Application Notes (Started 06/17/2008)

Discussion in 'Share Your Personal Experience' started by ST, Jun 19, 2008.

  1. ST

    ST Newbie

    RE: Surviving Spouse of WWII Veteran, Assisted Living with High Level of Care, Dementia, Less than $35,000 in (total) assets
    and Negative Cash Flow (Income minus Expenses = Negative ~$1,000.00)

    6/17/2008: I (son) delivered my Mother's Application(s) to the Denver Regional VA Office. (I was told I could have mailed them.)

    ***I AM NOT IMPLYING THAT I KNOW WHAT I AM DOING***, but I intend to report on my Mother's claim to this forum since I have received so much great help and advice here! The following is a list of what I delivered to the VA:

    Form 21-22a + Statement Required by 14.630 (Individual Representative)**(Text included below)
    Copy of General Durable Power of Attorney
    Form 21-534 Application for Benefits ... Surviving Spouse
    Form 21-8416 Medical Expense Report
    Medical Statement for Housebound or A & A-Completed & Signed by Examining Physician
    Form 21-0779 Request for Nursing Home Info [edited Form to “Facility” or “Assisted Living” by Director of Nursing]
    (2) Certified Statements of Nursing Home(s) [1 from previous Nursing Home and 1 from current Assisted Living]
    Death Certificate of Veteran
    Copy of Certificate of Marriage
    Copy of Veteran’s Birth Certificate
    Copy of Surviving Spouse Birth Certificate
    Certified Copies of Certification(s) of Military Service (in lieu of DD-214)
    Certified Copy of Separation Papers
    Copies of Annuity Payments-Air Force, Civil Service & Social Security
    Form 10-0137 VA Advance Directive: Living Will and Durable Power of Attorney for Health Care
    Statement (Signed by Surviving Spouse) requesting Son (Me) to be appointed as Fiduciary***(Text included below)
    Form 21-0792 Fiduciary Statement in support of Appointment

    I was told by the person accepting the above forms, etc. that “... the room and board portion of Assisted Living does NOT qualify as Medical Expense(s) ...”

    I hope this list helps someone. Again, I am NOT implying that I know what I am doing.



    Denver Regional Office (Colorado/Wyoming)
    Department of Veterans Affairs
    155 Van Gordon St.
    Lakewood, CO 80228

    RE: Statement Required by §14.630

    Dear Department of Veterans Affairs,

    This letter is to serve as the statement referred to in 38 CFR 14.630, partial reprint as follows:

    Ҥ14.630 Authorization for a particular claim.

    (a) Any person may be authorized to prepare, present, and prosecute one claim. A proper power of attorney, and a statement signed by the person and the claimant that no compensation will be charged or paid for the services, shall be filed with the office where the claim is presented. A signed writing, which may be in letter form, identifying the claimant and the type of benefit or relief sought, specifically authorizing a named individual to act as the claimant’s representative, and further authorizing direct access to records pertinent to the claim, will be accepted as a power of attorney.

    (b) Representation may be provided by an individual pursuant to this section one time only. An exception to this limitation may be granted by the General Counsel in unusual circumstances.

    [53 FR 52421, Dec. 28, 1988, as amended at 68 FR 8546, Feb. 24, 2003]”


    I, [MY NAME], will act as the One Time Individual Representative to prepare, present, and prosecute, as provided for by Section 14.630 as listed on VA FORM 21-22a [May 2007], for the following claim and claimant:

    • VA File Number:
    • Claimant: [MY MOTHER'S NAME], Surviving Spouse
    • Name of Veteran: [INSERT NAME OF VETERAN]-Deceased, SSN: ###-##-#### Army Serial Number: # ### ###
    • Claim: Pension (VA FORM 21-534) and the Aid and Attendance Benefit for financial relief as a result of facility charges, care and expenses in excess of income; associated with confinement in a nursing home.

    -- Continued on Page 2 --

    Further, I, [MY NAME], state that no compensation will be charged or received for the services and duties of this Individual Representation.

    Signature of Designated Individual Representative:
    [MY NAME], P.O.A


    I, [INSERT CLAIMANT'S NAME], Claimant, do specifically authorize [MY NAME], my son, to be and act as my Individual Representative, to prepare, present, and prosecute my Claim(s), as provided for by Section 14.630 as listed on VA FORM 21-22a [May 2007]. I authorize his direct access to records pertinent to the Claim(s) and accept [MY NAME] as my power of attorney. No compensation will be charged or paid for the services and duties of this Individual Representation. Please note that [MY NAME] is my legal Durable Power of Attorney (P.O.A.) and Attorney-in-Fact in all things financial, legal and medical and has acted in this capacity since [DATE I BECAME MY MOTHER'S P.O.A.].





    Denver Regional Office (Colorado/Wyoming)
    Veterans Affairs, Department of
    155 Van Gordon St.
    Lakewood, CO 80228-1709

    Request to Appoint a Fiduciary in Connection with VA Survivor Benefits, A & A

    Dear Department of Veterans Affairs,

    I would like to request that my son, [MY NAME], be appointed as my Fiduciary in connection with my application(s) for VA Pension and Aid and Attendance Benefits. I currently reside in an assisted living facility at a high level of care. I have not been able to manage my financial affairs since [DATE I BECAME HER POA]. [MY NAME] is my Medical and Financial Durable Power of Attorney and has handled all of my finances, including bill paying and tax returns, since [DATE I BECAME HER POA].

    Please initiate the process to make [MY NAME] my Fiduciary and Individual Representative with the Department of Veteran Affairs.

    Thank you very much.



    [MY NAME], P.O.A.
  2. nananorma

    nananorma Jr. Member

    Please, please keep us updated on your progress and success. We all seem to be in a holding pattern and I am so anxious to hear the outcomes of stories that are similar to mine. I received another letter from the VA today that they are working on my mother's claim and the director of her assisted living facility told me today that he had had a call verifing her expenses. His experience has been that other residents have started receiving benefits soon after he verifies this. I'm hoping!
  3. ST

    ST Newbie

    Update: 06/23/2008

    I received VA Form Letter 20-8992 saying "... received your application for benefits", "... great number of claims, action on yours may be delayed", "... in the process of deciding whether additional evidence or information is needed."

  4. ST

    ST Newbie

    Update: 07/08/2008

    ***Received a 4 page letter from the VA with attachments: Form 21-8416, Form 21-8767 & Form 4107***

    The letter states that A DECISION HAS BEEN MADE on "... your claim for dependency and indemnity compensation ...". The following are three of the paragraph titles and content:

    WHAT IS YOUR ENTITLEMENT AMOUNT AND PAYMENT START DATE? = $998.00 Per Month, Starting 7/1/2008 because of Original grant of death benefits.

    WHAT DID WE DECIDE? = We granted death pension benefits effective June 17, 2008. We have approved an additional allowance for aid and attendance effective June 17, 2008. We couldn't approve your claim for accrued benefits. We have denied your claim for service connected death benefits, ... DIC ... [Note: I wasn't trying to make a claim for accrued or death/DIC benefits.]

    HOW CAN YOU CLAIM FAMILY MEDICAL EXPENSES? = " ... complete the enclosed VA Form 21-8416 ... no later than December 31, 2010..." [Note: My Mother has no dependents so there are no "Family Medical Expenses".]

    The rest of the letter reiterates the income and expenses that I submitted, how they made their decision, and additional information about keeping them informed of changes, appeal methods, etc. The attachments were:
    Form 21-8416 Medical Expenses Report (I filed this form with the original application)
    Form 21-8767 which is in letter format with general information regarding Pension Awards
    Form 4107 which is in letter format regarding rights and methods of appeal


    Obviously, this all sounds like good news, i.e. my Mother has been granted the maximum benefit amount effective immediately. I will certainly post a message WHEN/IF my Mother actually receives some money. [Note: I have not received any reference or reply regarding my being appointed Fiduciary.]

  5. ST

    ST Newbie

    Update: 08/01/2008

    GREAT NEWS! My Mother received a check today from the United States Treasury in the amount of $998.00 (encoded: VA PENS FOR JUL). I believe this to be the maximum possible monthly amount for a surviving spouse for the VA Pension and Aid & Attendance benefit(s). MY SINCERE THANKS TO THIS FORUM AND ITS MEMBERS FOR THE ADVICE AND SUPPORT WE HAVE RECEIVED!!! I will continue to update this post if I receive any other communications from the VA.

    1. I will create another update when/if we receive another check next month.
    2. The VA has not responded to, or mentioned the application for me to become my Mom's Fiduciary.
    3. I have modified/added to my original post with the following: The text of the statement that I submitted with Form 21-22a -AND- the text of the statement that I submitted with Form 10-0137. These additions make my "submitted" list more complete. (Added to the bottom of the original post)
    4. I still don't claim that I know what I am doing. I can only assume that I did something right and that the sheer volume of my application covered the bases. GOOD LUCK TO ALL!
  6. nananorma

    nananorma Jr. Member

    I understand your mother has dementia - was this documented on the physician's statement? And you never received a letter from the VA stating that due to her dementia a fiduciary would have to be appointed because of her limited mental capacity (my letter also stated that because of this she could never purchase a firearm - an action I'm trying to picture my mother doing!!)? Every time I call, they state that the claim is waiting for a field agent to be assigned for a fiduciary. They can never give me a time frame that it will be happening. Do I understand that you first filed in mid-June? I've been waiting since mid-March - I'm not giving up.......we received confirmation that she was eligible within 10 days of filing and I submitted all required information at my original filing. They needed nothing else. The rep on the phone said "At least it shows your file is still open - that means somebody is working on it." RIGHT.
  7. ST

    ST Newbie

    Dear nananorma,

    On the physician's statement, the diagnosis reads as follows: Dementia, CVA, difficulty walking, pacemaker, a-fib, ... etc. So, yes, it does start off with dementia. This post lists ALL communications from the VA so, no, I have never received any communication relative to dementia or fiduciary or any visit by a field agent.

    Yes, I initiated this claim on 06/17/2008 by delivering all of the application (all listed in initial post) to the VA Office in Denver, CO.

    I don't know why our two similar claims have such different results and time frames. Since I am clearly no expert, the only advice I could offer would be to send anything on my list that you didn't do originally. Strategically, it might fill in a "blank" and extend the "open" status of your claim (even though they say they need nothing else). PLEASE let me know if I can help you in any way!

  8. nananorma

    nananorma Jr. Member

    Well, I got a call at 12:30 PM today, Saturday afternoon, from a field rep who set up a meeting with me and my mother at her assisted living facility on Monday. He gave me a long list of information I am to bring with me - my mother's latest bank statement, Dr. info, my sibling info, character witness information for me, insurance policies, proof of income, cost of care. Most of this information has already been sent to the VA, but I'll bring additional copies - didn't argue that point. I mentioned the fiduciary form I had already sent in with character witness information on it, and he said it hadn't been given to him. I'll take it all and anything else I can think of. Stay tuned!!
  9. vetadmin

    vetadmin Administrator Staff Member

    Well at least this seems like a positive update!! Not surprised that he said he does not have copies of all that information. It should be in the file he was assigned, but none the less, the important thing is you are nearing the finishing line!! Just be sure to only give him copies and keep your set. Keep us posted and we look forward to hearing how things go.
    Good Luck!
  10. nananorma

    nananorma Jr. Member

    Thanks for your encouragement. I hope we are nearing the finish line. Don't have any idea how long before we start receiving checks after this process. I've been expecting a letter, and was surprised to receive a phone call on a Saturday afternoon!!
  11. annetteP

    annetteP Newbie

    That IS great news! We are just getting started with the application. I have collected all the paperwork we will need (with the exception of the doctor's letter) and will turn it all in soon.

    Congratulation on a job well done!

  12. ST

    ST Newbie

    08/29/2008 :)
    My Mother received her 2nd Check for $998.00 for August, 2008. Along with the check came a form for "Direct Deposit Authorization". I filled this out to switch to direct deposits for future checks.

    This very much confirms that my Mother will receive the maximum benefit amount per month for VA Pension and Aid & Attendance Benefit(s). We are very pleased and thankful for the help we have received from this forum and for the quick and efficient way the VA has handled this claim... I will keep posting any communications (other than checks) that we receive from the VA.

    Good Luck to All!

  13. nananorma

    nananorma Jr. Member

    So thrilled with your success! It does happen. It's been a month since I met with the field rep to appoint me fiduciary and still haven't heard a word. I sent in the direct deposit info with a voided check with my original package, but would be thrilled to do it again - that would mean $$ is coming. Still don't understand how two people, both with dementia/Alzheimer's listed as primary diagnosis, can be treated so differently in determining benefits and the time line is so different. I was also told by field rep that her award was less than $600/month. (previously stated her assisted living expenses are $83/day with an income of less than $900/month - and we are in her doughnut hole with meds and have been paying in excess of $800/month for the past two month.) Not sure how they determined her award, but will challenge if/when I get the first check. I have never received any document listing what the award will be. My friend also applied in March (her mother is blind without dementia), as I did, and has receiving benefits since July - her award was $31 less than the maximum, then she got a check for the full award this month, plus a check for retro pay for the $31 back to March! And, she didn't contact them or anything, just was going to accept what she got and be happy. I'm going on vacation for a week and will pick up my mail and have SOME correspondence from the VA in that packet - right???
  14. vetadmin

    vetadmin Administrator Staff Member

    Hearing stories of success is always appreciated! Wonderful news for you to share for those either just starting the process of still in the middle of it. It helps to let others know they need to keep fighting and not get discouraged to the point of giving up.

    It is confounding how the same criteria, same application, same benefit can be processed and handled so differently depending on which processing center gets a claim. What makes perfect sense in one scenario does not apply to another.

    Hopefully a decision will arrive shortly regarding your meeting with the field rep, and yes after it is awarded, then you can appeal the monthly award.

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