Claim Denied -- what next?

Discussion in 'Share Your Personal Experience' started by MJC, May 3, 2016.

  1. MJC

    MJC Newbie

    My father served two tours in the Navy domestically during the Vietnam War. The first was 1958-1961. The second was 1962-1966. He and my mother both have dementia, and in the summer of 2014, after both were hospitalized for different ailments, they moved to assisted living. It costs about $1500 per month more than they get in Social Security, so my husband and I have been paying the difference. They live in Michigan, and I am caring for them from afar in NYC.

    We filed for the A&A benefit in February 2015. In June of 2015 we got a letter denying our claim. It stated that he was not eligible because his dates of service did not qualify. I had made a huge mistake, in that I filed using the separation papers I had available, which was for his first tour 1958-1961. It wasn’t until we got the denial letter that I learned that the dates for domestic service didn’t begin until 1964, and I should have filed the second papers too (that is a long story involving great difficulty in getting dad to participate in getting the DD-214 due to his declining mental skills).

    After some difficulty in getting his second tour separation papers, I filed a Statement in Support of Claim saying that we believed he was eligible and including the second separation papers. That was in October of 2015. It is now May and we haven’t gotten any news.

    Here are my questions:
    Would they even have considered the October statement, or was our case closed?
    Would they have automatically sent it through the appeals process, and that's why it's taking so long?
    Should I have filed an appeal instead? Everything I read said that the appeals process can take a year or more.
    Should I file an appeal now? We are approaching the 1 year anniversary of the denial so I am very worried.

    My parents have no savings or assets. My husband is out of work. We are quickly becoming desperate. Dad really needs to have his care level increased to include medication management and we just can’t afford it right now. I have looked at cheaper facilities in their area but they are either female only or cannot accommodate a couple. Their SS disqualifies them from low income assistance. Not to mention that we specifically chose the facility they live in because it has a Medicaid memory center, and being residents gives them priority entrance if they get to that stage.

    Thank you for any advice. I am at my wits end.
    Margaret
     
  2. Kaylin

    Kaylin Hero Member Staff Member

    MJC,

    They should consider your second set of separation papers with the Statement in Support of Claim. Since you did not specifically state that you were appealing, it should not have gone through the appeals process. The appeal process can take 2 years or more, it is not recommended at all.

    I would contact the state Senator where your parents are living. That is WAY too long for a Statement in Support of Claim with the updated paperwork to be waiting for a new decision. Let them know you are requesting a senatorial inquiry on the status of the updated information you provided to the VA to apply for the Aid and Attendance benefit for your parents.
     
  3. MJC

    MJC Newbie

    Thank you, Kaylin, for your prompt reply.

    How do I "let them know" about the senatorial inquiry... do I use another Statement in Support of Claim? And how long does it usually take after I initiate the senatorial inquiry to get an award? I have the paperwork for that all ready for Dad to sign next week. Is it useful to contact their Congressperson as well?
     
  4. Kaylin

    Kaylin Hero Member Staff Member

    MJC,

    You're welcome! You need to contact your parents' state Senator and ask them to make a formal inquiry into the status of their application. You can probably check the Michigan Senator website. The VA is required to respond to a Senatorial inquiry within 30 days, from my understanding.
     
  5. MJC

    MJC Newbie

    Thank you so much for your earlier help. I thought I'd post an update on our situation.

    After I contacted my parents' congressman, I heard back in about three weeks. They sent copies of three letters from the VA that I never saw. My father had received a letter last July asking for updated financials, which he did not respond to. He then received a second letter stating that he was medically entitled to benefits, but since he hadn't responded in 30 days to the request for financials, and since some third-party had tried to access his claim with an invalid POA, his claim was denied.

    Meanwhile, I had finally filed the proper DD-214, so he received a further letter in November stating that it was improperly signed (maybe illegible?) and they couldn't accept it, and our claim was still denied. They suggested we file an appeal and sent the form. We have until September 8, 2016 to keep the claim open, otherwise we will forfeit the back monies and have to file as a new claim.

    So. Here is my current plan. I already requested that our congressman ask for a copy of the Rating Decision, which I haven't seen. I plan to respond to the July and November letters with the documents they need. I'm going to have my father execute a fresh 21-22a in case that stupid POA nonsense screwed it up, I'm going to file another 21-4138 with my dad's updated medical records and reiterate that I need copies of every letter they send. And, just in case, I'm going to have my dad sign a 4107 in case we do actually need to appeal. He is not always cooperative so I need to get it when I can.

    I am already planning to petition for full guardianship of both my parents this summer. I expect I will need to become the fiduciary if and when we ever get any A&A.

    What do you think?
     
  6. Kaylin

    Kaylin Hero Member Staff Member

    MJC,

    Sounds like you're starting to get things worked out. I'm so glad the Senatorial inquiry worked.

    As for the 21-22a, you may want to be careful with that. This form used to be what applicant had to have to appoint a 3rd party. “Appointment of Veterans Service Organization As Claimant's Representative.” is what the form is called now. The only person who can call the VA to ask about application is representative given on form. Only time this form gets used is by an accredited agent, and even then it is rarely used. It is not recommended the applicant use this form. Instead you should use the 21-0845 Authorization to Disclose Personal Information to Third Party form.

    Yes, you will most likely be handling his finances if you are appointed fiduciary (if you choose to do so). Your plans sound good for updating the VA on everything they have requested. I would NOT recommend appealing, as that can take 2+ years and rarely results in the answer you want. Instead just continue to try to give the VA what information they need using 21-4138 Statement in Support of Claim and any supporting documents.
     
  7. vetadmin

    vetadmin Administrator Staff Member

    MJC,

    Do not send the 21-22a. You only want to send the 21-0845 as Kaylin said. Use form 21-4138 Statement in Support of claim to offer any other necessary information, but DO NOT appeal. The claim is still open pending the additional information.

    Good luck with getting it all sorted out and straight with the VA.
     
  8. MJC

    MJC Newbie

    First I want to say thank you for all the good advice I've received here. We were finally awarded the maximum benefit, and the first installment came in December. We were also awarded back benefits from February 2015, which is when I filed the first notice that we were going to file for A&A (which I learned to do here, so another thank you as that got us an additional four months of benefits). When the letter came I literally sat right down on the floor and cried. It has been such an ordeal.

    Getting our congressman involved was critical to the success of our application after my dad screwed it up, and the congressman's office did an excellent job of staying on top of things and getting information from the VA for me.

    The saga continues as I became legal guardian and conservator for both my parents this week. The VA website says to call my local VA office to become my dad's fiduciary, but I'm wondering if I can start the process by sending copies of the legal documents with a 21-4138 Statement in Support of Claim?
     
    Kaylin likes this.
  9. Kaylin

    Kaylin Hero Member Staff Member

    What an success story! Thank you for sharing! Usually the VA would send paperwork about the fiduciary process to get it started - have you received any paperwork by mail about the fiduciary process?
     

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