Updates and Contact Information from Milwaukee Pension Management Center

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Saquanna Carrillo, Coach
June 11, 2019
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Pension overview
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Contact Information
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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
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Appeals modernization
o
Net worth rule
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The Milwaukee PMC has a direct line for VSOs to inquire
about the current status of expedited claims.
Priority claims requiring expedited processing:
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Medal of Honor,
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Homeless,
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Terminal Illness,
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POW, GWOT, Seriously Injured (SI)/Very Seriously Injured (VSI),
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Medical Foster Home,
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Severe Financial Hardship,
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Age, and
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Purple Heart
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Answered by our Advocacy Team who also processes priority
claims
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Meant to alert the PMC when priority processing is required
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This email is answered by the Coach of the Advocacy Team
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All general claim questions should be routed here
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Allows the PMC to research answers and send something to you
in writing
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Allows the PMC to forward all information to the proper
division/department quickly
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Claim updates (i.e. POA updates or First Notice of Death
requests) should be sent to our claims intake mailbox for faster
processing
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Quarterly VSO Conference Call
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1-800-767-1750
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Access code 06606
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The PMC moved to Centralized Mail in February 2016
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PO Box 342000 was closed on February 29, 2016
The Contact information for the Milwaukee PMC is:
 
 
The fax number is 
1-844-655-1604
Deployed in April 2017
 
Department Of Veterans Affairs
Claims Intake Center
Attention:  Milwaukee Pension
Center
P.O. Box 5192
Janesville, WI 53547-5192
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VA Form 21-22 must contain the following information:
o
Enough information to identify the Veteran/claimant (Box 1 or Box 2),
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The name of the service organization (Box 3A),
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Signature of the Veteran/claimant with a corresponding date of
signature (Boxes 15 & 16), and
o
Signature of the representative acting on behalf of the service
organization with a corresponding date of signature (Boxes 17 & 18).
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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
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VAF 21P-534, 
Application for DIC, Pension, and/or Accrued by a
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VAF 21P-534EZ, 
Application for DIC, Pension, and/or Accrued
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VAF 21P-534a, 
Application for DIC by a Surviving Spouse or
Child - In-Service Death Only
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VAF 21P-535, 
Application for DIC by Parents
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Application for Burial Benefits
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Presidential Memorial Certificate Request Form
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VAF 40-1330M, 
Claim for Gov’t Medallion for Placement in a
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VAF 27-2008, 
Application for U.S. Flag for Burial Purposes
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Application for Accrued
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Application for Pension
VAF 21P-527, 
Income, Net Worth, and Employment Statement
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Request for
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Certify photocopy of discharge document using VSO stamp
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Do not send original documents
Completely fill out forms
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If a claimant wants consideration for SMP, it must be
specifically claimed (it may be written on Intent to File)
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Notice of nursing home status may not be sufficient
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Send current version of form- 
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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
(21-4142/4142a 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
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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
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Public Law (PL) 112-154, Section 502, amended 38 USC 5101
to authorize VA to accept an alternate signature on behalf of
claimants or beneficiaries who:
o
Are under age 18,
o
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
o
Are physically unable to sign a form
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A fully completed VA Form 21-0972, 
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
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When a VA Form 21-0972, 
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
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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
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A VA Form 21P-8416  along with an expense statement is now
required for claiming facility or care fees
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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
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Expenses will be considered
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Medicare Part B,
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Private medical insurance,
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Assisted living or fees,
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Oxygen,
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Incontinence supplies
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Doctor co-pay,
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OTC supplies,
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One time medical supply
expense like a cane or
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Examples of common forms in addition to VA Form 21P-8416
are:
o
VA Form 21-0779 for presumptive nursing home
o
VA Form 21-2680 for a rating decision granting special monthly
pension
o
Document showing assistance with activities of daily living and
care-related expenses for in-home care
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A claimant will receive the $90 Medicaid rate if the following
applies:
1.
Resident in Medicaid approved nursing home, see
https://www.medicare.gov/nursinghomecompare/search.html
,
2.
H
a
s
 
b
e
e
n
 
a
p
p
r
o
v
e
d
 
o
r
 
a
p
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e
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r
 
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e
d
i
c
a
i
d
 
s
t
a
t
u
s
,
 
a
n
d
3.
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
C
a
l
c
u
l
a
t
i
n
g
 
t
h
e
 
A
&
A
 
R
a
t
e
The A&A rate is calculated by:
o
Using the monthly rate from the status A&A MAPR (single
claimant or claimant with dependent),
o
Then subtracting the monthly rate using the same status, but
without the A&A MAPR
M
a
x
i
m
u
m
 
A
n
n
u
a
l
 
P
e
n
s
i
o
n
 
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a
t
e
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A
P
R
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h
a
r
t
T
r
u
s
t
s
 
a
n
d
 
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e
t
 
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o
r
t
h
 
I
m
p
a
c
t
(
S
l
i
d
e
 
1
 
o
f
 
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
T
r
u
s
t
s
 
a
n
d
 
N
e
t
 
W
o
r
t
h
 
I
m
p
a
c
t
(
S
l
i
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e
 
2
 
o
f
 
4
)
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
T
r
u
s
t
s
 
a
n
d
 
N
e
t
 
W
o
r
t
h
 
I
m
p
a
c
t
(
S
l
i
d
e
 
3
 
o
f
 
4
)
A trust is countable as belonging to a claimant if:
o
It is actually owned by the claimant,
o
T
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e
 
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l
a
i
m
a
n
t
 
p
o
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e
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e
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c
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p
r
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p
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h
a
t
 
t
h
e
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l
a
i
m
a
n
t
 
m
a
y
 
d
i
r
e
c
t
 
i
t
 
t
o
 
b
e
 
u
s
e
d
 
f
o
r
 
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h
e
 
c
l
a
i
m
a
n
t
s
 
b
e
n
e
f
i
t
,
 
o
r
o
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
T
r
u
s
t
s
 
a
n
d
 
N
e
t
 
W
o
r
t
h
 
I
m
p
a
c
t
(
S
l
i
d
e
 
4
 
o
f
 
4
)
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
B
u
r
i
a
l
 
B
e
n
e
f
i
t
s
(
S
l
i
d
e
 
1
 
o
f
 
3
)
M
2
1
-
1
 
V
I
I
.
1
.
A
.
4
.
d
.
 
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d
 
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o
r
 
b
u
r
i
a
l
 
c
l
a
i
m
s
.
o
If proof of death does not accompany the claim, it may be
obtained verbally
o
VBA will accept evidence if it reasonably indicates that a
beneficiary is deceased
o
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
M
2
1
-
1
 
V
I
I
.
1
.
B
.
1
.
b
.
 
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w
i
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p
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m
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b
u
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p
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o
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c
t
(
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M
A
)
 
R
e
f
e
r
e
n
c
e
s
FOR 
VA 
INTERAL 
USE 
ONLY
FOR 
VA 
INTERNAL 
USE
 
ONLY
6
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e
 
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a
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i
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h
 
L
e
v
e
l
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e
v
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w
 
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L
R
)
 
e
n
d
 
p
r
o
d
u
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t
 
t
o
 
h
a
v
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t
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c
u
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e
v
i
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c
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e
w
 
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M
A
 
F
o
r
m
s
VBA will include VA Form 20-0998, 
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:
o
VA Form 20-0995, 
Decision Review Request: Supplemental Claim,
o
V
A
 
F
o
r
m
 
2
0
-
0
9
9
6
,
 
D
e
c
i
s
i
o
n
 
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e
v
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w
 
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e
q
u
e
s
t
:
 
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i
g
h
e
r
-
L
e
v
e
l
 
R
e
v
i
e
w
,
o
r
o
VA Form 10182, 
Decision Review Request: Board Appeal (Notice
of  Disagreement)
F
o
r
m
s
 
C
h
a
n
g
e
s
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
I
m
p
o
r
t
a
n
t
:
 
 
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e
 
o
f
 
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A
 
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e
 
o
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y
 
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9
,
 
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p
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u
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b
a
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d
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w
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c
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e
 
3
8
 
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R
 
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3
.
1
(
p
)
 
a
n
d
 
3
.
2
5
0
1
)
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)
N
e
w
 
a
n
d
 
R
e
l
e
v
a
n
t
 
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v
i
d
e
n
c
e
Claimants must identify or submit new and relevant evidence
in support of a supplemental claim review
o
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v
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n
c
e
 
m
e
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3
8
 
C
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§
3
.
1
5
6
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a
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C
l
a
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o
Only form accepted by VA for disability benefit claims
E
v
i
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e
n
c
e
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A
p
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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
A
O
7
3
 
B
a
s
i
c
s
:
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r
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c
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s
F
o
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s
 
F
o
r
m
s
Other than the most current version, the following forms are
acceptable:
o
V
A
 
F
o
r
m
 
2
1
P
-
5
3
4
E
Z
07/2015 version can be accepted through 06/2019
06/2018 version can be accepted through 10/2019
o
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A
 
F
o
r
m
 
2
1
P
-
5
3
4
06/2014 version can be accepted through 06/2019
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m
 
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2
7
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Z
 
a
n
d
 
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m
 
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2
7
04/2016 versions can be accepted through 10/2019
o
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A
 
F
o
r
m
 
2
1
P
-
8
4
1
6
01/2018 version can be accepted through 11/2019
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s
 
 
2
 
Q
u
e
s
t
i
o
n
s
2.
Have you or any of your dependents transferred any assets since
October 18, 2018?
D
e
f
i
n
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t
i
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s
 
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s
 
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t
 
t
h
a
t
:
1.
Was part of the claimant’s net worth,
2.
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f
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k
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d
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a
n
d
3.
If it was not transferred, would have caused or partially
caused the claimant’s net worth to exceed the net worth limit
E
x
a
m
p
l
e
:
 
 
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i
v
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c
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t
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t
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r
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s
p
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e
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t
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r
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s
u
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s
p
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u
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e
P
e
n
a
l
t
y
 
P
e
r
i
o
d
A
 
p
e
n
a
l
t
y
 
p
e
r
i
o
d
:
o
Is a period of non-entitlement due to the transfer of a covered
asset(s) during the look back period,
o
Cannot exceed 5 years,
o
B
e
g
i
n
s
 
t
h
e
 
f
i
r
s
t
 
d
a
y
 
o
f
 
t
h
e
 
m
o
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t
h
 
f
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d
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f
 
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e
 
l
a
s
t
t
r
a
n
s
f
e
r
,
 
a
n
d
o
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
P
e
n
a
l
t
y
 
R
a
t
e
T
h
e
 
m
o
n
t
h
l
y
 
p
e
n
a
l
t
y
 
r
a
t
e
 
i
s
:
o
The MAPR for a Veteran in need of Aid and Attendance with one
dependent on the effective date of payment,
o
Divided by 12,
o
R
o
u
n
d
e
d
 
d
o
w
n
 
t
o
 
t
h
e
 
n
e
a
r
e
s
t
 
w
h
o
l
e
 
d
o
l
l
a
r
,
 
a
n
d
o
Is the same for all pension claimants
E
x
a
m
p
l
e
:
 
 
T
h
e
 
m
o
n
t
h
l
y
 
p
e
n
a
l
t
y
 
r
a
t
e
 
f
o
r
 
a
l
l
 
c
l
a
i
m
a
n
t
s
 
w
i
t
h
 
a
n
e
f
f
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c
t
i
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e
 
d
a
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e
 
o
f
 
p
a
y
m
e
n
t
 
o
f
 
1
2
/
0
1
/
1
8
 
i
s
 
$
2
,
2
3
0
.
0
0
P
e
n
a
l
t
y
 
P
e
r
i
o
d
 
R
e
m
i
n
d
e
r
s
Penalty periods end the last day of the month of the penalty
o
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
I
f
 
a
 
p
e
n
a
l
t
y
 
p
e
r
i
o
d
 
c
o
v
e
r
s
 
a
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y
 
p
o
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t
i
o
n
 
o
f
 
a
 
l
i
b
 
l
a
w
 
p
e
r
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o
d
,
 
t
h
e
c
l
a
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m
a
n
t
 
i
s
 
n
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t
 
e
n
t
i
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e
d
 
t
o
 
b
e
n
e
f
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t
s
 
f
o
r
 
t
h
e
 
e
n
t
i
r
e
 
l
i
b
 
l
a
w
 
p
e
r
i
o
d
C
a
l
c
u
l
a
t
i
n
g
 
E
n
t
i
t
l
e
m
e
n
t
 
A
f
t
e
r
 
a
P
e
n
a
l
t
y
 
P
e
r
i
o
d
 
E
n
d
s
:
 
E
x
a
m
p
l
e
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
C
a
l
c
u
l
a
t
i
n
g
 
E
n
t
i
t
l
e
m
e
n
t
 
A
f
t
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r
 
a
P
e
n
a
l
t
y
 
P
e
r
i
o
d
 
E
n
d
s
:
 
N
o
t
e
s
Takeaways:
o
E
a
r
l
i
e
s
t
 
p
o
s
s
i
b
l
e
 
e
n
t
i
t
l
e
m
e
n
t
-
p
a
y
m
e
n
t
 
d
a
t
e
 
w
o
u
l
d
 
b
e
 
0
6
/
0
1
/
1
9
;
p
a
y
m
e
n
t
 
d
a
t
e
 
i
s
 
n
o
t
 
s
u
b
j
e
c
t
 
t
o
 
o
m
n
i
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The time limit is controlled by VA Form 4107 for claims
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Payments for in-home attendants must be commensurate with
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VA will accept reports of monthly, weekly, or annual in-home
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If a claimant is in a nursing home, VA Form 21-0779 is
required.  No additional worksheet is required
If the claimant submits a 21-0779 and is in assisted living, the
information on worksheet will still be required; however, the
information on the 21-0779 may also be taken into
consideration to satisfy the requirement of documentation of
fees
For facilities other than nursing homes, VA Form 27-0820b is
necessary if the facility did not verify expense information
along with the worksheet
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Stay up to date with the latest updates and contact information from the Milwaukee Pension Management Center. The agenda includes details on pension overview, new features, contact information, and expedited claims processing. Learn how to reach out via telephone or email for queries regarding claims and general questions. Get insights into the centralized mail postal address for communication. Keep informed about important updates and ways to stay connected with the center.


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

  2. Agenda Pension overview o Contact Information o 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 o Appeals modernization o Net worth rule

  3. Contact Information

  4. 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: o Medal of Honor, o Homeless, o Terminal Illness, o POW, GWOT, Seriously Injured (SI)/Very Seriously Injured (VSI), o Medical Foster Home, o Severe Financial Hardship, o Age, and o Purple Heart

  5. Telephone Contact Information, continued The telephone number is (414) 902-5062 o Answered by our Advocacy Team who also processes priority claims o Meant to alert the PMC when priority processing is required Disclaimer: VSOs without POA authority will be referred to the 1-877-294-6380 call center

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

  7. E-mail 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 o The e-mail is pmcpctc.vbamiw@va.gov Quarterly VSO Conference Call o 1-800-767-1750 o Access code 06606 o E-mail PMCVSO.VBAMIW@va.gov to be added to the distribution list.

  8. Centralized Mail Postal Address The PMC moved to Centralized Mail in February 2016 o PO Box 342000 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 53547-5192 The fax number is 1-844-655-1604 Deployed in April 2017

  9. What Constitutes a Complete VA Form 21-22? VA Form 21-22 must contain the following information: o Enough information to identify the Veteran/claimant (Box 1 or Box 2), o The name of the service organization (Box 3A), o Signature of the Veteran/claimant with a corresponding date of signature (Boxes 15 & 16), and o 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

  10. How to Apply for Benefits

  11. 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

  12. Survivor Benefits DIC surviving spouse, children, parents o VAF 21P-534, Application for DIC, Pension, and/or Accrued by a Surviving Spouse or Child o VAF 21P-534EZ, Application for DIC, Pension, and/or Accrued o VAF 21P-534a, Application for DIC by a Surviving Spouse or Child - In-Service Death Only o VAF 21P-535, Application for DIC by Parents o DEA: https://www.benefits.va.gov/GIBILL/DEA.asp o CHAMPVA: https://www.va.gov/COMMUNITYCARE/index.asp o Fry Scholarship: www.benefits.va.gov./gibill/index.asp o Home Loan Guaranty - www.homeloans.va.gov

  13. Survivor Benefits, continued Burial Benefits www.cem.va.gov o VAF 21-530, Application for Burial Benefits o VAF 40-0247, Presidential Memorial Certificate Request Form o VAF 40-1330, Claim for Standard Gov t Headstone or Marker o VAF 40-1330M, Claim for Gov t Medallion for Placement in a Private Cemetery o VAF 27-2008, Application for U.S. Flag for Burial Purposes Accrued Benefits paid based on relationship or reimbursement o VAF 21P-534EZ, Application for Dependency and Indemnity Compensation , Pension, and/or Accrued o VAF 21P-601, Application for Accrued

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

  15. Special Monthly Benefits Special Monthly Compensation (for DIC) o VAF 21P-534 o VAF 21P-534EZ o VAF 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance o VAF 21-0779, Request for Nursing Home Information in Connection with Claim for Aid and Attendance Special Monthly Pension o VAF 21P-527EZ o VAF 21P-534 o VAF 21P-534EZ o VAF 21-2680 o VAF 21-0779

  16. Expediting the Claims Process Certify photocopy of discharge document using VSO stamp o Do not send original documents Completely fill out forms o Example: On income sections of VA Form 21-527EZ, 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) o Notice of nursing home status may not be sufficient o Submit VA Form 21-2680 or VA Form 21-0779 at the same time as application

  17. Expediting the Claims Process, continued Send current version of form- o 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 (21-4142/4142a 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

  18. Whats New?

  19. 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

  20. Alternate Signer (Slide 1 of 3) Public Law (PL) 112-154, Section 502, amended 38 USC 5101 to authorize VA to accept an alternate signature on behalf of claimants or beneficiaries who: o Are under age 18, o 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 o Are physically unable to sign a form

  21. Alternate Signer (Slide 2 of 3) A fully completed VA Form 21-0972, 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

  22. Alternate Signer (Slide 3 of 3) When a VA Form 21-0972, 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 21-22 is not an eligible form to be completed by an alternate signer o VA Form 21-22 must be signed by the claimant

  23. 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

  24. Medical Expenses (Slide 2 of 4) A VA Form 21P-8416 along with an expense statement is now required for claiming facility or care fees o 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

  25. Medical Expenses (Slide 3 of 4) Expenses will be considered either: 1. Continuing medical expenses (CMEs) which are counted on a continuous basis, or 2. Unreimbursed medical expenses (UMEs) that are counted for the period in which they were claimed CME examples: o Medicare Part B, o Private medical insurance, o Assisted living or fees, o Oxygen, o Incontinence supplies UME examples: o Doctor co-pay, o OTC supplies, o One time medical supply expense like a cane or walker

  26. Medical Expenses (Slide 4 of 4) Examples of common forms in addition to VA Form 21P-8416 are: o VA Form 21-0779 for presumptive nursing home o VA Form 21-2680 for a rating decision granting special monthly pension o Document showing assistance with activities of daily living and care-related expenses for in-home care

  27. Medicaid Approved Nursing Home A claimant will receive the $90 Medicaid rate if the following applies: 1. Resident in Medicaid approved nursing home, see https://www.medicare.gov/nursinghomecompare/search.html, 2. Has been approved or applied for Medicaid status, and 3. 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

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

  29. Maximum Annual Pension Rate (MAPR) Chart

  30. 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

  31. Trusts and Net Worth Impact (Slide 2 of 4) 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

  32. Trusts and Net Worth Impact (Slide 3 of 4) A trust is countable as belonging to a claimant if: o It is actually owned by the claimant, o The claimant possesses such control over the property that the claimant may direct it to be used for the claimant s benefit, or o 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

  33. Trusts and Net Worth Impact (Slide 4 of 4) 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

  34. Burial Benefits (Slide 1 of 3) M21-1 VII.1.A.4.d. Proof of death is required for burial claims. o If proof of death does not accompany the claim, it may be obtained verbally o VBA will accept evidence if it reasonably indicates that a beneficiary is deceased o 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.

  35. Burial Benefits (Slide 2 of 3) 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 3.1709 (c) and (d) o The requirement for burial in a national cemetery is not a factor when paying transportation benefits for VA hospitalization deaths o An itemized receipt of statement is required for a claim for transportation reimbursement

  36. Burial Benefits (Slide 3 of 3) 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

  37. Appeals Modernization Act (AMA)

  38. References Reference Title Veterans Appeals Improvement and Modernization Act of 2017 Applicability of modernized review system Review of decisions Supplemental claims Higher-level review Notice of Disagreement PL115-55 38 CFR 3.2400 38 CFR 3.2500 38 CFR 3.2501 38 CFR 3.2601 38 CFR 20.202 Appeals Modernization VA.gov AMO Intranet Site, Program Administration Page https://benefits.va.gov/benefits/appeals.asp https://vbaw.vba.va.gov/APPEALS/programa dministration.asp

  39. Three Review Options VBA BVA Supplemental Claim 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) Higher-Level Review 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 Board Appeal 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 INTERAL USE ONLY FOR VA INTERNAL USE ONLY 6

  40. 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 21- 0998, claimant may submit a 21-0996 to open an 030 High Level Review (HLR) end product to have the current evidence of record to be reviewed only; or the 21-0995 for a 040 Supplemental Claim to send new and relevant evidence

  41. New AMA Forms VBA will include VA Form 20-0998, 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: o VA Form 20-0995, Decision Review Request: Supplemental Claim, o VA Form 20-0996, Decision Review Request: Higher-Level Review, or o VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement)

  42. 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 21-0958, Notice of Disagreement, were discontinued for all decisions issued on/after February 19, 2019

  43. 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 3.2501) 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)

  44. New and Relevant Evidence Claimants must identify or submit new and relevant evidence in support of a supplemental claim review o New evidence means evidence not previously part of the actual record before agency adjudicators at the time of the prior decision o 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 3.156.

  45. Filing Requirements Required Form: VA Form 20-0995, Decision Review Request: Supplemental Claim o 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

  46. 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

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

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

  49. Forms

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

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