Presented By Veterans Legal Services Anna S. Richardson, Esq. Co-Executive Director. February 10, 2016 MCLE/MLRI

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1 Presented By Veterans Legal Services Anna S. Richardson, Esq. Co-Executive Director February 10, 2016 MCLE/MLRI Department Of Veterans Affairs 2 Main Divisions Veterans Benefits Administration Regional Offices Boston, Providence Pension Management Center Philadelphia Debt Management Center St. Paul Board of Veteran Appeals & CAVC Veterans Health Administration VA Hospitals Community Based Outpatient Clinics Separate from Military Healthcare System Must haveveteran status and qualifying discharge 38 USC 101 Active military, naval, or air service DischargeCharacterized as OtherThan Dishonorable to be eligible for VA benefits Types of Discharge based on service record: Honorable General Under HonorableConditions General Under OtherThan HonorableConditions Bad Conduct Dishonorable Uncharacterized

2 Requires veteran status and qualifying discharge Must meet minimum duty requirements: If enlisted after 9/7/1980, or entered active duty after 10/16/1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. Minimum requirements may not apply to Veterans who were discharged: for a disability incurred or aggravated in the line of duty, for a hardship or early out, or for those who served prior to September 7, Lots of exceptions so all vets should apply. 8 Priority Groups Priority Group 1 Veterans with VA Service-connected disabilities rated 50% or more. Veterans assigned a total disability rating for compensation based on unemployability. Priority Group 2 Veterans with VA Service-connected disabilities rated 30% or 40%. Priority Group 3 Veterans who are former POWs. Veterans awarded the Purple Heart Medal. Veterans awarded the Medal of Honor. Veterans whose discharge was for a disability incurred or aggravated in the line of duty. Priority Group 3 continued Veterans with VA Service-connected disabilities rated 10% or 20%. Veterans awarded special eligibilityclassificationundertitle 38, U.S.C., 1151, benefits for individuals disabled by treatment or vocational rehabilitation. PriorityGroup 4 Veterans receiving increased compensation or pension based on their need for regular Aid and Attendance or by reason of being permanently Housebound. Veterans determined by VA to be catastrophically disabled Priority Group 4 Veterans receiving increased compensation or pension based on their need for regular Aid and Attendance or by reason of being permanently Housebound. Veterans determined by VA to be catastrophically disabled.

3 Priority Group 5 Nonservice-connected Veterans and noncompensable Service-connected Veterans rated 0%, whose annual income and/or net worth are not greater than the VA financial thresholds. Veterans receiving VA Pension benefits. Veterans eligible for Medicaid benefits. Priority Group 6 Compensable 0% Service-connected Veterans. Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki. Project 112/SHAD participants. Veterans who served in the Republic of Vietnam between January 9, 1962 and May 7, Priority Group 6 continued Veterans who served in the Southwest Asia theater of operations fromaugust 2, 1990, through November 11, Veterans who served in a theater of combat operations after November 11, 1998 Veterans discharged from active duty on or after January 28, 2003, for five years post discharge Priority Group 7 Veterans with incomes below the geographic means test (GMT) income thresholds and who agree to pay the applicable copayment. Priority Group 8 Veterans with gross household incomes above the VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copays Eligible to Enroll Noncompensable 0% service-connected: Subpriority a: Enrolled as ofjanuary 16, 2003, and whohave remained enrolled since thatdate and/or placed in this sub priority due to changed eligibility status Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or less Nonservice-connected and: Subpriority c: Enrolled as ofjanuary 16, 2003, and who have remained enrolled since thatdate and/or placed in this sub priority due to changed eligibility status Subpriority d: Enrolled on or after June 15, 2009, whose income exceeds the current VA or geographic income limits by 10% or less NOT Eligible to Enroll Veterans not meeting the criteria above: Subpriority e: Noncompensable 0% service-connected (eligible for care oftheir SC condition only) Subpriority g: Nonservice-connected

4 VA Healthcare is creditable coverage for the purposes of MA Healthcare laws Admin. Bulletin 04-07, and Federal Affordable Care Act aka Obamacare VA may provide mileage reimbursement for travel for some veterans to access care VA may cover glasses, hearing aids, uninsured medicals, diabetes supplies, etc. VA Healthcare is direct-provided care, not insurance Eligible veterans should still apply for MassHealth to cover care at non-va facilities If VA facilities are not available, VA can pay for non-va care in some circumstances 38 USC 1728 relaxed regulations as of 1/12/12: Emergency care generally veteran must notify theva within 48 hours and submit claim within 90 days. Veteran must also transfer to VA medical facility as soon as possible. Non-emergency care VA preauthorizes payment for care because a VA medical facility is not feasibly available. Must submitva Form to Fee Basis Office at localva Medical Center to obtain payment of unauthorized non-va care Veterans Choice Program VA wait time of 30+ days or excessive travel burden/40+ miles Care must be approved by VA doctor Visit for more info How to apply for VA Health Care Visit nearest VA Medical Center Call VETS (8387) Apply online using VA form 1010EZ available at By mail download online VA form 1010EZ and mail it to your nearest VA Medical Center

5 Monetary payment for a disability caused or aggravated by military service 38 USC 101(16) Intended to replace lost earning capacity Originated post-wwii, tends to focus more heavily on physical disabilities Available regardless of income Requires veteran status and qualifying discharge Elements of the claim Medical evidence of current disability Evidence of in-service incurrence or aggravation or appearance of symptoms during or immediately following military service Nexus - Evidence that in-service injury and current disability are linked Disability is not the result of willful misconduct Three ways to establish service connection: Direct service connection Secondary service connection Presumptive service connection Agent Orange Exposure, ALS, etc. Some disabilities have a presumptive time period so that, if the disability manifests itself within the presumptive period, service connection may be granted. Example if psychosis manifests within two years of military discharge, it may be presumed that the condition arose in service. Includes aggravation of pre-existing conditions: Cannot claim results of natural progression of pre-existing conditions Service is presumed to aggravate pre-existing conditions Relaxed rules for certain claims Combat-related injuries can be established as serviceconnected by veteran s own account, if the veteran s description is consistent with the terms of his or her service. PTSD claims pending or filed after July 13, 2010 if the claimed stressor is fear of hostile military or terrorist activity, and is consistent with the veteran s service, then the diagnosis of PSTD is sufficient for service-connection if a VA doctor confirms the stressor is adequate to support the diagnosis 38 USC 3.304(f)

6 Award is based on percentage of disability - Amounts range from $133/month (10%) to $2,906/month (100%) Additional amounts paid if the veteran has dependents Includes dependent parents, spouse, children, and children who are full-time students AdditionalAmounts special monthly compensation -are payable for loss of function or loss of use Unemployability - Veteran can receive a rating of total disability and be paid at 100% rate if he or she is rated at least 70% and can show that his or her service-connected disabilitymakes him or her unemployable How to apply: Complete and submit Form to VA Regional Office Visit Developed by the VA to improve claims processing times and give more timely results. Claimants: Submit their claim on a specific form that contains language which satisfies the notice requirements of 38 U.S.C Simultaneouslywith their claim submit all private medical treatment records, identify any relevant treatment records at a Federal facility, and submit any additional forms or treatment records required under special circumstances that support their specific claim. Certify their claim is ready for processing at the time it is submitted. Forgo additional notice and requests for evidence from the VA. Receive priority claims processing and expedited decisions. Make an informal claim at first opportunity. Needs-based Requires annual income verification Most needs-based programs (SSI, Ch. 115, TAFDC) will not count as income to determine entitlement 38 CFR Most retirement and disability payments (Social Security, SSDI, VA service-connected compensation, private policies) will count as income and offset pension dollar for dollar 38 CFR Medical expenses that exceed $643/year may be deducted from income to determine eligibility Maximum benefit is $1,072 per month for single vet

7 Monthly Payment for wartime veterans who are over 65 or totally and permanently disabled 38 USC 1521 Requires veteran status and qualifying discharge Elements of the claim Total and permanent disability, or over age 65, or on SSDI, or in a nursing home 90 days of active service during period of war as determined bycongress Length of service requirement 38 USC 5303A(b) Before 1980, 90 consecutivedays, one dayduring time of war After 1980, 24months of active dutyor the fullterm for which the veteran was called to active duty, one day during period of war Financial need Income must be below $1,072 per month for single person Assets cannot be excessive and do not include primary residence, reasonable lot area, andpersonal effects.assets over $40k (single) or $80k (couple) require further assessment Irregular or non-recurring income is annualized 38CFR In-kind Maintenance income 38 CFR Aid & Attendance - An additional benefit available to a veteran who: Is eligible for non-service connected pension, AND Requires the aid of another person in order to perform personal functions required in everyday living, such as bathing, feeding, dressing, attending to the wants of nature, adjusting prosthetic devices, or protecting himself/herself from the hazards of his/her daily environment, OR, Is bedridden, in that his/her disability or disabilities requires that he/she remain in bed apart from any prescribed course of convalescence or treatment, OR, Is a patient in a nursing home due to mental or physical incapacity, OR, Is blind, or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less. Increases the monthly pension to $1,788 AssetTransfers VA revised 38 CFR to now count assets transferred to household members or transferred for less than fair market value, unless veteran relinquishes all rights/control Additional benefits available to a veteran who: Is eligible for non-service connected pension, AND Has a single permanent disability evaluated as 100- percent disabling AND, due to such disability, he/she is permanently and substantially confined to his/her immediate premises, OR, Has a single permanent disability evaluated as 100- percent disabling AND, another disability, or disabilities, evaluated as 60 percent or more disabling. Increases monthly pension to $1,310 Cannot be received concurrently with Aid & Attendance

8 Cannot receive pension and compensation at the same time VA will automatically pay higher amount unless veteran elects otherwise Veterans with SSDI or other non-va income may be better off taking lower amount in compensation and keeping other income How to apply: Complete and submit Form EZ to VA Pension Management Center Visit Two forms of benefits are available Compensation (disability based) & Pension (needs based) Available to qualifying spouses and children Now available to same-sex spouses in certain circumstances the state where the couple lived when they married recognizes the marriage as legal, or the state where the couple lived when the veteran's right to benefits began recognizes the marriage as legal. Not available to spouses who have divorced or remarried Available to children 18 to 23 if in school full-time Dependency and Indemnity Compensation Compensation program for surviving spouse or dependent parents, of Veterans who die during service Veterans whose death is the direct result of a service-connected disability Veterans who die of other causes but were 100% service connected disabled for a sustained period of time (10+ years, or since leaving service and 5+ years) Basic benefit - $1,254/month Additional amounts available if dependent children in household Non Service Connected Death Pension- Available to spouses of veterans whose death is not SC Veteran must have been eligible for pension Surviving spouse must have financial need Basic Benefit - $719/month Aid & Attendance or Housebound Benefits are also available to increase amount Medical expenses may also be deducted if exceed $431/year How to Apply for DIC and Death Pension Complete and submitva Form EZ to Regional Office Visit

9 Education benefit for qualifying veterans Comes in many forms. Most recent is the post 9/11 GI Bill for veterans who served after 9/10/01 Requires Honorable discharge and at least 90 days of active duty service, 3 years of service required for full benefit to be payable Can be transferred to a spouse or child if service was after 8/1/09 and veteran elected transferability during service Can be used for accredited colleges, and certain online, vocational, and technical programs What does it cover? Pays all in-state tuition and fees for public schools If attending a private school or as an out of state student the maximum tuition benefit effective 8/1/14 is $21,084 per academic year Includes a separate housing allowance at the rate of the Basic Allowance for Housing for an E-5 with dependents, amount varies based on zip code Includes a separate $1,000 annual allowance for books and supplies Additional $500 relocation benefit available for veterans from rural areas Occurs when a veteran receives benefits to which he or she is not entitled such as: Concurrent Receipt ofva Pension and Social Security Benefits or other income exceeding threshold Fugitive Felon Status Failure to remove spouses or dependents upon death, divorce, etc. Can be recovered by offset or termination of future benefits until repaid Can be waived if veteran can show hardship, error, or that collection would violate equity and good conscience No waiver if the overpayment is the result of fraud, misrepresentation, or bad faith by the veteran/claimant

10 One year appeal period for most denials To reopen a claim after one year New and Material Evidence required Low standard of proof /Any evidence can be considered Benefit of doubt goes to veteran Not taxable Not assignable for most purposes Can be garnished to satisfy a debt to a federal administrative agency (Social Security, IRS) Can be garnished for child support or spousal support payments to a limited extent Brockton Division 940 Belmont Street Brockton, MA Jamaica Plain Division 150 S. Huntington Avenue Boston, MA West Roxbury Division 1400 VFW Parkway West Roxbury, MA Veterans Health Administration in Massachusetts Boston VA Healthcare System - Healthcare Edith Nourse Rogers Memorial Veterans Hospital 200 Springs Road Bedford, MA Veterans Benefits Administration VA Regional Office Benefits Claims JFK Federal Building, 15 New Sudbury Street Boston, MA Attorney Agent Coordinator Jay Stasio Department ofveterans Affairs (VA) Evidence Intake Center PO Box 4444 Newnan, GA FAX

11 VA Regional Office and Medical Center Privacy Officers VA Release of Information Forms Benefits Authorization to Disclose Personal Information to athird Party VA Form Request for Consent to Release of Information from Individual s Records VA Form 3288 Medical Records/ Information Request for andauthorization to Release Medical Records - VA Form In order to represent a veteran in a VA benefits claim, a person must be accredited by VA Office of General Counsel or Limit representation to a single claim, or Be part of a recognized Veterans Services Organization See 38 CFR to The Department of Veterans Services and your local Veterans Service Officer. Local Veterans Organizations DAV, VFW, American Legion, etc. Your state and federal representatives Veterans Legal Services WilmerHale Legal Services Center