Entitled to A&A but denied Claim after a 1 year wait: what now?

Discussion in 'Veteran Application' started by cabnva, May 28, 2010.

  1. cabnva

    cabnva Newbie

    I'm so glad I found this helpful forum. I need some guidance on where to go next. My 81-year old father received an April 2010 rating that he's eligilble for A&A and a monthly pension, but does not qualify financially. Since we first submitted the application in April 2009, his circumstances have changed, but I believe he was always financially eligible.
    Here's a timeline:
    April 2009: I applied for A&A benefits for my father through the Philadelphia Service Center. My father lives at home and requires 24-hour care.
    May 2009: I received acknowledgement of receipt of my claim, with a request to submit additional specific forms.
    July 2009: Submitted additional requested forms.
    October 2009: My mother (father's spouse) died.
    November 2009: My father was admitted to hospice care at home.
    December 2009: Submitted a Request to Expedite my claim to the Service Center based on my father being terminally ill, death of a spouse which lowered his SS income.
    January 2010: Submitted another request to Expedite his claim due to his deteriorating condition. I also faxed an authorization to disclose info to a third party (21-0845) so I could call for regular status updates.
    February 2010: Received a letter from VA Regional Office stating they needed additional evidence to consider caregiver expenses.
    February 2010: FedExed the necessary additional evidence (over 20 pages), exactly as requested and with help from Service Center calls.
    April 2010: Called my Congressman after continued delays in even responding to status update requests.
    April 2010: We were sent a Rating Decision that my father is both entitled to special monthly pension effective April 2009 and entitled to nonservice-connected pension. In a separate letter, we were denied our claim for special monthly pension due to his income as of May 2009 exceeding the maximum annual limit. They used Forms 21-4138 and 21-686c to make this decision, but didn't say which ones.They included VA Forms 21-0516-1, 21-0510, 21-8416, and 4107 (I was told over the phone to complete and submit these), and said I could file an appeal.

    It appears they completely overlooked all my submissions after April 2009, though I carefully followed up with each submission to ensure it was received and recorded. My mother's income was used in deciding the claim, though she died in October 2009, and none of the caregivers' $140,000 annual cost was included in the medical expenses under the VA decision, "How Did we Make Our Decision".
    In a follow-up call to the VA to see if my February 2010 paperwork was used in deciding my father's claim, the VA Service Center person told me to send a letter of Reconsideration instead of an Appeal.
    At this point, I'm not sure what to do. We desperately need this assistance to keep my father at home and so can't wait another year for a decision. Should I:
    1) Send a letter of Reconsideration
    2) Resubmit everything; possibly in a 3-ring notebook with tabs for each months expenses and income (which changed when my mother died),
    3) Appeal the decision
    4) Complete the attached forms and submit them with a letter of Reconsideration.

    Thanks for any advice.
  2. vetadmin

    vetadmin Administrator Staff Member

    It sounds as though they said the home care costs were fluctuating too much to give on-going pension, and she is in the “Unreimbursed Medical Expenses”. It is nearly impossible to know what they are talking about in those type of award letters.

    I am sending you a personal email regarding a suggestion.
  3. jpez

    jpez Full Member

    could it be that the 21-6480 (doc letter for A&A) was not clear on the link between the condition and the CARE required????

    I know early on that when the Doctors wrote (sgribbled) the form, the VA would justy stare at it for 9 months and then just deny the case. Now Most Vets I know hand print the form with clear explinations and then have the Doc sign it. These apps get thru in 3-6 months

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