Benefits

Question:

I am the spouse of a deceased Vietnam vet. At the time of his death he had a disability rating of somewhere between 70 -80%. After his death in 2009, I applied for DIC and it was denied. He had confirmed PTSD and had developed AFib. He died from a stroke caused by the AFib. AFib was listed as secondary cause of death. VA denied my claim because AFib was not considered service connected at that time. Since then many more studies have connected PTSD and AFib. And I have spoken to a few vets who are receiving benefits for their AFib, or spouses who have shown AFib to be connected to service related condition. I’d like to submit a claim now and wonder if you are aware of more cases where AFib caused by PTSD is being considered as cause of death and benefits are being approved.

Jim's Reply:

No, I'm not aware of cases of atrial fibrillation that are secondary to PTSD and listed as the cause of death. You're able to research BVA decisions by clicking here https://www.index.va.gov/search/va/bva.jsp and entering the years and the key words you'd like to search. These are all cases where a denial has been issued and appeals are taking place.
 

You can also seek a no-cost consultation with an accredited veterans law attorney here https://www.vawatchdog.org/how-to-hire-a-veterans-law-attorney.html  Any of the lawyers you'll meet there are happy to evaluate your case.
 

To link A-Fib and PTSD together is likely to require an opinion from an expert disability physician. You can seek an Independent Medical Opinion here https://www.vawatchdog.org/imo-ime-medical-opinions-exams.html

Good luck.

Question:

Hi Jim, I am 80% service connected, TDIU since May of 2017. My award letter that I generate through ebenefits says that I am also P&T. I really want to get back to work. I am confused on how I go about letting the VA know that I no longer want to be considered unemployable. If I return to work, does my benefit pay automatically revert back to the original 80% designation? A VA rep told me today that because I am P&T, I will be paid at the 100% level indefinitely, no matter work status. This seems contrary to the vague and muddy information I am pulling off of the internet. Any help is greatly appreciated.

Jim's Reply:

You're in a spot that many veterans find themselves in. You're rated as unemployable due to service connected disabilities but you want to return to work as you believe that your condition is such that you can successfully reenter the work force.
 

That's great for you! I believe that regular work is of great value to veterans not only in terms of making some money but for self esteem. It feels good to accomplish a task.
 

However, yes...you'll lose the 100% benefit. When you are rated as permanently and totally (P & T) unemployable you aren't allowed to produce an income of more than the federal poverty wage or...you lose the 'permanent' 100% rating...your dependents would also lose their CHAMPVA and DEA benefits.
 

What will happen as you return to work is that VA will monitor your productivity for the next year or so. VA routinely tracks the SSA & IRS earnings of the TDIU veteran and at the point that your earned income exceeds the federal poverty wage, you'll get a notice from VA telling you that you may lose the 100% rating and revert to the 80% rating. They'll ask you to complete a VA Form 21-4140 to explain where your earned income is coming from.
 

In a nutshell, you don't need to notify VA of anything. You can begin to return to the work force and if you do well, VA will be in touch. If you discover that you aren't able to cope with the rigors of a return to gainful employment, you may not ever make enough money that VA will suspend the benefit and you'll not suffer any loss.
 

PRO TIP: Avoid those sketchy "VA Reps" at all costs. That info that you got isn't just wrong, it's dangerous. The word 'permanent' at VA doesn't mean permanent. It means that as long as you follow certain rules (don't work if you're TDIU) you are eligible for enhanced benefits for your dependents...CHAMPVA and DEA. If you were to return to work thinking your rating can't change, you'd be in for a rude awakening.
 

Good luck!

Question:

Jim, I have asked you questions in the past but here’s another one for you. I’m drawing 100%TDIU and I know that I can’t work, however, is there a certain amount that I can make like working P/T without getting in trouble?

Jim's Reply:

Yes. You're allowed to earn as much as the federal minimum wage.

Have a look here for the guidelines.

Question:

Hey Jim, been TDIU P+T for 10 years, just got married, how do I initially go about getting my new wife onto CHAMPUS.

Jim's Reply:

Adding dependents isn't as difficult as it once was. Be aware that for certain benefits you and your spouse must be together at least a year before she'll be eligible.

VA explains it all here https://www.va.gov/disability/add-remove-dependent/  

Question:

My soon to be ex husband applied for CHAMPVA for me and my son. My concern is when we get divorced, I loose it. Does loss of insurance create a event where I can enroll in my job's insurance? Is CHAMPVA creditable insurance? Are there a lot of out of pocket costs to CHAMPVA? Would it be a good idea for me to get a work policy due to those? How would that work?

Jim's Reply:

CHAMPVA is a health insurance benefit that is available to the dependents of some totally disabled veterans. There aren't a lot of out of pocket costs associated with CHAMPVA, there are some deductibles and such but less than most insurance policies.
 

Unfortunately, once you're divorced you're no longer a dependent and CHAMPVA won't be available to you. 
 

When you enter the divorce court the magistrate will take all this into consideration. Often enough the party that has been providing health insurance will be ordered to continue that arrangement. If that is the case it's then up to your ex to find insurance comparable to what you have today. You can speak with your attorney about that. Good luck.

Question:

My husband recently passed away from myocardial infarction, coronary artery disease and hypertension. He served in an artillery unit near the Korean DMZ in 1967-68 . He had his 1st hart attack in 1996. In 2005, we asked about Agent Orange exposure but at that time he wasn't eligible. He did receive a 30% VA rating for his hearing. He was unable to work after he had multiple bypass surgeries and stints in 1999. In 2014, VA doctors said that they couldn't do anything for him other than give him medication. He spent 4 years under hospice care and 24/7 family care. The VA regulations regarding Korean Agent Orange exposure have changed & includes his time in country and his medical condition that resulted in his death. I am seeking DIC benefits but can anything else be done?

Jim's Reply:

Veterans who served in Korea who are eligible for agent orange benefits fit into a fairly small segment of all those who served there. There is a distinct time frame and geographic region that must be verified for the veteran to be eligible for agent orange benefits.
 

If your veteran's record shows that he was eligible for agent orange presumption and if his death certificate shows that he died of heart disease, it's likely that you're eligible for DIC.
 

If you've properly filed for DIC benefits there isn't anything more to be done than I can think of. Once you filed VA generally processes DIC claims within weeks so you shouldn't encounter big delays. Good luck. 

Question:

I was discharged with an OTH due to drug use. Down through the years I have filed for different benefits starting with unemployment compensation the month after I got out. With the exception of a VA home loan guarantee, I have been denied each time. There have been Character of Discharge (COD) reviews that say that my service was not honorable for VA purposes. In 2013 and 2014, I filed after getting a diagnosis for PTSD and was denied again. I appealed to the BVA. There was no action taken on the claims since I first had to have veteran status.

When I filed my Notice of Disagreement (NOD), I mentioned that I was in disagreement with the COD ruling since I had the diagnosis that shows my in-service stressor and other evidence. There was no decision or Statement of the Case (SOC) referencing the claims, just the discharge. I had a hearing with Board of Veterans' Appeals (BVA) and my case was remanded for further development and records while we awaited the decision from BCNR.
 

My discharge was eventually upgraded to general under honorable conditions by the BCNR. The BCNR notified the VA and they granted my appeal and closed it out. I have not heard from the BVA that they closed it. Before they closed it, I wanted to know if they would give instructions to review for any unadjudicated claims (which is what these are)? According to this piece in the Federal Registry, it sounds like that is part of their final instructions to the VA. This would give me an earlier effective date than if I were to file a new claim (which is what I was instructed to do by the VA). 

Jim's Reply:

"I wanted to know if they would give instructions to review for any unadjudicated claims (which is what these are)?"
 

Yes, that should be the way this is managed. "Should be" leaves a lot of room for VA to not do it the way it should be done though.
 

The biggest problem I see is that your claim and appeal has traveled all over the map. Back and forth from VBA to BVA and with input from BCNR, your folder is scattered in bits and pieces of electronic records and unscanned paper records. Reconciling all that in front of a rater with instructions to review inferred unadjudicated claims is a tall order. The juncture where you find yourself today is why the appeals phrase, "the hamster wheel" came into being. Once remands start from once place or another, it can take a long while to catch up. You feel like you're in a cage and the hamster wheel is the only thing moving...and going nowhere.
 

Your best bet is to be meticulous in your keeping of your records so that when time comes, you'll have all the t's crossed and i's dotted. If I were you I'd go ahead and formally file the claim(s) that I believed were legit and would cause that earlier effective date and then...wait patiently. Good luck.

Question:

I filed a supplemental claim following a denial. I submitted an Independent Medical Opinion (IMO) and 4 other pieces of new evidence and now VA wants me to attend 2 additional C&P exams. Why? I thought the point was to reevaluate the claim based on the new evidence I supplied?

Jim's Reply:

You are absolutely correct...in theory.
 

According to the VA policy Acceptable Clinical Evidence (ACE) to Support the Compensation and Pension (C&P) Disability Examination Process your medical records and any other evidence you've submitted should suffice in almost every case.
 

But in the real world everyone gets a C & P exam whether they need it or not. No matter the other evidence in your record, if you miss your scheduled C & P exam VBA defaults to denial because of a lack of evidence.
 

I've long been convinced there are reasons this happens. I'm well known to be a cynic, a curmudgeonly sort who casts doubt on most everything so take this with a grain of salt.
 

The contractors who provide the C & P exam services to the VA are paid by piecework. They get a fee for each exam properly completed. No surprises here that the more exams they churn through, the more money the subcontractor earns.
 

The surprise comes when we learn that many of these contracting companies employ retired VA executives as 'consultants' to help refine their services. The more exams there are, the more of your tax dollars everyone earns!
 

In the end there is nothing to be done about it but go to any scheduled exam and don't say anything negative. If you object to any part of the process that can put your appeal at risk. If you've submitted a good IMO that will be the final piece of evidence that wins your claim and you'll be done. Maybe. I was once called in to a C & P 25 years after I'd filed any claims. Nobody knew why, the doc had no clue. I went, got examined, had lunch and months later got a letter saying my claim was moot...I have no clue to this day.
 

C & P exams are in large part a scam perpetuated by old habits at your VA. "It's always been done this way...".
 

Good luck.

Question:

I am currently rated at 100 % TDIU, but I have other major problems that come from the disabilities I am rated for. I could also be receiving special compensation for one of my eyes but no one knows how to file for any of my other ailments because they say I am TDIU. I have BBC sleep apnea treated by the VA, high blood pressure caused by sleep apnea. I take meds for my high blood pressure that cause glaucoma symptoms. I have also lost vision in my right eye because my high blood pressure caused a retina tear. Is there any way you can see to help? Thank you.

Jim's Reply:

I don't understand what you mean when you tell me, "no one knows how to file for any of my other ailments because they say I am TDIU"?
 

That you are TDIU makes no difference in filing additional claims. If you believe that you have additional conditions that should be service connected, you simply file the claim as always. The same for any rated condition that you believe has worsened...you file the claim.
 

That doesn't mean you'll prevail or that if you do prevail that you'll get any additional money. There are often times our ratings add up to over 100% but we're limited to the monetary benefit of 100% because that's how the rating system works. There are times that our ratings will add up to indicate a need for Special Monthly Compensation (SMC) that can greatly increase the monetary benefit a very seriously disabled veteran needs to live.
 

Filing additional claims after you're rated at 100% does carry some risk. When we file claims our entire profile is reviewed and we're always subjected to new C & P exams. If your exams found improvement in your rated conditions you could actually lose benefits.
 

We have to be careful what we ask for, VA is full of surprises. Good luck.

Question:

Can you withhold arrears from VA Disability?

Jim's Reply:

I'm going to go ahead and assume you're talking about child support. No, you can't withhold arrears from VA disability.
 

However, if the veteran obligor who has a disability rating falls behind in the obligation to timely pay child support and/or alimony, the obligee may file an apportionment request with VA and if VA agrees, they will withhold a portion of the disability money and send it directly to the obligee.
 

The apportionment request form is here and must be completed as the instructions say. Once VA receives the form they'll notify the veteran of the request and the vet will complete a financial statement. VA will usually make a decision within a few weeks. Good luck.