Benefits

Question:

I’m 80% covered with the VA for Service connected disability. I also have part B Medicare. Should I have part A also? I’m 66 years old.

Jim's Reply:

I'm going to guess that you have Part A and you're asking if you need Part B? Part A is required if and when you receive either SSDI or retirement benefits while Part B is elective and costs extra.
 

If you like your VA health care and don't think you'll ever need any other care, you can decline Part B and save a buck or two. However, should you change your mind down the road you'll pay a penalty and a higher price for coverage.
 

I see health insurance as a process each vet must think through for their own situation. I use both VA care and Part B and I use B a lot. My civilian care under Part B is very affordable and oh so convenient. To access VA care I can drive between one to three hours or I can access civilian care in 5 minutes. Part B Co-pays are affordable and there are so many procedures done closer to home that in my estimation it's worth the few dollars it costs.
 

As you get older that little extra insurance may come in handy. Good luck.

Question:

I have a customer at our bank who noticed our large us flag that we display and mentioned his Vietnam vet status and that he never received a flag. How can I help him get his flag he deserves?

Jim's Reply:

Thank you for your concern. You've made my day! I think it's awesome when a citizen shows concern for another citizen.
 

Unfortunately the news that circulates about the government bestowing a flag on veterans prior to their death is a rumor. Once we're at a cemetery, VA will pay for a marker, a flag and a few other things but prior to that, a tip 'o the VA hat in our direction is the thanks we get.
 

However...if you'll provide me some information at my secure personal email, I'll be sure you get an appropriate flag, (maybe with honors), and your branch can present it to him. 
 

Thank you again. 

Question:

I've been 100% Total & Permanent since 2012. My Type 2 Diabetes has now caused me to have an above the knee amputation a month ago. My wife has had to retire early in order to stay home to care for me. If she weren't able to do that, I'd be in a nursing home. I have applied for Spec comp R1 because I need assistance with all ADL's, and I will for quite some time - possibly for life. Do you think I qualify for R1?

Jim's Reply:

I don't know. The SMC scheme is quite complex with an astounding number of variables that can affect a decision. That and the fact that decisions seem inconsistent at times makes me hesitate to guess at it.
 

The best I can tell you is that thorough and complete documentation of your struggles with ADLs is an essential part of prevailing in an SMC claim. When I say thorough and complete I mean to the point of overkill and beyond. If tying your shoes is a challenge, document each limb, what you have to do to get one side done, then the other and how long the entire process takes because first you have to find your shoes and you can't remember because of medication...you get the idea.
 

This is another one of the times that it's not only appropriate to give VA too much evidence, it's absolutely necessary. Much of the evidence must be documented by a health care provider so you have to prepare anything you want and need a physician to sign off on in meticulous detail. And again, the Activities of Daily Living or ADLs such as brushing your teeth, preparing your meals, eating without aspirating, grooming and elimination are all topics that have to be discussed in detail, not just acknowledged.
 

Detail, detail and more detail and you'll prevail. Good luck.

Question:

Good evening, my husband is a veteran who served in the army for 10 years. He has been out since 2013 but has had many difficulties transitioning to civilian life. His VA benefits letter currently classifies him as TDIU & P&T. He got TDIU five years ago and P&T backdated to 2013 because he has sleep apnea. So since the sleep apnea pushed him to P&T, now they say he has both TDIU & P&T.

He has for the past few years have had difficulty staying home and not working. He doesn’t want to lose his benefits but he feels like he must go out into the workforce to regain his sanity. The VA has him at a rating of 70% for PTSD, 50% sleep apnea, 10% shoulder, 10% neck, 10% back, 10% TBI, 30% post concussive migraine. We understand he will lose SSDI, but he wants to make sure that if he doesn’t succeed in the workforce that the VA won’t leave him empty handed.

Being a veteran spouse is a very hard job. I work full time and we have a child. I truly want to see my husband feel like he’s worth something. I know he will do great in whatever he does, I just don’t want him to lose the benefits he sacrificed his life and sanity for. Thank you for everything you do for our vets and thank you for your service. May God always bless you.

Jim's Reply:

He can return to work at any time and he may not lose any benefits. He doesn't need to tell anyone that's he's going back to work, he just needs to find a job.
 

The VA will track his IRS and SSA accounts...they do that on all TDIU vets routinely these days. In a year or two, if he makes too much money, he'll get a letter from VA that will propose that his TDIU benefit be lowered. The letter will propose to lower the TDIU 100% to the underlying ratings. If he isn't successful in returning to work, nothing happens.
 

The SSA has a formal return to work program https://www.ssa.gov/redbook/eng/returning-to-work.htm He may not have to give up SSDI.
 

I'm also TDIU and have been for many many years. I understand the desire to return to work and I think it's very good therapy for us. When I felt the same as he did I volunteered. I've been a civic volunteer most of my life and this time I decided to volunteer for the VA. It was one of the best things I've ever done. Since you aren't earning an income you can work 40 hours a week (and many vets do volunteer that much) and it won't affect benefits. You get to make your own hours, VA will buy lunch and I promise you there's nothing like helping another vet who needs a hand. Good luck!

Question:

Good day Jim, my question is about collecting Federal Pandemic Unemployment Assistance (PUA) and TDIU. I am TDIU P&T, but also work a seasonal part time job that pays well below the federal poverty line. Last year, I was furloughed for a couple of months from my part time job due to the COVID pandemic and “stay at home” orders during the early lockdown stages of the pandemic. I applied for PUA due to being only part time and being furloughed, but didn’t see any assistance for months and after returning to my part time job that seasonally ended in September. I was eventually back paid PUA, and started getting paid a minimal $131 a week for awhile. My ultimate question is, does PUA (reported on a 1099G) count towards any income I earn, as it relates to my VA TDIU? My part time employment earnings were only about $3800, and my wife earned about $7000 at her part time job. However, throw in the PUA, now I may be above the poverty line. So is PUA counted towards my evaluated incomes? Or it just earned income (W2s) that’s potentially reviewed? Many thanks in advance.

Jim's Reply:

I don't know. I've read through what the DOL has to say on the matter and I still don't know...it simple isn't directly addressed. https://www.dol.gov/coronavirus/unemployment-insurance 
 

Were I you I wouldn't spend a lot of time worrying about it. If I had to guess I'd guess that the PUA will not count towards an earned income limit and then affect your TDIU. In the end the TDIU benefit determination is dependent on your income earned from gainful employment and the potential for you to do that in the future so I don't believe you'll hear anything from VA. Good luck.

Question:

I am 70% P&T and have been for 12 years. I also have private health insurance. VA bills my insurance for all my services. How do I get this straightened out?

Jim's Reply:

This is a chronic problem that VA pays no attention to...because they're making money by their "honest mistake" when they bill your private insurer. The first way to address it is to be persistent in knocking on doors at your VA medical center. You can't write emails or make phone calls and expect answers, you have to be there in person.
 

The next option is to bedevil your Congressional representative to help you. The outcome of that will depend on how strong a VA contact person your representative has in place and whether they will do what it takes to get action from the VA.
 

The last option is to simply tell your insurer what's happening. This isn't a great option because the insurer may fault you for whatever is going on.
 

VA continues to do this because trying to fix it is an onerous burden and most vets give up...since it doesn't affect their wallet they ignore it.
 

Good luck.

Question:

Service connected prostate cancer is temporarily rated 100% disabling until veteran receives surgery treatment. Approximately six months following treatment, VA evaluates 100% rating and if PSA is considered undetectable at time of evaluation, VA reduces rating to applicable % for any secondary conditions. Reason for rate reduction is VA considers veteran cured of prostate cancer due to undetectable PSA. Five years hence of rate reduction, veteran diagnosed with biochemical prostate cancer recurrence and is treated again, this time with radiation therapy and adjuvant hormone deprivation therapy. The VA increases disability rating to 100% due to active cancer recurrence. Again, 100% rating is temporary and subject to VA evaluation approximately six months following treatment. Likewise, if PSA level is again undetectable, VA will reduce 100% rating because the veteran prostate cancer is considered cured once again. Question: So how many times must the prostate cancer recur and be treated before the VA rates the disability permanent?

Jim's Reply:

Great question. The answer...maybe never.

The VA stance on whether or not any cancer is permanent is in need of an update by Congress. For that matter, the entire VA disability rating system is ancient and doesn't serve anyone well today. Attempts have been made to get the system updated and failed.

The Dole Shalala Commission was probably the most thorough analysis and recommendation update I've seen. It was complete, workable, understandable and affordable so it was promptly shelved by VA.

Let your Congressional representatives know how you feel and maybe some day we'll have a system that works.

Question:

I wanted to know if I am able to get paid for taking care of my husband ? He is a veteran 100 % disabled, I saw where some family members are paid for care of disabled but did not see anything on a spouse taking care of the 100% disabled veteran. Thank you for your time.

Jim's Reply:

There is such a program. The details are here The Program of Comprehensive Assistance for Family Caregivers  Good luck!

Question:

Can a RoJ refuse to complete a BVA Remand, the remand was to determine was I service connected for hypertension and a non functional testicle. I completed my appointments and it was in the decision phase and then my va.gov read appeal closed.

Jim's Reply:

Well...no, the regional office is expected to complete the orders they receive in any remand in a timely fashion. In fact, remands from BVA are supposed to be prioritized to the front of the line.
 

It sounds to me as if you had a remand for an exam to determine service connection for two conditions. You completed exams and those results were delivered to the RO.
 

The RO seems to have completed the process and your appeal is completed and closed.
 

You'll be getting a letter soon to tell you the results of your appeal. If you're looking for answers on eBenefits, take anything you see with a grain of salt. The eBenefits function isn't always helpful or even correct. Wait for your letter. Good luck.

Question:

I am 70% PTSD disabled, and have stage 4 cancer. If I apply for TDIU, can I be denied for my cancer, or age? I'm 78.

Jim's Reply:

I can't say that either cancer or age would have an effect on the decision. However, if the cancer is not service connected, then VA won't consider that in the decision. 
 

The TDIU benefit is there for veterans who aren't able to work because of a service connected condition. If at age 78 you can convince VA that were it not for the PTSD you'd be working you may get the rating you want. But if you haven't worked in many years and consider yourself retired, the VA may not agree that you're eligible for TDIU. Good luck.