Updates and Contact Information from Milwaukee Pension Management Center
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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Updates from the Milwaukee Pension Management Center Saquanna Carrillo, Coach June 11, 2019
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
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
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
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
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.
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
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
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 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
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
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) 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
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
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
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) 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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
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
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)
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
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)
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.
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
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
AO73 Basics: Net Worth, Asset Transfers, and Income Exclusions for Needs-Based Benefits
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
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
