Need help Pls

[JAR]

My family member was acceptd for A&A 2007.
9/09 I received a ltr from Pension Managment Ctr stating a Special Review of 2008 Medical Expenses is being conducted & requested &  send 2008 Unreimbursed Medical Exp.
10/20/09 sent ltr to VA requesting more time.
10/26/09 recvd  Post offcie receipt had recved request more time of 10/20/09.
12/9/09 recd VA ltr stating they granted 30 days (they never sent me a ltr) & since VA never heard from me and they proposed to reduce monthy pymt.
12/14/09 I sent 80 plus pgs 2008 Unreimbursed Med Exp. I had DAaV rep send; DAV mailed to Debt Mgmt Ctr instead of Pension Mgmt Ctr. Luckily I had the docs date stamped by VA same day & I  FAXED to VA Pension Mgmt Ctr.
6/4/10 I recd another VA ltr stating that since that had not heard from me, they would be reducing the pymt. I axed another set of 80 pages
6/16/10 I called Pension Mgmt ctr and got confirmation VA had 2008 Unriembursed docs and had Virtual Doc ID #s to prove it since 12/14/09.
6/17/10 I faxed the 12/12/09 Virtuals doc ID #s of 2008 Unreimbursed Med Exp to VA Pension Mgmt Ctr
7/1/10 recd Bank notice monthly benefit reduced to half
7/6/10  I received a ltr from VA Debt Mgt Ctr dated 6/18/10 w/30 days to respond stating owed $6889.00 and would stop paying reduced monthly amt until all recouped. They aslo requested Finaical Status Form be filled in including Income Exp and reslae value of car and home.
The reduction in monthly pyments was for caregivers in the home as loved one has VA dx memory loss and needs safety, security and caregiving. VA has now placed this Vet in Jepordy for institutionalization...and he can't afford his dental care now...
What to do to get VA to realize THEY HAVE THE 2008 MED RECc and have had them since 12/09?

[vetadmin]

I am sending you a private email about this issue.  You need help!

[VSR]

This is always a tricky situation...

The problem is that when she submitted her EVR in 2009, she also submitted a medical expense report for 2008.  The expenses listed there are the ones that  you need to get proven.  My suggestion is to put in an inquiry at iris.va.gov after getting an 0845 on file to request a call back for a veterans service rep to have them walk you through the expenses that were not being counted.  I'm sure it is a simple misconnect between VA and your mom. 

The situation you are experiencing is called "provider proof."  A provider proof claim is an issue that is randomly generated by VA to essentially audit VA beneficiaries to maintain program integrity.  In almost all cases, VA will just take the claimant's word when they report medical expenses (unless they report using $1000.00 worth of Q-tips in one year (I've actually seen that reported...)).  This procedure is used to just make sure that she actually paid for her expenses and that a family member or insurance wasn't paying for them for her.

If you have other questions, feel free to let me know.

[JAR]

Deb..thank you from the bottem of my heart. I have an appt 7/15, faxed VA ltr time sequence and Facts tatemetn w/backup and Fed Ex 2008 Unreimbursed Med Exp overnight...I am so, so grateful.

MAX your insights are AWAYS appreciated & fascinating.

MAX, I want to reassure you, I have everything 2008 Unreimbursed Med Exp itemized, by date , by actual check copy, actual receipt/bill copy side by side, very easily readable spreadsheets of the 2008 UNREIMBURSED EXP by line item. . and I even printed Google maps of mileage. And no we did not use $1000.00 of anything ;-) but the total does meet the type of MEd exp lookin for and required amt. of Homehealth, Public health, drugs, health ins etc.  to maintain the $86. amonth Aid and Attendence Pension by amout 3.00 dollars over. (Helps that I have a healthcare and business background.)

The real isue is the Dec 09 letter, they said they never heard from me (I have US post rtn receipts confirming, VA date stamps confirming, fax confirmations and VA virtual ID numbers.) My documentation is airtight..they just won't look at the file..it is all there...and of course DAV sent the Dec 09 response to the Debt Mgmt Ctr instread of the Pension Mgmt Ctr...

[vetadmin]

You're welcome and will look forward to hearing how things turn out for you!