Applying for Benefits Twelve Month Prior to Successful Claim

[AnnieN]

Hi.  My mother's claim (she's the vet) was recently approved and the claim decision letter says that she may be entitled to pension up to one year prior to the date of the claim.  Since her expenses, income, and dementia are all the same as they were twelve months ago I think this is worth pursuing.  They ask that we fill out a Form 21-0510 (EVR form) and a Form 21-0516, Medical Expenses Report. 

I'm looking for some advice and guidance on filling out the Form 21-0516 Medical Expenses Report and I've searched this forum but I can't find what I'm looking for.  Hence my specific post.  Can someone with experience with this "twelve month prior" process tell me how they did it or answer these questions?

1.  For medical expenses for Assisted Living for someone with dementia who needs help with activities of daily living, do I put down the total cost of the ALF ($2950/mo.) or the part that the ALF states that they charge for "care" ($350)?  It makes a big difference, obviously.

2.  The Dr's form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, was filled out for the initial claim was signed January 13, 2010.  Do I need to get and submit something on a VA form that says that her diagnosis was the same through 2009?  Would a letter do?  Or nothing at all?  Sometimes the less submitted the better.

3.  With the initial claim I submitted a letter from her current ALF that stated the amount she paid monthly and the assistance she received for that amount.  In 2009 she lived in a different ALF.  Should I get a letter from that one too or just submit the expenses with the name of the facility?

4.  The VA asks for expenses for the period of Feb. 2009 to Dec. 2009.  If the expenses were the same for each month do I need to list each expense for each month (date paid) on the Form 21-8416 or can I abbreviate it, like, 2/09 through 12/09. 

5.  How important is the, "Send us the facts or papers we need as soon as possible, preferably within 30 days" statement?  I'm gonna miss the 30 days. 

Thanks for sharing your experience.

[vetadmin]

#1 Total
#2 Note from doctor stating that she needed the Assistance of another person sometime prior to the 12 month look back
#3 I would get a Statement of Occupancy from them for the period she was there
#4 Abbreviate
#5 I would send a letter stating that she was eligible at that time and that the paperwork is being accumulated and will be submitted as quickly as possible.

[AnnieN]

You Rock, vetadmin! 

[vetadmin]

Thanks! 

[jpez]

To reiforce what admin said:
Item 2: 21-268 doc form........
The form needs to state clearly and legibily that the 'condition' DIAGNOSIS - exisited over a year ago AND required the Assistance that the VA reguires.

re: (sample)Patient diagnosed with severe XXXXXXXX on 01-01-01 that requires she move to a ALF to recieve the neccesary assistance on a daily basis

There has to be: 1. the diagnosis 2. the severity of level 3. that assistance is required at that level 4. the date that all of that came together.

Just because some has Alzheimer's for example, doesn't tell the VA how severe or if it needs the level of assistance.
some one 'could' move to assisted living early so the get aclimated....before they really need hands on care.

It is SSSSSOOOOOOOOOO IMPORTANT (even on new claims) that you establish the date in the diagnosis box. Othertwise, the VA tends to use the date signed as the BEGINNING date of the claim. (not the date mailed in)

To question 1: on the cost of care. ALF are licienced facilities. Just the 'rent' (as they like to call it) includes care that is not provided at an Independent living facility. nurse on staff, meal prep, etc

[AnnieN]

Hi.  My questions mostly have to do with "net worth" on the EVR form 21-0516-1 for an application for past benefits.  I'm posting them here because I don't want to confuse anyone with the current thread discussing net worth for initial pension eligibility.

After receiving VA pension effective March 1, 2010, the VA stated that my Mom the Vet may be entitled to pension up to one year prior to the date of the claim.  I think she is eligible for at least partial.  To apply, they stated:

 "Please complete and return the attached VA Form 21-0516-1, Improved Pension Eligibility Verification Report (Veteran with No Childred) and VA Form 21-8416, Medical Expense Report showing your income, net worth and un-reimbursed medical expenses for the following periods:
  - February 2, 2009, to December 31, 2009
  - January 1, 2010, to February 28, 2010
  - March 1, 2010, to December 31, 2010"

For the monthly income questions of the EVR I have no problem as they don't change.  For the annual income portion of the EVR I provided January 1 2009 through Dec. 31 2009 annual income and January 1 2010 through Dec. 31 2010 estimated income.

However, on Net Worth Question 7G I don't know at what point in time to give the worth or bank account, stocks and bonds, etc.  Would it be:
1.  Net worth on Feb. 2 2009 or net worth on December 31, 2009 and,
2.  Net worth on January 1, 2010 or net worth on Feb. 28, 2010 and,
3.  Net worth on March 1, 2010 or net worth on day the application is completed?

Or something else entirely?  Advice is appreciated.

[jpez]

The answer is the same.
Net worth at each of the  starting points.

BUT if you know you are over asset  at the starting point AND below asset in the middle someplace I would point that uot.

[AnnieN]

Jpez, it looks like the the VA form 21-0516-1 for question 7G (Net Worth) is not designed for two answers.  There is a single column titled "Veteran" and the computerized fill-able form only takes one number per type of account.  Furthermore, there is no room for dates.

I'm beginning to think they mean the starting date.     

[VSR]

Annie,

It would mean the starting dates.  Keep in mind though that the ONLY reason VA has forms is so that way they get all of the information the law requires.  If you have additional information or something else that is relevant, just write it on a separate sheet of paper and send it in.  They'll figure it out.

[AnnieN]

Hi Max.  Welcome back to the forum.  I'm glad you're back, you contribute a lot.  On this application, I sent it in yesterday before I saw your reply.  As it turned out I called the VA for clarification on this net worth question and they told me to use the Dec. 31, 2009 net worth on the first form and current net worth (I used June 10, 2010 which is the same as today) on the second form. 

I explained what I did and how I came up with the amounts.  These forms weren't easy and I'm good at forms.  We'll see how it turns out. 

[Catie]

I'm wondering whether this type of scenario is possible only for veterans. Or can it happen for veterans' spouses?

[emce48]

My Mother is now receving A&A benifits as Wife of My deceased Dad who was the veteran. Could anyone tell me please if she may be elligeible for the 12 months prior to her orginal determination or is this only a benefit the veteran is elligebile for ?

Thank you !

[vetadmin]

The claim decision letter would have informed you  that she may be entitled to pension up to one year prior to the date of the claim. If that was not in the award letter, then the likelyhood of that being the case is doubtful.

[rosco]

    Hello  I am not only new to this website but also new to using a computer.  Please excuse any mistakes you may find, I am learning as quickly as possible.  My question is, can I submit paperwork for the 12 months back pension?  I applied in March of 2010 for A&A and received my award letter stated I had been approved.  I didnt see anywhere on letter stating I was eligible for the 12 months back pension.  I am 92 and have very, very little in any savings. Is it still possible to obtain that 12 month back award if it doesent state so on award letter.  Thank You    I found this site by accident.  I sure wish I had found it previous to filing my original forms.  Nice job.                                                           

[vetadmin]

Rosco,

Welcome to the forums, and thank you sir for your service to our country.

Regarding the previous 12 months, if you qualified for this, there would have been a paragraph in your award letter letting you know that you were eligible.  There does not seem to be a clear understanding as to how the VA arrives at who qualifies to apply for the previous 12 months, so we can't offer you much more insight than this.

Thank you for your kind words, and we wish you had found us sooner as well.