Updates from the Milwaukee Pension Management Center

Updates from the Milwaukee Pension Management Center
Saquanna Carrillo, Coach June 11, 2019

Agenda Pension overview Recent updates to pension program
Contact Information What’s New? Signatures (Electronic) Alternate Signer Medical Expenses Net Worth and Trust Documents Burial Benefits Power of Attorney Updates Recent updates to pension program Appeals modernization Net worth rule

Contact Information

Telephone Contact Information The Milwaukee PMC has a direct line for VSOs to inquire about the current status of expedited claims. Priority claims requiring expedited processing: Medal of Honor, Homeless, Terminal Illness, POW, GWOT, Seriously Injured (SI)/Very Seriously Injured (VSI), Medical Foster Home, Severe Financial Hardship, Age, and Purple Heart

Telephone Contact Information, continued The telephone number is (414) Answered by our Advocacy Team who also processes priority claims Meant to alert the PMC when priority processing is required Disclaimer: VSOs without POA authority will be referred to the call center

Contact Information The Milwaukee PMC has an address for VSOs to inquire about the current status of all other claims and ask general questions The address is This is answered by the Coach of the Advocacy Team All general claim questions should be routed here Allows the PMC to research answers and send something to you in writing Allows the PMC to forward all information to the proper division/department quickly

Contact Information, continued Claim updates (i.e. POA updates or First Notice of Death requests) should be sent to our claims intake mailbox for faster processing The is Quarterly VSO Conference Call Access code 06606 to be added to the distribution list.

Centralized Mail Postal Address
The PMC moved to Centralized Mail in February 2016 PO Box was closed on February 29, 2016 The Contact information for the Milwaukee PMC is: Department Of Veterans Affairs Claims Intake Center Attention: Milwaukee Pension Center P.O. Box 5192 Janesville, WI The fax number is Deployed in April 2017

What Constitutes a Complete VA Form 21-22?
VA Form must contain the following information: Enough information to identify the Veteran/claimant (Box 1 or Box 2), The name of the service organization (Box 3A), Signature of the Veteran/claimant with a corresponding date of signature (Boxes 15 & 16), and Signature of the representative acting on behalf of the service organization with a corresponding date of signature (Boxes 17 & 18). Note: This form documents the appointment of the entire service organization listed in Block 3A and does not indicate the designation of only the specific representative to act on behalf of the organization

How to Apply for Benefits

Standard Forms Effective March 24, 2015, VA will only recognize compensation, pension, survivors, and related claims if they are submitted on the required standard forms See M21-1 III.ii.2.B.1.a. for the most up-to-date listing

Survivor Benefits DIC – surviving spouse, children, parents
VAF 21P-534, Application for DIC, Pension, and/or Accrued by a Surviving Spouse or Child VAF 21P-534EZ, Application for DIC, Pension, and/or Accrued VAF 21P-534a, Application for DIC by a Surviving Spouse or Child - In-Service Death Only VAF 21P-535, Application for DIC by Parents DEA: CHAMPVA: Fry Scholarship: Home Loan Guaranty -

Survivor Benefits, continued
Burial Benefits – VAF , Application for Burial Benefits VAF , Presidential Memorial Certificate Request Form VAF , Claim for Standard Gov’t Headstone or Marker VAF M, Claim for Gov’t Medallion for Placement in a Private Cemetery VAF , Application for U.S. Flag for Burial Purposes Accrued Benefits – paid based on relationship or reimbursement VAF 21P-534EZ, Application for Dependency and Indemnity Compensation , Pension, and/or Accrued VAF 21P-601, Application for Accrued

Veterans Pension VAF 21P-527EZ, Application for Pension
VAF 21P-527, Income, Net Worth, and Employment Statement

Special Monthly Benefits
Special Monthly Compensation (for DIC) VAF 21P-534 VAF 21P-534EZ VAF , Examination for Housebound Status or Permanent Need for Regular Aid and Attendance VAF , Request for Nursing Home Information in Connection with Claim for Aid and Attendance Special Monthly Pension VAF 21P-527EZ VAF 21P-534 VAF 21P-534EZ VAF VAF

Expediting the Claims Process
Certify photocopy of discharge document using VSO stamp Do not send original documents Completely fill out forms Example: On income sections of VA Form EZ, do not leave any items blank. If no income was received from a particular source, write “0” or “none” If a claimant wants consideration for SMP, it must be specifically claimed (it may be written on Intent to File) Notice of nursing home status may not be sufficient Submit VA Form or VA Form at the same time as application

Expediting the Claims Process, continued
Send current version of form- While claims submitted by VSOs are currently exempt from outdated forms regulations, it is imperative that the information submitted address all information requested on the current version of the form ( /4142a from Mar 2018) PMCs are no longer allowed to send any locally generated forms; however, claim processors are allowed to use any information sent to them, regardless if it is a VA standardized form or not

What’s “New”?

Electronic Signatures
Effective June 20, 2017, VA will accept any electronic or digital signature or other image of a signature on a claim or appeal for benefits, or associated form, unless there are clear indications of fraud

Alternate Signer (Slide 1 of 3)
Public Law (PL) , Section 502, amended 38 USC to authorize VA to accept an alternate signature on behalf of claimants or beneficiaries who: Are under age 18, Lack the mental capacity to provide substantially accurate information needed to complete a form or to certify that the statements made on a form are true and complete, or Are physically unable to sign a form

A fully completed VA Form , Alternate Signer Certification, allows VA to accept the signature of an alternate signer on behalf of certain claimants or beneficiaries without further development; however it is not always necessary to have the form to accept the signature of an alternate signer Proof of inability to sign or evidence beyond relationship is not required

When a VA Form , Alternate Signer Certification, was previously of record, the alternate signer named on that form may sign subsequent forms on behalf of the claimant The form itself lists the acceptable forms for which the alternate signer certification applies Important: VA Form is not an eligible form to be completed by an alternate signer VA Form must be signed by the claimant

Medical Expenses (Slide 1 of 4)
Beneficiaries are allowed to submit medical expenses to reduce their available income Medical expense adjustments are now required to be submitted on VA Form 21P-8416, Medical Expense Report If the VA Form 21P-8416 is incomplete, it requires development which will delay the claims process

A VA Form 21P along with an expense statement is now required for claiming facility or care fees Nursing home, assisted living, in home care taker If a claimant with a running award moves from one facility to another, an updated VA Form 21P-8416 along with an expense statement is required If a claimant moves in to a facility for the first time, a VA Form 21P-8416, expense statement, and a document to support the claim for special monthly pension is required

Expenses will be considered either: Continuing medical expenses (CMEs) which are counted on a continuous basis, or Unreimbursed medical expenses (UMEs) that are counted for the period in which they were claimed CME examples: Medicare Part B, Private medical insurance, Assisted living or fees, Oxygen, Incontinence supplies UME examples: Doctor co-pay, OTC supplies, One time medical supply expense like a cane or walker

Examples of common forms in addition to VA Form 21P are: VA Form for presumptive nursing home VA Form for a rating decision granting special monthly pension Document showing assistance with activities of daily living and care-related expenses for in-home care

Medicaid Approved Nursing Home
A claimant will receive the $90 Medicaid rate if the following applies: Resident in Medicaid approved nursing home, see Has been approved or applied for Medicaid status, and Does not have any dependents If only one or two of the three stipulations apply, the claimant will not receive the $90 Medicaid rate; however they could still be eligible for a presumptive A&A rate 0779 needs to be submitted with 8416, otherwise we will issue Due Process

Calculating the A&A Rate
The A&A rate is calculated by: Using the monthly rate from the status A&A MAPR (single claimant or claimant with dependent), Then subtracting the monthly rate using the same status, but without the A&A MAPR

Maximum Annual Pension Rate (MAPR) Chart

Trusts and Net Worth Impact (Slide 1 of 4)
Net worth is evaluated to determine whether the claimant’s resources are sufficient to meet his/her basic needs without assistance from VA Pension is not intended to protect assets or build up the beneficiary’s estate If a trust is established prior to October 2018 to become eligible for benefits then we are going to count for eligibility determination.

VA should include trust assets in net worth calculations if trust assets are available for use for the claimant's support Estate planning preserves assets for heirs while taking advantage of Medicaid and other governmental assistance programs When a claimant indicates that they moved assets into a trust or that they benefit from a trust of any kind, a copy of the trust documents is needed to evaluate the effect of the trust on the claimant’s net worth Expenses do not reduce Net Worth

A trust is countable as belonging to a claimant if: It is actually owned by the claimant, The claimant possesses such control over the property that the claimant may direct it to be used for the claimant’s benefit, or Funds have actually been allocated for the claimant’s use Such control may be considered a sufficient ownership interest to bring the property within the scope of the pension laws. If the claimant or someone with legal authority to act on the claimant's behalf has some control to use property, it can reasonably be expected to be consumed for a claimant's maintenance and thus be includable in the claimant's estate

Assets transferred by a legally competent claimant, or by the fiduciary of a legally incompetent one, to an irrevocable “living trust” or an estate-planning vehicle of the same nature designed to preserve estate assets by restricting trust expenditures to the claimant's “special needs,” while maximizing the use of governmental resources in the care and maintenance of the claimant, should be considered in calculating the claimant’s net worth for pension purposes Disbursements from a trust counted as net worth are not income but a reduction of net worth

Burial Benefits (Slide 1 of 3)
M21-1 VII.1.A.4.d. Proof of death is required for burial claims. If proof of death does not accompany the claim, it may be obtained verbally VBA will accept evidence if it reasonably indicates that a beneficiary is deceased For claims of SC death where a rating decision is needed, a death certificate or other acceptable proof of death (coroners report, CAPRI, clinical summary, etc.) is required M21-1 VII.1.B.1.b. Concede service as verified for burial purposes if there is evidence that the Veteran is buried in a national cemetery when there is no service verified.

M21-1 VII.1.B.2.b. If a Veteran is eligible for the VA hospitalization death burial allowance, regardless of whether VA is paying the SC burial allowance as the greater benefit, the Veteran is entitled to transportation benefits as subject to the limitations set forth in 38 CFR (c) and (d) The requirement for burial in a national cemetery is not a factor when paying transportation benefits for VA hospitalization deaths An itemized receipt of statement is required for a claim for transportation reimbursement

M21-1 VII.1.B.3.b. Unless VA has evidence on the date of receipt of the notice of the Veteran’s death that the expenses incurred were less, VBA will pay the maximum NSC burial, SC burial and plot or interment allowance

Appeals Modernization Act (AMA)
AMA is new to us and we recently received FAQs that are being reviewed for clarification

References Reference Title PL115-55
Veterans Appeals Improvement and Modernization Act of 2017 38 CFR Applicability of modernized review system 38 CFR Review of decisions 38 CFR Supplemental claims 38 CFR Higher-level review 38 CFR Notice of Disagreement Appeals Modernization – VA.gov AMO Intranet Site, Program Administration Page

Three Review Options VBA BVA Supplemental Claim Higher-Level Review
Board Appeal Replaces “reconsiderations” and “reopening” claims with “new and material” evidence VA will readjudicate a claim if “new and relevant” evidence is presented or identified with a supplemental claim (open record). VA will assist in gathering new and relevant evidence (duty to assist). Effective date for benefits is always protected when submitted within 1 year of prior decision. Tracked and controlled under EP 040 series Decisionmakers are Veterans Service Representatives (VSRs) and Rating VSRs (RVSRs) More experienced VA employee takes a second look at the same evidence (closed record and no duty to assist). Option for a one-time telephonic informal conference with the higher-level reviewer to discuss the error in the prior decision De novo review with full difference of opinion authority Duty to assist errors returned to lower-level for correction (quality feedback) Tracked and controlled under EP 030 series Decisionmakers are Decision Review Officers (DROs) and Senior VSRs Evidence only docket: The appellant may submit evidence within the 90 day window following submission of the NOD. The Board does not have a duty to assist and the record is otherwise closed. Direct docket: The appellant receives direct review by the Board of the evidence that was before VBA in the decision on appeal. The Board has a 365-day timeliness goal for this docket. Quality feedback loop for VBA. Hearing docket: The appellant will be scheduled for a Board hearing. Additionally, the appellant may submit evidence within the 90 day window following the scheduled hearing. The Board does not have a duty to assist and the record is otherwise closed. FOR VA INTERNAL USE ONLY FOR VA INTERAL USE ONLY 6

Submitting Applications
If a claim was processed prior to 2/19/19 and the claimant received a 4107, the traditional method of submitting applications applies If a claim was processed on or after 2/19/19 and received a , claimant may submit a to open an 030 High Level Review (HLR) end product to have the current evidence of record to be reviewed only; or the for a 040 Supplemental Claim to send new and relevant evidence Submit 0995 (Supplemental Claim) to protect earlier entitlement with evidence. Submit Application with Evidence.

New AMA Forms VBA will include VA Form , Your Rights to Seek Further Review of Our Decision, with all decision notices This form provides claimants with information on the available decision review options Claimants will use new enterprise wide VA forms to file under one of the new options: VA Form , Decision Review Request: Supplemental Claim, VA Form , Decision Review Request: Higher-Level Review, or VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement)

Forms Changes VBA will no longer provide the appeals forms to claimants with decision notices Claimants will access the new forms on the VA.gov forms page Important: Use of VA Form 4107 and VA Form , Notice of Disagreement, were discontinued for all decisions issued on/after February 19, 2019

Supplemental Claim Definition
Supplemental claims are requests for review with new and relevant evidence, submitted by a claimant or their authorized representatives based on a “disagreement with a prior VA decision” (see 38 CFR § 3.1(p) and ) This new process closely mirrors and replaces the former “reconsideration” processes AMA Supplemental Claims have an open evidentiary record and requires VA to assist in the gathering of evidence (see 38 CFR §3.159, duty to assist) Main difference between HLR and Supplemental claims is that we can provide DTA for supplementals. Examples of types of benefits: • service connection (SC) for right knee arthritis • entitlement to individual unemployability • SC for cause of death, and • entitlement to nonservice-connected pension

New and Relevant Evidence
Claimants must identify or submit new and relevant evidence in support of a supplemental claim review New evidence means evidence not previously part of the actual record before agency adjudicators at the time of the prior decision Relevant evidence means evidence that tends to prove or disprove a matter at issue in a claim. Relevant evidence includes evidence that raises a theory of entitlement that was not previously addressed Important: The “new and relevant” evidentiary standard is a lower standard than that of “new and material” under 38 CFR §

Filing Requirements Required Form: VA Form , Decision Review Request: Supplemental Claim Only form accepted by VA for disability benefit claims Evidence: Claimants must identify or submit new and relevant for the request to be considered a complete claim Time Period For Filing: May be filed at anytime; however the request must be filed within one year of the date of notice of the prior decision on the issue(s) to maintain entitlement to earliest possible effective date Possibly cut this slide- we are still waiting on guidance if a 0996 is required to open the 040 or if a claimant can submit a prescribed for an process under a 120/etc end product

“Opt-in” Opportunities for Legacy Appeals
If a claimant would like to “opt-in” to the new modernized review system while they have a legacy appeal pending, it must be filed within 30 days of the receipt of the SOC/SSOC, or within the one year appeal period I did not include RAMP/BEAAM as they do not apply for pension, and the date of the law is now live and that stipulation does not matter

AO73 Basics: Net Worth, Asset Transfers, and Income Exclusions for Needs-Based Benefits

References Reference Title M21-1 V.iii.1.G.3.
Sources of Medical Expenses M21-1 V.iii.1.J. Net Worth, Asset Transfers, and Penalty Periods 38 CFR 3.274 Net worth and VA pension 38 CFR 3.277 Eligibility reporting requirements 38 CFR 3.278 Deductible medical expenses

Forms Other than the most current version, the following forms are acceptable: VA Form 21P-534EZ 07/2015 version can be accepted through 06/2019 06/2018 version can be accepted through 10/2019 VA Form 21P-534 06/2014 version can be accepted through 06/2019 VA Form 21P-527EZ and VA Form 21P-527 04/2016 versions can be accepted through 10/2019 VA Form 21P-8416 01/2018 version can be accepted through 11/2019

Outdated Forms Development will be required for any information required to process the claim that is requested on the current version of the form, but not requested on the outdated version When the information collected on the current version is not required to process the claim, then additional development is not necessary unless indicated in other policies or procedures

Development Necessary For All Outdated Forms – 2 Questions
1. Do you own your primary residence? If yes, ask… What is the size of your lot? If more than 2 acres, or 87,120 sq. ft., ask… Could part of your lot be sold without selling your primary residence? What is the value of the property greater than 2 acres? Have you or any of your dependents transferred any assets since October 18, 2018?

Definitions

Less Than Fair Market Value
Fair market value (FMV) is the price at which an asset would change hands between a willing buyer and seller A transfer for less than FMV means the selling, conveying, gifting, or exchanging of an asset for an amount less than FMV, or a voluntary asset transfer (or purchase) of any financial instrument that reduces net worth Examples: Selling a house, opening an irrevocable annuity before applying for pension, etc. Conveying means the claimant has promised or “conveyed” that they will transfer assets in the future

Covered Asset A covered asset is an asset that:
Was part of the claimant’s net worth, Was transferred for less than FMV during the look-back period, and If it was not transferred, would have caused or partially caused the claimant’s net worth to exceed the net worth limit Example: Giving away money to a friend to ensure net worth is under the bright line limit within look back period Important: All covered assets are transfers less than FMV, but not all transfers less than FMV are covered assets

Covered Asset: The Exception
A trust established on behalf of a child that VA rated as incapable of self-support should not be included as a covered asset if distributions of the trust cannot benefit the Veteran, Veteran’s spouse, or Veteran’s surviving spouse

Penalty Period A penalty period:
Is a period of non-entitlement due to the transfer of a covered asset(s) during the look back period, Cannot exceed 5 years, Begins the first day of the month following the date of the last transfer, and Is calculated by dividing the total covered asset amount by the monthly penalty rate and rounding down. The resulting whole number is the number of months VA will not pay pension

Penalty Rate The monthly penalty rate is:
The MAPR for a Veteran in need of Aid and Attendance with one dependent on the effective date of payment, Divided by 12, Rounded down to the nearest whole dollar, and Is the same for all pension claimants Example: The monthly penalty rate for all claimants with an effective date of payment of 12/01/18 is $2,230.00

Penalty Period Reminders
Penalty periods end the last day of the month of the penalty The payment date would be the first day of the following month 90 day limit after decision to submit evidence for VA to re- calculate penalty period If a penalty period covers any portion of a lib law period, the claimant is not entitled to benefits for the entire lib law period

Calculating Entitlement After a Penalty Period Ends: Example
Veteran transferred covered assets on 02/03/19, then applied for pension on 02/12/19 The Veteran is assessed a 3-month penalty period (Mar-Apr- May 2019) VA processes the claim on 06/20/19 If the Veteran did not incur a penalty period, she would have qualified for benefits The penalty period ends 05/31/19

Calculating Entitlement After a Penalty Period Ends: Notes
Takeaways: Earliest possible entitlement-payment date would be 06/01/19; payment date is not subject to omnibus The claimant must apply within the last month of the penalty period in order to be entitled the following month Otherwise, date of claim controls the entitlement date and then payment date is subject to omnibus Exception: If the penalty period ends before the claim is processed, benefits may be granted from the end of the penalty period without a new application

When No Penalty Period Exists
When the claimant is denied for excessive net worth without covered assets, there is no penalty period The time limit is controlled by VA Form 4107 for claims adjudicated prior to 2/19/19. The time limit is controlled by VA Form for claims adjudicated on or after 2/19/19 The claimant may reapply whenever assets fall below the bright line limit

VA Form 21P-0969

When to Send VA Form 21P-0969 If the claimant submits a new application and… Has income other than Social Security, or Has net worth over $10,000.00, or Has transferred any assets since 10/18/18, …then VA Form 21P-0969 will be needed

When VA Form 21P-0969 is Received
Unlike other VA forms, when VA receives a 21P-0969, the claimant is not obligated to fill in every box with “0” or “NA” They are required to check the “Yes” or “No” box at the top the section indicating whether they have that asset or income The claimant may not be aware of future income amounts, therefore it is acceptable if they do not report an amount

Worksheets

Worksheets and Medical Expenses
The worksheets included with the new applications and VA Form 21P-8416 are now considered the official VA forms for in- home attendant expenses, and care facilities other than nursing homes or medical foster homes Important: VA may accept information submitted by the claimant in any form or method, as long as the initial claim is submitted on a prescribed form VA is no longer allowed to send out any locally-created instruments for collecting information from claimants (i.e., Attendant Affidavit)

A separate document from each in-home attendant specifying the following information in addition to the worksheet is required: Amount paid, Date payment was made, Purpose of the payment (nature of the product or service provided), Name of the person to or for whom the product or service was provided, and Identification of the provider to whom payment was made

Payments for in-home attendants must be commensurate with the number of hours that the provider attends to the claimant VA will accept reports of monthly, weekly, or annual in-home attendant fees, no change from prior guidance Worksheets are the forms that are included for facility other than nursing homes and in-home care taker that is sent with the 8416 and applications. Commensurate meaning proportional with hours otherwise questionable and development sent

If a claimant is in a nursing home, VA Form is required. No additional worksheet is required If the claimant submits a and is in assisted living, the information on worksheet will still be required; however, the information on the may also be taken into consideration to satisfy the requirement of documentation of fees For facilities other than nursing homes, VA Form b is necessary if the facility did not verify expense information along with the worksheet

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Updates from the Milwaukee Pension Management Center

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