Claim Denied, seems to be math error on VA's part?

Discussion in 'Surviving Spouse Application' started by af vet, Jul 25, 2016.

  1. af vet

    af vet Newbie

    I would greatly appreciate anybody helping me on this. I served in Vietnam 1968-69. My wife is in a nursing home. Without going into all of the numbers, my claim for Aid & Attendance for her was denied for income exceeding "the maximum annual disability pension set by law."

    They give our total income of $66,750. I disagree with their expenses, which doesn't seem to include my wife's medication which I included in the application, but they give a total of $50,310 for Medicare Part B premiums, Private Medical Insurance, and nursing home fees.

    I am the court-appointed guardian of my wife. The letter states that "the income limit for a veteran with 1 dependent is $16,851. Your income for VA purposes is $17,282."

    But $66,750 minus $50,310 equals $16,440. On the surface, this seems a simple mathematical error, as using their own numbers results in a net income below the threshold. Are there other numbers they are using besides the two they supplied in my denial letter?

    Thank you for any assistance.
  2. Kaylin

    Kaylin Hero Member Staff Member

    I hope I can help you. If not, I know someone who we can refer you to who is very good at helping with any sort of denials by the VA.

    Were they ongoing medication expenses? Not just one-time expenses? You may want to try sending in a Statement in Support of Claim form 21-4138 with any additional expenses you can show (for costs of care) and/or explain the medication expenses and that they are ongoing.

    To me, it seems like you would be eligible for the veteran benefit with one sick spouse. If the Statement in Support of Claim does not work or you do not think you can show other expenses that would help, I can refer you to a woman who can help. You never want to appeal a claim because it can result in a very long process that may never even give you the result you want.
  3. VA Legal Team

    VA Legal Team Full Member

    Medical expenses must exceed 5 percent of the maximum annual pension rate. This means that the VA will not count the first $643.00 of your medical expenses. That is potentially the issue, though I couldn't say for sure without reviewing the letter.

    Unfortunately, the VA does not count medications as a medical expense on original applications. They are not considered regular and predictable by the VA. That is silly but that's the way the VA works. You can include medication costs after the fact, but not on the original application.
    Kaylin likes this.
  4. Kaylin

    Kaylin Hero Member Staff Member

    Thank you for your input VA Legal Team!
  5. af vet

    af vet Newbie

    Thank you for your help everybody. I believe you are both correct. I was finally able to get through to the VA, they said there is an $842 medical expense deductible added to the final, so $66,750-$50,310+$842, I guess. The rep said medication needs a note from the doctor indicating it is a continuing medical expense and to send another 21-4138 as a "reconsideration" not an appeal. I think I will be below the threshold if the medication is included. Thank you. I hope this helps another veteran navigate the maze of an application.
    Kaylin likes this.
  6. Kaylin

    Kaylin Hero Member Staff Member

    That sounds like the best thing to do moving forward with your application, I agree. Best of luck! Please keep us updated.

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