Wondering if my father's claim was denied..any info greatly appreciated.

Discussion in 'General Discussion' started by kls22695, Feb 19, 2014.

  1. kls22695

    kls22695 Newbie

    To anyone who can provide any information or had this experience: As of February 2013, my father requires 24 hour memory care after a stroke resulting in severe cognitive impairment. I worked with a Veteran Services rep who submitted a claim for Pension (A&A) to VA in June 2013. Included with the paperwork was a request for me to become my father's fiduciary. My father currently receives service connected compensation at 40%.

    In November, the PHL office (for pension) referred the claim to the Winston-Salem office (compensation). Told this was because my father currently receives compensation even though this latest claim is not service connected. In January, I was told by the VA that the claim is now in the "determining incompetency & fiduciary" review phase and that someone would be contacting us to schedule an interview, etc.
    My concern is that we have received no documentation on if my dad was awarded any additional benefit. It appears to me that if they are now at the phase of determining whether my father is incompetent, is it say to say that the claim will be approved? It does not make sense to me that they would begin this process if they had not already made this determination. I cannot get a specific answer on this from VA or the rep..my father's monthly expenses in memory care (~7000 a month) far exceed his monthly income so I cannot imagine how this could be denied as he seems to meet all the requirements.
    Also confusing, on the Benefits website under Status it says 11/18/2013 Claim Received. Under Claim Type it says Regulatory Procedureal Review in progress. Under Historical claims, it now shows two claims, one for Pension and one for Compensation. Under status, both say status is Closed..Compensation as of February 11 2014. And under Action it says: Appeal is possible. Does anyone have experience with this and shoud I just assume that they denied the claim after all? Any information is really appreciated.
  2. vetadmin

    vetadmin Administrator Staff Member

    A veteran cannot draw both "compensation" and "pension". It's one or the other, and given that he is already in the system receiving the 40%, it should have been an easy process to switch him over to "pension" for A&A.

    If anything on his medical implies a diminished mental capacity, the VA will rule "incompetent" and require a Fiduciary be appointed. You cannot apply for that until they make that ruling.

    You never "appeal" for A&A as it will mean an automatic 2++ years to get a hearing. You use VA form 21-4138 Statement in Support of Claim to submit additional evidence to support the claim.

    I highly suggest you call the VA and talk to someone. If the SO that you worked with did a 21-22a appointing them as Claimant's Rep, they won't talk to you. You will need to have a VA form 21-0845 Approved 3rd Party on file with them showing you as that person so they will speak with you.
  3. kls22695

    kls22695 Newbie

    Thank you for your quick response, appreciate your guidance.

    The SO filed both the 21-22a and the 21-0845 when he submitted the paperwork. I have been able to speak with the VA about the status of my father's claim all along, but get the usual "it is being processed" until January when the latest two reps I talked to said it is now going through incompetency, but they could not tell if the claim was "approved". They actually sort of "implied" that it was "approved"..they said they could not tell me anythign about whether or not approved, but did say if they are now starting the incompetency, that would make sense...read between the lines? Crazy to have to do that..

    But since then, I have been unable to get through to a "live" person at the VA for a couple weeks now. I get the same message after going through all the prompts..they are busy helping others and then disconnect. I think my confusion is that I was told they are determining incometency now and that I would get a call, but then the website says claims are closed and appeal is possible. And I have never received any letter with any information on if approved.
  4. vetadmin

    vetadmin Administrator Staff Member

    Whose name was put on the 21-0845 - Yours or the SO's?
  5. kls22695

    kls22695 Newbie

    My name is down on the 21-0845.

    I did finally get someone today. The rep said based on what she could see, it appeared that the initial claim submitted for A&A was incorrectly closed and transferred to the compensation office. She could not provide any info on why they transferred the claim to the compensation office..it doesn't matter that my dad currently gets compensation. They would rate it and depending on which one works out better for him..go with that if approved. She said someone would be calling me within a week's time, but if I didn't hear anything, call back. I am at a loss..I still don't have any more information than before.

  6. vetadmin

    vetadmin Administrator Staff Member

    There is no valid reason for it to have been kicked over to "compensation", but hopefully whoever gets it will figure it out, and get it straight. If you don't hear back from anyone, you need to keep calling, and keep in mind that the award should be retro from the time you applied.

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