Introduction to the United States Department of Veterans Affairs

Introduction to the

United States Department of

Veterans Affairs

Overview of the

U.S. Department of Veterans Affairs

(DVA or VA)

Department of Veterans Affairs The DVA provides medical care to veterans and their dependants through

the Veterans Health Administration (VHA) and processes and pays benefits to veterans through the Veterans Benefits Administration (VBA).

There are more than 23.4 million veterans in the nation. In 2009, VA reported that:

About 5.75 million people were treated in VA health care facilities.• 153 hospitals, 755 community based outpatient clinics, 230 Vet

Centers, 132 Community Living Centers, 48 residential rehab treatment programs and 128 comprehensive home care programs

3.9 million veterans and survivors received VA disability compensation or pensions.

More than 564,000 veterans used GI Bill education benefits and nearly 326,000 home loans were guaranteed by GI Bill home loan benefits.

Nearly 78,127 veterans took advantage of VA’s vocational rehabilitation and employment service.

Your State & the U.S. DVA http://www1.va.gov/opa/publications/factsheets.asp

Number of Veterans: _________

VA expenditures: $ ____________– Compensation & Pension: $ ________– Readjustment benefits: $ ___________– Medical & construction programs: $ _______– Insurance & indemnities: $ __________

Vets receiving disability compensation or pension payments: _______

Vets using GI Bill education benefits: ______

Two Major VA Disability Benefits Categories

Service Connected Disability Compensation

and

Non-Service Connected Pension

Eligibility for either benefit begins with a determination of...

Who is a Veteran?

• A Veteran:

– Served in the active military

– Released from service “under conditions other than dishonorable”

What is Service Connected Disability Compensation?

Money paid to veterans who are disabled by an injury or illness that was incurred or aggravated during active military service. These disabilities are considered to be service connected.

Amount of compensation is determined by the VA Regional Office based on the level of disability of the veteran referred to as a “Rating”.

Establishing a Claim for Service Connected Disability Compensation

Five Elements to Establish a S/C Disability Claim:

(1) Veteran Status

Discharged under conditions other than dishonorable

(2) Existence of a current disability

Medical diagnosis of a current disability by anyone qualified & trained to offer a diagnosis including nurse practitioner, doctor, psychiatrist, psychologist, chiropractor, social worker and professional counselor. [generally, statements from veterans will to satisfy this requirement]

Establishing a Claim for Service Connected Disability Compensation

(3) Connection between service and the current disability Medical evidence (or in certain circumstances lay evidence) of in-service incurrence or aggravation of a disease or injury that is not the result of the veterans own willful misconduct alcohol or drug abuse AND Medical evidence of a link or nexus between the in-service incurrence or aggravation (of a disability that existed before service but was aggravated in service) and the current disability.

Standard – “as likely as not” that the disability is caused by the in service even Examples: cancer diagnosed during service; injured leg during parachuting exercise; gun shot wound during combat; car accident while on leave

Establishing a Claim for Service Connected Disability Compensation

There are five different legal theories that can be used to show that a disability is linked to service:

1. Direct: injury or death during service

2. Secondary service connected: when a disability is the result of

another service connected disability [i.e. service connected anxiety

condition causes hypertension]

3. Presumptive: veterans with certain diseases are presumptively

service connected [i.e. Exposure to herbicides while serving in

Vietnam; conditions related to being a POW]

4. Aggravated: noted pre-existing condition or disease is aggravated

during service

5. Medical Malpractice – injury or death sustained at a VA Hospital/

Medical Center

Establishing a Claim for Service Connected Disability Compensation

(4) Degree of disability

Assessment by a VA rating officer based on average impairment of earning capacity

(5) Effective date

Date from which claim will be paid; file claim immediately to preserve the earliest possible effective date

Establishing a Claim for Service Connected Disability Compensation

No compensation if the injury has healed

No compensation for pre-existing or congenital disorders

Pain is not a disability

Special Rules for Combat Veterans Trying to Prove Service Connection

Because detailed recordkeeping is not possible in combat situations lay statements can be accepted as proof that a disability occurred (or was aggravated) in combat

The statements must be consistent with the circumstances, conditions or hardships of the veterans service

Combat veterans can use their own statements, buddy statements or statements of family members or others

Must still show that you suffer from a current condition and that the condition is linked to the incident in service

Possession of certain award and decorations or mention of such awards or decoration in a vets military personnel records usually indicates combat involvement

Presumptive Service Connection Claims

Vietnam War Veterans– Agent Orange Exposure– Served in Vietnam between January 9, 1962 and May 7, 1975– Develop a condition identified as a presumptive A/O disease:

• Diabetes mellitus• Hodgkin’s disease• Non-hodgkin’s lymphoma• Prostate cancer• Respiratory cancers• Multiple myeloma• Chloracne• B-Cell Leukemias• Parkinson’s Disease• Ischemic Heart Disease

Presumptive Service Connection Claims

Persian Gulf War Veterans– Gulf War Syndrome

• Unexplained fatigue• Skin problems• Headache• Muscle pain• Gastrointestional symptoms• Abnormal weight loss

New Regulation for PTSD Claims Effective July 13, 2010

PTSD is a condition resulting from exposure to direct or indirect threat of death, serious injury or physical threat.

The events that can cause PTSD are called “stressors” and may include natural disasters, accidents or deliberate man-made events/disasters, including war.

Symptoms of PTSD can include: – recurrent thoughts of a traumatic event– reduced involvement in work or outside interests– emotional numbing– hyper-alertness– Anxiety– irritability

The disorder can be more severe and longer lasting when the stress is human initiated action (Example: war, rape, terrorism)

New Regulation for PTSD Claims Effective July 13, 2010

A veteran will be able to establish the occurrence of an in-service stressor through his or her testimony provided that:

1. The veteran is diagnosed with PTSD and

2. VA (or VA contracted) psychiatrist or psychologist confirms that the claimed stressor is adequate to support a PTSD diagnosis and

3. the veterans symptoms are related to the claimed stressor and

4. the claimed stressor is related to “fear of hostile military or terrorist activity”, is consistent with the places, types and circumstances of the veteran’s service and the record provides no clear and convincing evidence to the contrary.

What is Non-Service Connected Pension?

Needs based payment

Pre-1980 basic eligibility for pension:– 90 days consecutive service, – 1 day during war time period, – Limited income & assets– Permanently and totally disabled (satisfied if over 65 yrs.)

Post 1980 basic eligibility for pension:– 24 months of active duty or the full period for which called or ordered

to active duty– 1 day during a period of war– Limited income & assets– Permanently and totally disabled (satisfied if over 65 yrs)

What is Non-Service Connected Pension?

Income over a certain amount will render a veteran or widow not eligible for pension benefits. However, it should be noted that income may be reduced by countable medical expenses.

– Current income limits:• Vet w/o spouse or child $ 11,830• Vet w/one dependent $ 15,493• Surviving spouse/children $ 7,933• Surviving spouse w/child $ 10,385

Overview of the

U.S. DVA

Administrative Process

When and How Does a Veteran File a Claim for Benefits?

A claim for benefits may be filed at anytime using VA Form 21-526 , Application for VA Compensation/Pension:

– At the local VA Regional Office (VARO)– With a Veterans Service Officer– At a VA Medical facility with a Veterans Service Organization– On-line at www.va.gov

Once the claim is filed the VA has a duty to assist the veteran in proving the claim by obtaining medical records, military personnel file, compensation & pension examination ***YOU are your best ADVOCATE!***

VA designed to be a non-adversarial veteran friendly system

Takes an average of 6-18 months to receive Initial Rating Decision from VA

Not Satisfied with the VA Decision?

VA decision may be appealed by filing a Notice of Disagreement (NOD) within 1 year of the date that VA mailed the original decision denying the claim.

After VA receives NOD it will create a Statement of the Case (SOC) which is a detailed explanation of the evidence and laws and regulations used in deciding the claim. It takes roughly 7 months to receive SOC.

The SOC is mailed to the claimant along with VA Form 9 Substantive Appeal Form to the Board of Veterans Appeals. Appeal to the Board of Veterans Appeals (BVA) must be made within 60 days of receipt of the SOC or within the remainder of the 1 year period from the date of mailing of the NOD to the VARO, whichever period ends later.

Two Types of VA Administrative Hearings1. Decision Review Officer (DRO) hearing

• Request in NOD or w/in 60 days of VA Notice of Right to Review• All evidence is reviewed anew• Non adversarial informal hearing• Veteran can submit additional new evidence at hearing• DRO denial proceeds to BVA

2. Board of Veterans Appeals hearing • BVA hearing can be conducted in DC where the Board is located; by

video conference with vet at local VARO & Board in DC (quickest way is video conferencing); at local VA office with Travel Board

• Non adversarial informal hearings• Roughly 2.5 years from the time the NOD is filed for case to be certified

to Board and another 2.5 years for the Board to decide the case • BVA decision is the last step in the administrative process• BVA can remand the claim back to VARO for further development, grant

the claim or deny the claim• If BVA denies the claim the vet may:

– Re-open claim at the VARO with new and material evidence– File motion with BVA asking for review based on clear &

unmistakable error– Appeal final Board decision to the U.S. Court of Appeals for

Veterans Claims within 120 days (strongly advised to seek legal representation)

Questions