply:

I have some good news for you. Not only will this have no impact on your VA rating, the SSA will try to fast track your application. Keep in mind that the system is a mess because of the pandemic but with luck, your application may move right along.
 

On this page https://www.vawatchdog.org/social-security-and-medicare-benefits.html you'll find a lot of info about all this and on this page https://www.ssa.gov/pubs/EN-05-10565.pdf you'll learn about expedited processing of your claim.
 

Good luck sir.

Question:

Hello Jim. My husband died last October. He was rated P&T/TDIU. I was approved for DIC in November. I am planning on moving to be close to my daughter so called the 800 number to get a letter to see what benefits I was eligible for. They sent me a letter back and on the bottom of the letter it states:

You are in receipt of CPDS.

Your monthly award is $0.00.

The veteran died as a result of a service connected disability: No. (He did)

Was the veteran considered P&T at the time of his death: No (He was)

Do you have any idea what this means? What should I do?

Thanks!

Jim's Reply:

My condolences, I'm sorry for your loss.
 

CPDS is a payee code used to designate who is eligible to be paid. Otherwise the data indicates that you are not eligible for DIC benefits because he was not rated as permanently and totally disabled when he passed nor did he die of a rated service connected disability.
 

You disagree with that and you say that he was P & T and that he died of a service connected condition. 
 

You'll have to appeal the decision if you were denied. There is no way to avoid that. You can seek help from a veterans law attorney here.
 

Good luck.