Aid and Attendance Claim Question

Discussion in 'General Discussion' started by Oldvet66, Apr 21, 2012.

  1. Oldvet66

    Oldvet66 Newbie

    My father filed a claim about 15 months ago and finally received a letter in 2/12 stating that "Entitlement to Special Monthly Pension for Aid and Attendance has been established"

    Then he gets a letter this week stating that the benefit has been denied. Does anyone know how that can happen? He is over 80 years old with many health issues and on a fixed income. He does need help with his daily routines including dosing of medication, dressing and undressing, feeding, etc. He is 100% blind in one eye and about 30% blind in the other eye.

    Just can't understand how they can say "entitlement has been established" and then deny the claim.

    Any help would be greatly appreciated from anybody with experience in this area.
  2. newpenny

    newpenny Jr. Member

    I can not answer the question. The only thing I know is that when I found out I was awarded the pension was when I got an Award Letter stating everything out. I thought you had to get an Award letter to state establishment.
  3. Oldvet66

    Oldvet66 Newbie

    Thank you.

    Just seems strange since the first letter came about a month after his evaluation by the VA doctor.

    Anybody out there who may have gone through similiar circumstances and what are his options, if any?
  4. newpenny

    newpenny Jr. Member

    what did the letter say?
  5. Oldvet66

    Oldvet66 Newbie

    He had also put in an injury claim from his time in service, it was back in the Korean War days and the military had lost the records in a fire. He was told to file that claim anyway along with the application for Aid and Attendance.

    The letter that he received after the doctor evaluation stated that those items were "deferred" but on the second page it said "Entitlement to the special pension for Aid and Attendance has been established, however final rating decisions are made by" regional office or something to that effect.

    After several phone calls to Tiger Team and the state office of the VA, he was told "you have nothing to be concerned about, your claim is almost finished, etc.. now this latest letter says denied Aid and Attendance because disability is not at least 60%. But he needs my mother's help in almost everything he needs to do daily.

    He is so heartbroken, I am worried about his health even more now. Seems like they drag out the process only to deny you and then hope you go away.

    Thank you, newpenny
  6. newpenny

    newpenny Jr. Member

    it sounds like the injury claim was refused because it was not 60%. Aid and attendance is for people that that need the aid of someone. Form 21-2680 must state what kind of aid he needs, if he needs the aid and attendance of some of these and the doctor signs this and his income meets the requirements then he get the aid and attendance. It sounds like you had 2 claims in there. I am new here so I really don't know. Someone more qualified here will answer you.
  7. vetadmin

    vetadmin Administrator Staff Member

    Time out here. Think part of the problem is two applications were put in. One for "compensation" and one for A&A Pension.

    Unless the veteran is rated 100% service connected, you cannot draw both compensation and pension. It sounds like the claim got processed the wrong way.

    You are applying for Pension. My suggestion is that you get it straight as to what he was applying for. You do not appeal this ruling. Use VA form 21-4138 Statement In Support of Claim, and do a cover letter stating the application was for A&A and that he surrenders his compensation IF the A&A is the higher amount.

    The VA has to give a reason for a denial. It would be either excessive assets, the physical need for assistance has not been established. etc. Sounds like they denied the addition of A&A due to the 60% rating, and as I said, less than 100%, you have to choose which will pay more and decide which one to take.
  8. newpenny

    newpenny Jr. Member

    Thanks Debbie I knew you would solve the problem.
  9. vetadmin

    vetadmin Administrator Staff Member

    Hope that sheds some light on what I think the problem is.
  10. Oldvet66

    Oldvet66 Newbie

    I will forward the info to my he tells me that he did sign a form and return it which stated that he was withdrawing the claim for the injury. Is it possible that he will get a separate decision letter for the aid and attendance pension?

    Whatever happens, you folks are awesome!

    Thank you very much.
  11. vetadmin

    vetadmin Administrator Staff Member

    He should, but since the matter is somewhat complicated with the way it was submitted, I would wait no more than 30 days to call the VA and ask for an updated status.

    If unable to get an acceptable answer, I would submit the 21-4138 spelling it out in writing, and of course mailing Return Receipt.

    Glad we have been able to help!
  12. Oldvet66

    Oldvet66 Newbie

    It looks like you were right. He called and they said he will be getting something for A & A. It seems that something was messed up as you thought.

    How is the amount of the benefit calculated? My mother is the caretaker and they are both on Social Security.

    Thanks again
  13. vetadmin

    vetadmin Administrator Staff Member

    You may have another problem here as a spouse is generally not going to be allowed to be compensated as a caregiver. The VA feels that it is reasonable for spouses to take care of one another, and you would not pay your spouse to take care of you.

    If he does not have outside services coming in and paying for care, he won't have expenses to claim.

    I don't recall your previous posts referencing that his care was being provided by your Mom.

    I will be interested in how the VA rules on this.
  14. Oldvet66

    Oldvet66 Newbie

    I bumped this old post up for reference purposes.

    They sent the award letter showing how they computed the monthly amounts.

    He got the letter today and it breaks everything down but it looks like they did not account for any medical expenses beyond their Medicare Part B premiums. They did include a medical expense report form with instructions. Is this how they determine what they will allow for medical expenses? Are only medical expenses for actual caregiving deductible for this purpose?
    This is where we are confused since they also included forms to update medical expenses. My mother had cancer surgery last year, so there are alot of medical bills, etc.

    They also included a form(21-0516-1) for filing for up to one year prior to date of claim along with a form(21-268) for his doctor to fill out. Is this worth filing for or is it going to take another 18 months like the original claim?

    Thank you for all of your help!
  15. vetadmin

    vetadmin Administrator Staff Member

    OK, think I have it now.

    Your Mom has acted as his caregiver, and no outside services coming in. so there was not much in the way of expenses to claim.

    I am assuming that you filed just for your Dad as the veteran. That being the case, your Mom's medical would not factor in.

    Is this correct?
  16. Oldvet66

    Oldvet66 Newbie

    Pretty sure it was veteran with a spouse
  17. vetadmin

    vetadmin Administrator Staff Member

    I think the issue here is there is not enough in the way to show for expenses.

    I know there is confusion when the VA says your "entitlement" has been established. That just means that his service, discharge etc qualifies him from an eligibility standpoint "if" he meets the other requirements of requiring care, which he does, and financailly, meaning that without this pension, he could not afford care and services. That is established by being able to show the expenses related to his care.

    The other option could be if Mom's medical expenses completely depletes their combined monthly income, he could file as a veteran with an ill spouse. That award would be $1338, but it also has to be ongoing expenses that depletes them.

    If Mom has pretty much recovered and has resummed acting as your Dad's caregiver, and services are not coming in to take care of both of them, you won't be able to demonstrate the need financially.

    I hope this makes a little more sense.
  18. Oldvet66

    Oldvet66 Newbie

    That helps. We will submit the form to go back 1 year prior to the claim date. I guess the expenses have to be directly related to caregiving as far as dad goes. Mom's expenses are not ongoing.

    Thanks again for your help, Debbie
  19. vetadmin

    vetadmin Administrator Staff Member

    You're welcome, and yes, the expenses are primarily related to the costs of care and services.
  20. Oldvet66

    Oldvet66 Newbie

    Amazing that they include her income as income to the household and take off her Medicare Part B premiums as an expense but her other medical is not counted.

    Dad has some small transportation expenses from last year up to May of this year(when it became free) related to his care that I guess we could submit but all of his other medical is taken care of already by VA.

    God bless and thank you.

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