What is Special VA Benefits for the Disabled Service Connected Vets: Automobiles, Conveyances, and Adaptive Equipment

Special VA Benefits for the Disabled Service Connected Vets: Automobiles, Conveyances, and Adaptive Equipment

Automobile Allowance

Servicemembers and Veterans may be eligible for a one-time payment of not more than $21,058.69 (10/1/2018) toward the purchase of an automobile or other conveyance if you have certain service-connected disabilities. The grant is paid directly to the seller of the automobile and the Servicemember or Veteran may only receive the automobile grant once in his/her lifetime.

Certain Servicemembers and Veterans may also be eligible for adaptive equipment. Adaptive equipment includes, but is not limited to, power steering, power brakes, power windows, power seats, and special equipment necessary to assist the eligible person into and out of the vehicle.

VA may provide financial assistance in purchasing adaptive equipment more than once. This benefit is payable to either the seller or the Veteran or Servicemember.

Important: You must have prior VA approval before purchasing an automobile or adaptive equipment.

Eligibility Requirements (Automobile Grant)

  • You must be either a Servicemember who is still on active duty or a Veteran, AND
  • You must have one of the following disabilities that are either rated as service-connected or treated as if service-connected under 38 U.S.C 1151 or, for a Servicemember, the result of disease incurred or injury contracted in or aggravated by active duty:
    • Loss, or permanent loss of use, of one or both feet, OR
    • Loss, or permanent loss of use, of one or both hands, OR
    • Permanent impairment of vision in both eyes to a certain degree, OR
    • Severe burn injury, OR
    • Amyotrophic Lateral Sclerosis (ALS).

Evidence Requirements (Automobile Grant)

To support a claim for automobile allowance, the evidence must show that you are service-connected or are treated as if service-connected under 38 U.S.C 1151 or, for a Servicemember, the result of disease incurred or injury contracted in or aggravated by active duty, for a disability resulting in:

  • The loss, or permanent loss of use, of one or both feet, OR
  • The loss, or permanent loss of use, of one or both hands,OR
  • Permanent impairment of vision in both eyes, resulting in
    1. Central Visual acuity of 20/200 or less in the better eye with glasses, OR
    2. Central Visual acuity that is greater than 20/200, if there is a visual field defect in which your peripheral field has contracted to such an extent that the widest diameter of visual fields subtends an angular distance no greater than 20 degrees in the better eye, OR
  • Severe burn injury: Deep partial thickness or full thickness burns resulting in scar formation that cause contractures and limit motion of one or more extremities or the trunk and preclude the effective operation of an automobile, OR
  • Amyotrophic Lateral Sclerosis (ALS).

To support a claim for adaptive equipment, the evidence must show that you have a disability as shown above, OR you have ankylosis of at least one knee or one hip due to service-connected disability.

How to Apply (Automobile Grant)

  • Complete, VA Form 21-4502, “Application for Automobile or Other Conveyance and Adaptive Equipment” and mail to your regional office OR
  • Work with an accredited representative or agent OR
  • Go to a VA regional office and have a VA employee assist you. You can find your regional office on our Facility Locator page
  • If you are entitled to adaptive equipment only (i.e., service connected for ankylosis of knees or hips) you should complete VA Form 10-1394, “Application for Adaptive Equipment – Motor Vehicle” and submit it to your local VA medical center. You can find your local VA medical center on the health Facility Locator page.

Conveyances

You may purchase a new or used automobile, truck, station wagon, or certain other types of conveyance if approved by VA.

Adaptive Equipment

A veteran or servicemember who qualifies for the vehicle allowance also qualifies for adaptive equipment unless he or she is blind, requires a driver, or doesn’t have a valid State driver’s license or learner’s permit. See the attached list for more information about adaptive equipment. Important: VA will not pay for the purchase of add-on adaptive equipment (equipment furnished by someone other than the automobile manufacturer) that is not approved by VA. Contact the nearest VA health care facility for more information on add-on equipment. The adaptive equipment benefit may be paid more than once, and it may be paid to either the seller or the veteran or servicemember.

Special drivers training for disabled veterans should contact the nearest VA health care facility to request this training.

To Apply use VA form 21-4502, http://www.vba.va.gov/pubs/forms/VBA-21-4502-ARE.pdf.  There is no time limit for filing a claim; however, the claim must be authorized by VA before you purchase the automobile or conveyance.

Special Instructions to Veteran or Servicemember,

1. Complete all items of Section I in duplicate and submit both copies to VA. If you have previously applied for disability compensation, send the form to the VA regional office where your claims folder is located. If you have not applied for disability compensation or have not separated from military service, send the form to the nearest VA regional office.

2. VA will determine your eligibility and, if eligibility exists, VA will complete Section II and return the form to you.

3. Purchase a vehicle. When you receive the vehicle and the adaptive equipment from the seller, complete Section III.

4. Give the original VA Form 21-4502 to the seller.

5. Submit any invoices for adaptive equipment and/or installation not included on the seller’s invoice to the nearest VA health care facility. These invoices, identified with your full name and VA file number, must show the itemized net cost of any adaptive equipment and installation charges, any unpaid balance, and the make, year and model of the vehicle to which the equipment is added.

Special Instructions to Seller:

1. Make sure that Section II of VA Form 21-4502 is completed and signed by VA.

2. Deliver the vehicle, including VA-approved adaptive equipment provided and/or installed by the seller.

3. Obtain the original copy of VA Form 21-4502 from the veteran or servicemember after he or she has completed Section III.

4. Submit the original copy of VA Form 21-4502 and itemized invoice to the VA regional office shown in Section II, Attention: Financial Division, for payment.

The itemized invoice must include the following:

  • The net cost of any approved adaptive equipment and installation charges. If certain items of approved adaptive equipment (automatic transmission, power seats,     etc.) are included in the purchase price, also submit a copy of the window sticker.
  • A list of which adaptive equipment is standard on the vehicle or combined with other items.
  • The unpaid balance due on the vehicle which is to be paid by VA.
  • A certification that the amounts billed do not exceed the usual and customary cost for the purchase and installation of the adaptive equipment.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims! Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

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How VA Evaluates Income for Non-Service Connected Pension

Countable Income for Non-Service Connected Pension

To determine the income limit requirement for eligibility, the VA will require the Veteran to report all “countable income” for the Veteran’s household.

Countable income” refers to all household income:

  • the Veteran’s,
  • Veteran’s spouse (if living with the Veteran), and
  • Dependents.

The Veteran’s “countable income” must be below the maximum annual pension rate, MAPR, and the Veteran’s “net worth” must not provide adequate maintenance of the Veteran.

The need for pension is determined by “countable income” minus allowable deductions. The calculated reduced income is then subtracted from MAPR limit and the result is the annualized pension divided by 12 months.

As an example:

  • The MAPR for a Veteran who needs aid and attendance with no dependents is $21,531 income per year.
  • The Veteran’s countable income is $32,000 per year.
  • After subtracting the allowable deductions, the countable income of the Veteran is reduced to $15,000/year.
  • The MAPR of $21,531 minus $15,000 of countable income equals $6,531 per year of VA Pension.
  • The $6,531 yearly VA Pension is divided by 12 months to determine the monthly amount.
  • The Veteran receives a VA pension for $544.25 monthly for this example.

Allowable Deductions from Countable Income for VA Pension

The Veterans “countable income” is reduced by specific expenses. However, often Veterans believe that they are not eligible for pension because they make too much or are denied because they do not know the complete list of income exclusions and deductible expenses that would reduce their “countable income”.

The complete list of income exclusions is provided in 3.272 of title 38, Code of Federal Regulations. This knowledge is important because most Veterans mistakenly think that the only income deduction is unreimbursed medical expenses over 5% of the Veteran’s household income. When in fact there are many deductions and when the Veteran uses all of the deductions that apply to their situation, the outcome is greater.

Another mistake that Veterans make is reporting income that is excluded from income reporting on the pension application.       Not knowing the rules or what information to supply can cause a VA denial!

All income received from the following exclusions are not considered countable income by the VA. Veterans should make sure that when applying for pension, all deductions are applied and only income not excluded is counted. The list includes 22 income sources that are excluded from reporting and are found in Title 38 CFR 3.272:

  1. Welfare,
  2. Maintenance in an institution or facility due to age or impaired health,
  3. VA pension benefits ( Payments under Chapter 15 of Title 38 and including accrued pension benefits payable under 38 U.S.C. 5121),
  4. Reimbursement for casualty loss,
  5. Profit from the sale of property,
  6. Joint accounts,
  7. Unreimbursed medical expenses that are 5% of the MARP,
  8. Veteran’s final expenses,
  9. Educational expenses for Veteran or Spouse,
  10. Domestic Volunteer Service Act Programs,
  11. Distribution of funds under 38. U.S.C 1718,
  12. DOD survivor benefit annuity,
  13. Agent Orange settlement payments,
  14. Restitution to individuals of Japanese ancestry,
  15. Cash surrender value of life insurance,
  16. Income received by American Indian beneficiaries from trust or restricted lands,
  17. Payments from the Radiation Exposure Compensation Act,
  18. Alaska Native Claims Settlement Act,
  19. Monetary allowance under 38 U.S.C. chapter 18, Victims of Crime Act,
  20. Healthcare premiums to include Medicare, (make sure to include all insurance premiums paid for all 4 Parts of Medicare-A,B,C,D and Supplemental plans),
  21. Medicare prescription drug discount card and transitional assistance program, and
  22. Lump-sum life insurance proceeds on a veteran.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims! Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

What Veterans Must Know About VA Pension

VA “shall pay to each veteran of a period of war who meets the service requirements of this section . . . and who is permanently and totally disabled from non-service-connected disability not the result of the veteran’s willful misconduct, pension at the rate prescribed by [statute].”   38 U.S.C. § 1521(a).  The maximum annual rates for improved pension must be reduced by the amount of the veteran’s countable annual income.  38 U.S.C. § 1521; 38 C.F.R. § 3.23(b); Springer v. West, 11 Vet. App. 38, 40 (1998).  “Payments of any kind from any source shall be counted as income during the 12-month annualization period in which received unless specifically excluded under [section] 3.272.”  38 C.F.R. § 3.271(a); 38 U.S.C. § 1503; see Martin v. Brown, 7 Vet. App. 196, 199 (1994) (stating “statute and VA regulations provide that ‘annual income,’ as defined by statute and applicable regulation, includes payments of any kind from any source, unless explicitly exempted by statute or regulation”); but see 38 C.F.R. § 3.272 (enumerating categories to “be excluded from countable income for the purpose of determining entitlement to improved pension”).

Certain countable income is specifically excluded from this rule and as a result, a veteran’s pension will not be reduced.  38 C.F.R. § 3.272.  Social Security Administration (SSA) old age and survivor’s insurance and disability insurance payments are considered income and must, therefore, be included.  38 C.F.R. §§ 3.262; 3.271(g); Burch v. Brown, 6 Vet. App. 512, 513 (1994).  Benefits under noncontributory programs, such as old age assistance, aid to dependent children, and supplemental security income are treated as charitable donations.  See 38 C.F.R. §§ 3.262(d), (f).  Unreimbursed medical expenses paid within the 12-month annualization period are excluded from income to the extent that they are in excess of 5% of the maximum annual pension rate.  38 C.F.R. § 3.272(g)(1)(iii).  Whether a claimant is entitled to VA pension benefits is a question of fact.

Pursuant to 38 U.S.C. § 1505, pension benefits administered by the Secretary shall not be paid to or for an individual who has been imprisoned in a Federal, State, or local penal institution as a result of conviction of a felony or misdemeanor for any part of the period beginning 61 days after such individual’s imprisonment begins and ending when such individual’s imprisonment ends.  38 U.S.C. § 1505(a); 38 C.F.R. § 3.666; see also Latham v. Brown, 4 Vet. App. 265 (1993).

VA Non-Service Connected Pension or Wartime Pension

Many people confuse VA Pension with VA disability compensation. The two are different.

  • VA pension is based on wartime service, having a non-service connected disability and the Veteran must be of low income.
  • VA disability compensation is based on a service connected disability rating for the Veteran. The focus of this article is to provide the facts on the VA Pension since recently there has been misleading TV and internet advertisements promoting Veteran’s and Spouses to apply for the Pension.

Over the years the VA improved pension has been known as a Non-service connected Pension, a VA low-income Pension, live VA pension and most recently on TV and the internet advertised as a VA Wartime Pension for Veterans or Surviving Widows of Wartime Veterans.   The current improved pension became effective January 1, 1979 and was preceded by Section 306 Pension and Old-Law Pension Program.   All three non-service connected programs are disability and needs based. Today, the only available program for applicants is the improved pension program or non-service connected pension.

Eligibility for Non-Service Connected Pension

The improved pension program is for Veterans who served during wartime and meet specific requirements. It is for the requirement reason that TV advertisements refer to this pension as a wartime pension. The following program qualifying requirements must apply for the Veteran to receive this pension:

The Veteran must have an have a discharge “under other than dishonorable conditions” also known as a “honorable discharge”,

  1. actively served a minimum of one day during wartime,
  2. meet specific service time requirements,
    1. 90 days or more of active duty
    2. Veterans with active duty enlistment after September 7, 1980 must serve at least 24 months of active duty or complete the full period for which they were called to active duty.
  3. be of limited income (determined by the Maximum Annual Pension Rate or MARP) and net-worth, which are discussed later in this article and
  4. the Veteran must have one or more of the following :
    1. age 65 or older, or
    2. have a permanent and total non-service connected disability that will continue throughout the Veteran’s lifetime and prevents the Veteran from sustaining employment, or
    3. be a reside in a nursing home for long-term care , or
    4. be a recipient of Social Security disability benefits.

Maximum Annual Pension Rate for VA NSC Pension

Date of Cost-of-Living Increase: 12-01-2017
Increase Factor:  2.0%
Standard Medicare Deduction: Actual amount will be determined by SSA based on individual income.

Maximum Annual Pension Rate (MAPR) Category

Amount

If you are a veteran… Your yearly income must be less than…
Without Spouse or Child $13,166
To be deducted, medical expenses must exceed 5% of MAPR,  or,  $ 659
With One Dependent $17,241
To be deducted, medical expenses must exceed 5% of MAPR,  or,  $ 863
Housebound Without Dependents $16,089
Housebound With One Dependent $20,166
A&A Without Dependents $21,962
A&A With One Dependent $26,036
Two Vets Married to Each Other $17,241
Two Vets Married to Each Other One H/B $20,166
Two Vets Married to Each Other Both H/B $23,087
Two Vets Married to Each Other One A/A $26,036
Two Vets Married to Each Other One A/A One H/B $28,953
Two Vets Married to Each Other Both A/A $34,837
Add for Early War Veteran (Mexican Border Period or WW1) to any category above $2,991
Add for Each Additional Child to any category above $2,250
Child Earned Income Exclusion effective: 01-01-2000 $7,200
(38 CFR §3.272 (j)(1))
This link takes you to the full regulation;
scroll down to get the specific citation.
01-01-2001 $7,450
01-01-2002 $7,700
01-01-2003 $7,800
01-01-2004 $7,950
01-01-2005 $8,200
01-01-2006 $8,450
01-01-2007 $8,750
01-01-2008 $8,950
01-01-2009 $9,350
01-01-2012 $9,750
01-01-2013 $10,000
01-01-2014 $10,150
01-01-2015 $10,300
01-01-2016 $10,350
01-01-2017 $10,400
01-01-2018 $10,650

*Child dependents are: (1) under the age of 18, (2) between the ages of 18 and 23 who are attending college, or (3) declared a “helpless child” due to an infirmity before the age of 18. Veterans with additional dependent children should add $2,205 to the MAPR limit for each child.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims! Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

How VA Compensates Disabled Veterans With Special Monthly Compensation (SMC)

Special Monthly Compensation (SMC)

Special Monthly Compensation (SMC) is available when, ‘as the result of service-connected disability,’ a veteran suffers additional hardships above and beyond those contemplated by VA’s schedule for rating disabilities.”  Breniser v. Shinseki, 25 Vet. App. 64, 68 (2011) (citing 38 U.S.C. § 1114(k)–(s)).  The Board’s determination as to whether a veteran is entitled to SMC is a finding of fact that the Court reviews under the “clearly erroneous” standard of review.  Id. (citing Prejean v. West, 13 Vet. App. 444, 447 (2000); Turco v. Brown, 9 Vet. App. 222, 224 (1996)).  Section 1114( l ) provides, in pertinent part:  if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, with 5/200 visual acuity or less, or is permanently bedridden or with such significant disabilities as to be in need of regular aid and attendance, the monthly compensation shall be $3,075.  38 U.S.C. § 1114(l).

While a scheduler rating depends on the severity of a condition, SMC for loss of use does not depend on the degree of loss, except that the loss of use must be permanent. The more seriously disabled veteran may be eligible for SMC payments for combinations of anatomical loss or loss of use. In addition, severely disabled veterans may be awarded further compensation for regular aid and attendance needs and for permanent housebound conditions. As SMC has many possible combinations and involves a significant amount of additional compensation, it is recommends that severely injured veterans get help in filing their SMC claims from someone experienced in such cases.

In addition to compensation based on the degree of disability, Congress has also authorized additional compensation for certain disabilities. This “special monthly compensation” (“SMC”) is intended to compensate claimants for service-connected conditions that involve loss of use or anatomical loss (amputation) of body parts, such as hands or feet, or loss of hearing or sight. SMC can result in significantly more monthly compensation for severely injured veterans.

VA has promulgated regulations implementing section 1114 relevant to the determination of whether a veteran “is so helpless as to be in need of regular aid and attendance are contained in § 3.352(a).”  38 C.F.R. § 3.350(b)(3); see 38 C.F.R. § 3.351(c)(3) (providing that a claimant is entitled to SMC based on the need for aid and attendance by establishing “a factual need for aid and attendance under the criteria set forth in [38 C.F.R. § 3.352(a)].”).

The Court has held that the order in which disabilities are service connected is not relevant to VA’s determination of a claimant’s eligibility for special monthly compensation under 38 U.S.C. section 1114(s).  Whenever a veteran has a total disability rating, schedular or extraschedular, based on multiple disabilities and the veteran is subsequently awarded service connection for any additional disability or disabilities, VA’s duty to maximize benefits requires VA to assess all of the claimant’s disabilities without regard to the order in which they were service connected to determine whether any combination of the disabilities establishes entitlement to special monthly compensation under section 1114(s).  If, after such an assessment, VA determines that the claimant is entitled to special monthly compensation, the effective date of the award of special monthly compensation will be the effective date assigned for the award of benefits for the final disability that forms the relevant combination of disabilities.  Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010), as amended (Apr. 21, 2011).

Levels of SMC Ratings 

Each level of SMC ratings are successive and are preceded by an entitlement to certain conditions included under SMC(K).  The basic elements of Special Monthly Compensation ratings include:

  • anatomical (or physical) loss or the loss of use (Loss of use from neurological, muscular, vascular, contractures, etc.)  of one or more of the following:
    • limbs,
    • hands,
    • feet
    • reproductive organs;
  • aphonia (loss of voice);
  • deafness;
  • blindness;
  • loss of bowel and bladder control;
  • being permanently housebound;
  • and a need for regular aid and attendance with activities of daily living or a higher level of care–all of which must be a result of the veteran’s service-connected disabilities.

A rating of SMC (K) would include: 

  • The anatomical loss or loss of use (Loss of use from neurological, muscular, vascular, contractures, etc.) of:
    • one hand.
    • one foot.
    • both buttocks (where the applicable bilateral muscle group prevents the individual from maintaining unaided upright posture, rising and stooping actions).
    • one or more creative organs used for reproduction (absence of testicles, ovaries or other creative organ, ¼ loss of tissue of a single breast or both breasts in combination) due to trauma while in service, or as a residual of a service-connected disability(ies). NOTE: these do not serve as eligible prerequisite conditions for the higher levels of SMC.
    • One eye (loss of use to include specific levels of blindness).
  • Complete organic aphonia (constant loss of voice due to disease)
  • Deafness of both ears to include absence of air and bone conduction.

A rating of SMC(L) would include:

  • The anatomical loss or loss of use of:
    • Both feet,
    • One hand and one foot
  • Blindness in both eyes with visual acuity of 5/200 or less.
  • Permanently bedridden.
  • Regular need for aid and attendance to assist with activities of daily living such as dressing oneself, tending to personal hygiene, care and adjustment of assistive appliances or prosthetics, feeding oneself, and the like. (specific criteria is established in 38 CFR § 3.352(a)) (NOTE: If such services are not being provided at the expense of the U.S. Government due to hospitalization).

Ratings above the SMC(L) level to include SMC(M), SMC(N), SMC(O), SMC(P), SMC(R) and SMC(S) are specialized multifaceted levels which are based on various specific combinations of anatomical loss or loss of use of designated extremities and/or senses, together with seriously disabling conditions and particular degrees of aid and attendance requirements, housebound or bedridden statuses deemed medically necessary, and explicit service-connection ratings. These levels also outline various requirements to include full and half step upgraded SMC level ratings. The conditions providing the basis of these levels are as follows.

A rating of SMC(M) would include:

  • The anatomical loss or loss of use of (neurological loss):
    • Both hands,
    • Both legs at the region of the knee
    • One arm at the region of the elbow with one leg at the region of the knee
  • Blindness in both eyes having only light perception.
  • Blindness in both eyes resulting in the need for regular aid and attendance.

A rating of SMC(N) would include:

  • The anatomical loss or loss of use of both arms at the region of the elbow.
  • The anatomical loss of both legs so near the hip that it prevents the use of a prosthetic appliance.
  • The anatomical loss of one arm so near the shoulder that it prevents the use of a prosthetic appliance along with the anatomical loss of one leg so near the hip that it prevents the use of a prosthetic appliance.
  • The anatomical loss of both eyes or blindness in both eyes to include loss of light perception.

A rating of SMC(O) would include:

  • The anatomical loss of both arms so near the shoulder that it prevents the use of a prosthetic appliance.
  • Bilateral deafness rated at least 60 percent disabling along with service-connected blindness with visual acuity of 20/200 or less of both eyes.
  • Complete deafness in one ear or bilateral deafness rated at least 40 percent disabling along with service-connected blindness in both eyes to include loss of light perception.
  • Paraplegia – paralysis of both lower extremities along with bowel and bladder incontinence.
  • Helplessness due to a combination of anatomical loss or loss of use or two extremities with deafness and blindness or a combination of multiple injuries causing severe and total disability.

A rating of SMC(P) would include:

  • The anatomical loss or loss of use of a leg at or below the knee along with the anatomical loss or loss of use of the other leg at a level above the knee.
  • The anatomical loss or loss of use of a leg below the knee along with the anatomical loss or loss of use of an arm above the elbow.
  • The anatomical loss or loss of use of one leg above the knee and the anatomical loss or loss of use of a hand.
  • Blindness in both eyes meeting the requirements outlined in SMC (L), (M) or (N) levels.

A rating of SMC(R):

Ratings under SMC(R) are assigned for seriously disabled veterans in need of advanced levels of aid and attendance.

SMC(R) ratings require a minimal combination of entitlement to both SMC(O) and SMC(L). Additionally, Veterans in receipt of SMC rates based on Aid and Attendance are strongly advised to contact their service representative and/or VA Regional Office should they become hospitalized at the expense of the U.S. Government (i.e. a VA medical facility) as failure to do so could create an overpayment of monetary benefits.

A rating of SMC(S):

Ratings under SMC(S) are also available if the veteran is permanently housebound. The VA defines “permanently housebound” as being substantially (as opposed to completely) confined to a dwelling as the result of service-connected disability and it is reasonably certain that that such disability will continue throughout the veteran’s lifetime. These kinds of determinations should be made by a physician, whose written opinions or reports in this respect would serve as the best evidence to submit in support of a claim for “s” SMC benefits.

A rating of SMC(T):  Traumatic Brain Injury

Ratings under SMC(T) are available to veterans who need regular aid A&A for residuals of Traumatic Brain Injury (TBI), but is not eligible for a higher level of A&A under (R)(2), and would require hospitalization, nursing home care, or other residential institutional care in absence of regular in-home aid and attendance.

What Disabled Veterans Must Know About Schedular Rating 100%-Temporay Disability Rating

Temporary 100% Disability Rating

There are three types of temporary disabiltiy ratings:

  • Prestabilization Ratings
  • Total Ratings for Service-Connected Disability Requiring Hospitalization
  • Convalescence Rating (TDCC)

Prestabilization Ratings:

  • Prestabilization Rating of 100% is for Veterans who have experienced, during active, an unstable condition resulting in a severe disability that renders gainful employment either not feasible or adviseable.  Such conditions would include: residuals resulting from a head injury or gunshot wound residuals.
  • The VA is not allowed to assign a 100% prestabilization rating if the Veteran’s case warrants a 100% regular rating.
  • Assigned immediately after discharge from the military and continues for 12 months after discharge.
  • During the 12 months, the Prestabilized rating can change to a “another rating authorizing a greater benefit” if the change would be a better benefit for the Veteran.
  • There must be a VA exam of the Veteran between the 6 month and the 12 month. following discharge.  If the exam calls for a reduction in benefits, the VA can not make the reduction until the end of 12 month period.

Total Ratings for Service Connected Disabilities Requiring Hospitalization

  • The condition must be service-connected.
  • The period of hospitalization or observation must exceed 21 days.
  • The Increased rating starts on the first day of continuous hospitalization and ends on the last day of the month of hospital discharge.
  • If hospialization occurs for a non-service connected condition and during the hospitalization a service connected disability is treated for over 21 days, then the 100% can be granted.

Convalescence Rating (TDCC) :

  • Three circumstances for TDCC:
    • The Veteran has surgery that requires 1 month of convalescence, or
    • The Veteran’s surgery has resulted in severe postoperative residuals,or
    • The Veteran has a major joint immobilzed by a cast.
  • Convalescence for Mental Disorder:
    • Veteran must have a service connected mental disorder
    • Hospitalized for at least 6months for the service connected mental disorder
    • Convalescent rating will last for 6 months after hospital discharge.  This rating is protected under 38 C.F.R. 3.105(e)
  • Benefit is for up to a year.
  • The conditions must be service connected and the medical documentatin indicates that the Veteran needs time to convalesce after hospital discharge or outpatient release.
  • Home Confinement is not necessary. Ruling from  Felden v. West, defines convalescence as ” the act of regaining or returning to a normal or healthy state after a surgical operation, or injury”  Medical documentation is necessary.  If Veteran’s doctor prescribes: “Do not return to work for 12 weeks”, then the CAVC has ruled that the note establishes 12 weeks of convalescence.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims! Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

What Veterans Should Know About Extra-Schedular Rating

VA regulations provide for referring a case for extraschedular consideration when a claimant demonstrates an “exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of regular schedular standards.”  38 C.F.R. § 3.321(b)(1).  Consideration of referral for an extraschedular rating must begin with “a comparison between the level of severity and symptomatology of the claimant’s service-connected disability [and] the established criteria found in the rating schedule for that disability.”  Thun v. Peake, 22 Vet. App. 111, 115 (2008).  VA must evaluate whether “the rating schedule is inadequate to evaluate a claimant’s disability picture.”  Id. at 116.  The disability picture includes all of a claimant’s service-connected disabilities.  See 38 C.F.R. § 3.321(b)(1) (goal of extraschedular consideration is to arrive at “an extra-schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities”).

The award of an extraschedular disability rating is the result of a three-step inquiry the responsibility for which may be shared among the RO, the Board, and the Under Secretary for Benefits or the Director, Compensation and Pension Services.  Thun, 22 Vet. App. at 115.  The first step is to compare the level of severity and symptomatology of the appellant’s disability with the established criteria in the rating schedule.  Id.  If these criteria “reasonably describe the claimant’s disability level and symptomatology” then the regular schedular rating system is adequate and extraschedular referral is not warranted.  Id.

If the rating schedule does not contemplate the claimant’s level of disability and symptomatology and is found inadequate, then “the RO or Board must determine whether the claimant’s exceptional disability picture exhibits other related factors,” such as “marked interference with employment” or “frequent periods of hospitalization.”  38 C.F.R. § 3.321(b)(1).  When an analysis of the first two steps reveals that the rating schedule is inadequate to evaluate a claimant’s disability picture, then the case must be referred to the Undersecretary for Benefits or the director of the Compensation and Pension Service to complete the third step which is to determine whether to assign an extraschedular disability rating in order to “accord justice.”  Thun, 22 Vet. App. at 116; 38 C.F.R. § 3.321(b)(1).

The Board must consider referral for an extraschedular rating when either a claimant or the evidence of record suggests that a schedular rating may be inadequate.  See Thun v. Peake, 22 Vet. App. 111, 115 (2008).  “The governing norm in these exceptional cases is:  A finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards.”  38 C.F.R. § 3.321(b).  The effects of medications for service-connected conditions can warrant an extraschedular rating referral. Fisher v. Principi, 4 Vet. App. 57 (1993).  Where the Board did not address whether referral for extraschedular consideration was warranted, the Court’s review is “limited to whether the evidence of record sufficiently raises the possibility that this regulation is applicable, such that the Board was required to discuss whether referral was warranted [under section 3.321(b)(1)].”  Barringer v. Peake, 22 Vet. App. 242, 245 (2009).

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

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What Disabled Veterans Must Know About Schedular Rating 100%-TDIU or Indiviual Unemployability

Schedular Rating 100%-TDIU or Indiviual Unemployability

In some cases, however, a veteran with less than a 100% scheduler rating is so affected by service-connected conditions that he or she cannot work at gainful employment. The law allows for another type of claim in such a case.

VA benefits are available to compensate a veteran at the 100% level if he or she is not able to work because of service-connected conditions even without a 100% schedular rating. This benefit is called “total disability on the basis of individual unemployability”, (“TDIU”), or sometimes “individual unemployability, ” (“IU”).

The key issue in a TDIU claim is the inability of the veteran to engage in “substantially gainful employment” because of his or her service-connected conditions. “Substantially gainful employment” means to hold a job that pays at least an amount equal to the annual poverty level set by the federal government. In order to qualify for TDIU benefits, a claimant must meet the following requirements:

  1. If the claimant has only one service-connected condition, that condition must be schedular rated at least 60% or more;
  2. If the claimant has two or more service-connected conditions, at least one of those conditions must be rated at 40% or more, and the veteran’s combined disability rating must be 70% or more; and
  3. In either case, the veteran must be unemployable because of his or her service-connected conditions.

To establish “unemployability” or “inability to substantially maintain gainful employment”, the Veteran must provide:

  1. evidence of unemployment due to service-connected conditions, employment history records for example, and
  2. medical evidence that the veteran’s service-connected condition renders him or her totally disabled and unemployable, generally a doctor’s opinion letter.

Having a paying job does not automatically disqualify a claimant from a TDIU award.  If the wages are considered “marginal” (low paying) or “sheltered” (protected from usual requirements) employment are exceptions to the TDIU qualification requirements.  Examples of employment that are allowed under TIDU:

  • A job that pays substantially less than the prevailing poverty level,
  • A job that is protected from requirements that someone else in that position would be expected to satisfy, or
  • A job working for a friend or relative, may not be “substantially gainful employment.”

Although it is always better to submit a specific claim for TDIU.  The VA has a duty to look for potential TDIU claims based on the evidence in the claimant’s VA claims file, known as a “C-file”. The VA is required to review the claims for TIDU, even if not specifically requested by the Veteran, because entitlement to TDIU is part of every claim for disability compensation. Upon reviewing the claim, the VA determines if TDIU is an appropriate award for the claim.  Evidence of unemployability can be submitted after an initial decision denying TDIU, if while a claim for schedular benefits is still being processed.

As with most VA benefits, TDIU is not a permanent benefit. The VA can require a claimant undergo periodic medical examinations to confirm that the claimant remains unable to work due to a service-connected condition. And, as with all VA examinations, a failure to report for a scheduled examination can result in suspension or termination of a TDIU benefit.

In addition, since a TDIU award is also based on “unemployability,” the VA can  periodically request employment information from a claimant receiving TDIU benefits. The VA will also cross check employment earnings with the IRS.

The TDIU rating could be terminated and the claimant could be liable to repay VA for the TDIU benefits paid since that employment began, if:

  1. the VA becomes aware that a claimant is working at a job that is not marginal or sheltered,
  2. A claimant must also be careful in performing volunteer work because the nature and time spent at unpaid work shows that a claimant could be employed and  is no longer unemployable.

If a Veteran is determined to be employale, the TDIU award can and will probably be revoked. When a TDIU rating is revoked, a claimant’s benefits go back to the amount of compensation payable under the scheduler rating and the VA can make the Veteran repay the TDIU award.

Additional Information:

Although it is best to make an explicit claim for TDIU if a claimant believes he or she is eligible, it is no longer required.  Potential entitlement to TDIU is part of every claim for disability compensation.  See Rice v. Shinseki, 22 Vet. App. 447, 454-55 (2009) (TDIU “is part and parcel of the determination of the initial rating for [a] disability”).  It is now well established that the Board must consider “whether a TDIU award is warranted whenever a pro se claimant seeks a higher disability rating and submits cogent evidence of unemployability, regardless of whether he states specifically that he is seeking TDIU benefits.”  Comer v. Peake, 552 F.3d 1362, 1366 (Fed. Cir. 2009) (citing Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001)); see also Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (same).  “[A] request for TDIU, whether expressly raised by a veteran or reasonably raised by the record, is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability or disabilities, either as a part of the initial adjudication of a claim or . . . as a part of a claim for increased compensation.”  Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009); see also Floyd v. Brown, 9 Vet. App. 88, 96 (1996) (the question of an extraschedular rating is a component of the appellant’s claim for an increased rating).  A request for a higher disability rating and evidence indicating that the claimant’s ability to work was “significantly impaired” by his or her service connected conditions reasonably raises the issue of entitlement to TDIU as an alternative basis for increased compensation.  Id.

VA regulations provide two methods by which TDIU may be granted.  Under the first, TDIU may be assigned to a claimant who is “unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities” provided that he has received a disability rating of 60% or greater, or, if he is service-connected for two or more disabilities, at least one of those disabilities has been assigned a disability rating greater than 40%, and the combined disability rating for all disorders is at least 70%.  38 C.F.R. § 4.16(a).  If the claimant does not meet these schedular TDIU requirements, a TDIU rating may still be obtained by referral to the director of Compensation and Pension Service for extraschedular consideration when the claimant is unemployable by reason of service-connected disabilities.  38 C.F.R. § 4.16(b).

38 C.F.R. section 3.321(b)(1) provides an alternative method of referring a case for extraschedular consideration when a claimant demonstrates an “exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of regular schedular standards.”  Extraschedular consideration under section 3.321(b) is not the same as TDIU under section 4.16(b) because sections 4.16(b) and 3.321(b)(1) are not interchangeable.  See Kellar v. Brown, 6 Vet. App. 157, 162 (1994) (“the effect of a service-connected disability appears to be measured differently” by the two regulations).  Section 4.16(b) requires evidence of unemployability, while § 3.321(b)(1) requires only “marked interference with employment,” which is a somewhat less severe standard.  See Thun v. Peake, 22 Vet. App. 111, 117 (2008); see also Stanton v. Brown, 5 Vet. App. 563, 564-70 (issue of extraschedular rating is separate from issue of TDIU rating).  In other words, a claimant need not demonstrate total unemployability to obtain a section 3.321(b) extraschedular disability rating.

The term “substantially gainful occupation” is not defined by VA regulation; however, the Court has held that the term refers to, at a minimum, the ability to earn “a living wage.”  Bowling v. Principi, 15 Vet. App. 1, 7 (2001); Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991).  The Court has also held that a person is engaged in a “substantially gainful occupation” when that occupation “provides annual income that exceeds the poverty threshold for one person.”  Faust v. West, 13 Vet. App. 342, 355-56 (2000).  The M21-1MR states that “voluntary withdrawal from the labor market” is an “extraneous factor” whose “effects” should be “[i]dentif[ied] and isolate[d]” in determining whether the severity of the service-connected conditions preclude a veteran from “obtaining or retaining substantially gainful employment.”  M21-1MR, pt. IV, subpt. ii, ch. 2, sec. F.27.e.  Consequently, voluntary withdrawal from the labor market should not be an automatic bar to TDIU.

In adjudicating an assertion of entitlement to TDIU, the Board must also consider whether the existing VA medical examination reports adequately “address the extent of functional and industrial impairment from the veteran’s service-connected disabilities.”  Gary v. Brown, 7 Vet. App. 229, 232 (1994).  Thus, if the Board determines that the existing examination reports are insufficient to assess the matter of TDIU, it should request additional medical evidence before adjudicating the matter.

In resolving a TDIU case, the question is whether the claimant is capable of securing or maintaining a substantially gainful occupation.  Although a claimant may be physically able to perform sedentary employment, he or she may not be educationally and vocationally qualified to perform such employment.  Although the duty to assist does not require VA to provide a vocational assessment to a claimant seeking a total disability rating based on individual unemployability, a claimant’s education and work experience are relevant to the issue of entitlement to such a rating.  Smith v. Shinseki, 647 F.3d 1380, 1386 (Fed. Cir. 2011).

Specifically, it is within VA’s discretion to determine whether a vocational assessment was required based on “the facts of a particular case” and an assessment would be required “if, for example, the veteran were found medically qualified for a particular type of job, but there was an unusually difficult question as to whether the veteran had the educational or vocational skills for that position.”  Id.  Accordingly, Smith does not require VA to provide a vocational assessment in every instance where a claimant is seeking a total disability rating based on individual unemployability, but it does require VA to at least consider whether a vocational assessment is required and to support its determination that one is not required with an adequate statement of reasons or bases.  Id.see also 38 U.S.C. § 7104(d)(1) (requiring the Board to provide a written statement of the reasons or bases for its “findings and conclusions[] on all material issues of fact and law presented on the record”).

If a claimant does not meet the schedular rating for unemployability provided in 38 C.F.R. § 4.16(a), he may still be granted TDIU on an extraschedular basis.  38 C.F.R. § 4.16(b).  The central inquiry “is whether that veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.”  Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993).  In making its decision, VA may consider the veteran’s education, special training, and previous work experience, but may not take into consideration any impairment caused by non-service-connected disabilities.  See 38 C.F.R. §§ 3.341, 4.16, 1.19.  The Board’s determination as to whether a claimant is unable to secure and hold substantially gainful employment is a finding of fact that the Court reviews under the “clearly erroneous” standard.  Bowling v. Principi, 15 Vet. App. 1, 6 (2001).

Although the Secretary and the Board can separate parts of a claim and develop and adjudicate them separately, see Fagre v. Peake, 22 Vet. App. 188, 191 n.4 (2008) (noting the Secretary is free to “issu[e] separate Board decisions with regard to each, some, or all disabilities claimed by a veteran”), TDIU remains a component of an increased rating claim for any period not adjudicated separately, and the Board has jurisdiction over the issue as long as it has jurisdiction over an increased rating claim.  See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009).  Evidence of unemployability subsequent to a decision denying TDIU and while a claim for increased benefits is still being processed may lead to an award of TDIU for the time period under adjudication.  If TDIU is not warranted pursuant to 38 C.F.R. section 4.16(a), the matter of a TDIU rating may still be referred to the director of Compensation and Pension Service for extraschedular consideration when it is found that the claimant is unemployable by reason of service-connected disabilities.  38 C.F.R. § 4.16(b).

 “Evidence of unemployability,” does not equate to “100% unemployable.”  Roberson v. Principi, 251 F.3d at 1378, 1384-85 (Fed. Cir. 2001).  Instead, an appellant is not required “to show 100[%] unemployability in order to prove that he cannot ‘follow substantially gainful occupation.'”  Id.  Section 4.16(a) also indicates that “[m]arginal employment shall not be considered substantially gainful employment.”  Marginal employment includes employment in a “protected environment” including a “sheltered workshop.”  38 C.F.R. § 4.16(a).

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

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How Same Sex Marriage is Handled During VA Benefits Claims

On June 26, 2015, the Supreme Court held in Obergefell v. Hodges that the Fourteenth Amendment of the U. S. Constitution requires a state to license a marriage between two people of the same sex and to recognize a marriage two people of the same sex when their marriage was lawfully licensed and performed out-of-state.

Accordingly, the Department of Veterans Affairs (VA) may now recognize all same-sex marriages without regard to a Veterans’s state of residence. VA will generally accept a claimant’s statement that he or she is married, but may investigate further if an assertion appears unreliable. The same procedure applies regardless whether the claimant is in an opposite-sex marriage or a same sex marriage.

VA is dedicated to serving all eligible Service members, Veterans and their families and providing them the benefits they have earned. All Veterans is same-sex marriages who believe they are entitled to benefits, (including those whose claims were previously denied on a ground related to their marriage) are encouraged to promptly apply for benefits.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims! Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

What Veterans Should Know About Disability Benefits Questionaires (DBQs)

Disability Benefits Questionnaires (DBQs)

Disability Benefits Questionnaires (DBQs) are downloadable forms for Veterans to use in the disability evaluation process. DBQs can help speed the processing of compensation and pension claims.

DBQs allow Veterans and Service members to have more control over their disability claims process by giving them the option of completing an examination with their own healthcare provider instead of at a Department of Veterans Affairs (VA) facility.

DBQs enable private healthcare providers to capture important information needed by VA to accurately evaluate and promptly decide Veterans’ claims for benefits.

More than 70 DBQs are available that use check boxes and standardized language to streamline the process. DBQs average about five pages in length. Veterans are responsible for any fees their private provider may charge for completing a DBQ.

The DBQ process involves four steps:

  1. Access the form online and download it;
  2. Have your healthcare provider complete the form;
  3. Save a copy for your records; and
  4. Submit the form to VA.

The DBQ forms are available on our “List by DBQ Form Name” page

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims! Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

What Disabled Veterans Must Know About VA Disability Claims Nexus Letter

A “nexus letter” is a document prepared for a claimant by a medical professional that explicitly connects an in-service event to the current medical condition for which a claimant is seeking compensation. A claimant is not required to submit a nexus letter, but such a letter can make the difference between an award and a denial. A nexus letter can be submitted with an initial application, during claim development, or after an adverse C&P exam. Submitting a properly worded nexus letter as early as possible in the process, however, is good practice.

A nexus letter is especially important in cases where a claimant has not submitted any medical evidence and a C&P examiner concludes that there is no connection between a claimant’s condition and military service. Without a nexus letter, the claim will be denied. Even when a claimant supplies supporting medical evidence with an application, VA raters can and often do choose the opinion of the VA examiner over a private physician’s opinion for many reasons. In such a case, a “nexus letter” from a private physician is necessary to respond to the C&P examiner’s conclusion.

One reason for raters favoring VA examiner’s conclusions regarding a nexus when there are conflicting or unclear medical opinions is that VA examiners are more familiar with the terms that raters look for when deciding a claim. As described above, VA regulations require only that it be “at least as likely as not” that a condition be related to service for an award. This means that the likelihood of service connection is equal to or greater than 50% (a 50/50 chance or better).

Most medical professionals, however, are not familiar with the VA system or the VA concept of “at least as likely as not.” Physicians are generally familiar with the concept of “medical certainty,” which is a much higher standard than that required by VA. As a result, private physicians may apply the wrong standard if the VA terms are not explained to them. Even then, a private physician may be reluctant to state a conclusion regarding nexus and, if they do, may qualify their conclusion with terms such as “may,” “could,” “suggests,” or “possibly.” VA will often point to such qualifying terms as not meeting the legal standard for establishing a nexus, although the physician actually believed that the condition was more than 50% likely service connected.

To prevent such misunderstandings, a claimant should make sure that the medical professional asked to provide a nexus letter understands the importance of the letter and of using the VA “magic words” to correctly state the physician’s medical opinion. The terms “more likely than not” (meaning greater than 50% likelihood of a connection) and “at least as likely as not” (meaning equal to or greater than 50% likelihood of a connection) are important to use so that VA will have to recognize the nexus letter as supporting service-connection. Any other terms may be misunderstood or misconstrued by VA into something not supporting service-connection. Bringing the relevant C&P Examination Worksheet to the examination or providing it to the medical professional may be helpful.

The Court has stated that “when a nexus between a current disability and an in-service event is ‘indicated,’ there must be a medical opinion that provides some nonspeculative determination as to the degree of likelihood that a disability was caused by an in-service disease or incident to constitute sufficient medical evidence on which the Board can render a decision with regard to nexus.”  McLendon v. Nicholson, 20 Vet. App. 79, 85 (2006) (emphasis added).  The Court has also noted that medical evidence that is too speculative to establish nexus is also insufficient to establish a lack of nexus; a VA medical examination must be undertaken to resolve the nexus issue.  Id. (citing Forshey v. Principi, 284 F.3d 1335, 1363 (Fed. Cir. 2002) (Mayer, C.J., and Newman, J., dissenting) (“The absence of actual evidence is not substantive ‘negative evidence'”)).  Jones v. Shinseki, 23 Vet. App. 382, 387-88 (2010).

If the Board finds his or her testimony credible, a claimant does not need competent medical evidence to substantiate his or her claim.  See Savage v. Gober, 10 Vet. App. 488, 495–96 (1997) (holding that, per 38 C.F.R. section 3.303(b), medical evidence of nexus is not required for benefits if the veteran demonstrates continuity of symptoms between his present disability and service); see also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).  Arneson v. Shinseki, 24 Vet. App. 379, 388 (2011).

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims! Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency