Success in obtaining Entitlement to Survivors Pension and Aid and Attendance for Mom-Part 2

Discussion in 'Share Your Personal Experience' started by Sunshine, Jan 17, 2017.

  1. Sunshine

    Sunshine Newbie

    Continuing the rest of the story (this box only allows 10,000 characters)...

    On 10/14/16, we received a letter from the VA asking for more information. This is about the time that we found the site. Our VSO rep was telling us, "just give them the information that they ask for" but the post from gmasjo titled "Got it. Woo hoo!" on this site was very clear on what she had submitted, so we used her advice for a guide. Our 10/14/16 letter said we had 30 days to respond or they would deny the application. 30 days wasn't much time to gather all of the information but my brother and I did it. We submitted the following on 11/09/16 via certified mail to our VSO rep and he made sure it got to the examiners within the 30 day time limit to the VA Regional Office, WI Department of Veterans Administration, 5400 W. National Avenue, Milwaukee, WI 53214: (LESSON LEARNED: on every single page, I wrote my Dad's full name, VA File Number, and current date, so I could keep track of what we submitted and when and so they couldn't get the pages mixed up with any other application.)
    1. 21-4138 Statement in Support of Claim-explaining all answers to questions that were posed in the 10/14/16 letter
    2. Seller's Statement from the sale of her condo showing her net profit
    3. Copy of bank statement showing condo sale profit going into her bank savings account (I wrote hand written notes on these documents explaining what the key pieces of information on the statement were showing)
    4. Copy of bank statement showing part of condo sale profit going into her bank checking account
    5. Copy of bank statement showing part of condo sale profit going into her investment account
    6. Copy of current brokerage account showing additions and withdrawals, realized gains/losses and income summary. I sent the summary AND Account Activity Detail pages (not just the summary)
    7. Copy of current bank summary showing current value of Mom's checking and savings accounts
    8. 21-8049 Request for Details of Expenses for 10/30/14 to 10/30/15 - they said that on the 7/24/16 application, in the 21-534EZ, we had summarized Mom's expenses for 10/30/15 through 7/24/16, but now they wanted the summary of expenses going back to the original application date, even though they said that she didn't qualify. It took a bit of digging to find the itemization of these expenses, but we did it, and eventually it paid off, so my advice is, once you file your first application, make sure you keep track of these types of medical expense each month, even if his/her assets seem to make him/her not qualify. Eventually, you may be able to be compensated, but don't count on it.
    9. Mom's assets are held by a Revocable Trust, so this time, they asked us to also send a copy of the actual living trust document...all 12 pages of it!
    10. Attendant Affidavit for all services rendered by the Home Instead (in home aid assistance) company. They asked for a signed affidavit by each care giver. Since it was now 2 years later, and there's such a high turnover of these positions, I called the franchise owner. He agreed to summarize the number of hours of service for the year and the amount the franchise was paid by Mom for services rendered from 11/20/14 until she moved into assisted living on 4/16/15, and he signed the form himself. (This was acceptable documentation by the VA.)
    11. 21-0518-1 Improved Pension Eligibility Verification Report (Surviving Spouse with No Children)
    12. Rent Certificate from WI Dept of Revenue showing how much Mom is paying for Assisted Living along with letter from Director of Nursing explaining services provided by Assisted Living.
    13. There was a VA form that had to be filled out by the Assisted Living director. She sent it in and I didn't get a copy but our VSO director said that she sent in the right one. Sorry, I don't know the form number. (LESSON LEARNED: The form said something about Nursing Home. I just crossed out Nursing home and wrote in Assisted Living and this was acceptable to the VA. The VSO rep told me to do this.)
    14. 1099's from Mom's investments showing income from 2015 and 2014

    On 11/18/16, I emailed our VSO rep to make sure that the VA processing center had all 55 pages of our documents by 11/14/16 (within the required 30 days). He said, "confirmed that the VA POA received it. Will follow up to ensure that they don't need anything else and are working the claim." (LESSON LEARNED: This was a very helpful step. Always check with either the VA or the VSO to make sure that they actually receive what you mailed them or sent in via the VSO rep. It will save you sleepless nights when you get a denial letter like we got. I knew we were in the right because of this correspondence.)

    On 11/21/16, Mom got a letter saying "we denied your claim." They listed the forms that they used to decide and they had not looked at ANYTHING we submitted on 11/09/16. They ALSO stated "we gave you 30 days to submit the requested information. These 30 days have expired and we have not received the requested information. Therefore, we must deny your claim for benefits." (This caused my brother and I great frustration, but a quick call the next day to the VSO rep helped us to understand that, no, his office had HANDWALKED our materials to the VA processing center and it was recorded that they received them on 11/10/16, within the required 30 days. The VSO rep said, "oh, that's just a form letter that they send out. I checked and they still have your Mom's case marked as "in process. Just be patient.") !!!!!

    Because of what I had read on this site, I decided to also submit the 21P-8416 Medical Expense Report for 10/30/14 to 10/30/15 and from 10/30/15 to 10/30/16, just so they had every bit of information they could want. The VSO rep said, "I wouldn't send this in", but by this time, I was following the advice by gmasjo on this site, and thought, "it can't hurt." On the itemization of expenses, we summarized the expenses for 21 "Itemization of Medical Expenses" as follows:
    a. Medicare Part B (date range) monthly amt paid x 12 months = annual amount to fit in box B
    b. Medicare Part D (date range) monthly amt paid x 12 months = annual amount to fit in box B
    c. Private Medicare Supplemental Insurance (date range) monthly amount paid x 12 months
    d. Home Instead Health Aides (annual)-used until she went into assisted living)
    e. Assisted Living Cost (annual)
    f. Urinary incontinence pads/diapers (broke out by 2014 and 2015 charges)
    g. Prescriptions/OTC drugs (broke out by 2014 and 2015 charges)
    h. Lymphedema stockings, education by OTs to use them
    I. Wheelchair repairs (broke out by 2014 and 2015 charges)
    j. Diabetic nail care (broke out by 2014 and 2015 charges)
    k. Home emergency call system (used until she went into assisted living)

    All of this work paid off. As I mentioned at the beginning, on 12/29/16, we received a letter stating that Mom will receive a monthly benefit of $1,153.00 effective 12/01/16 for Survivors Pension. They also sent a letter saying that Mom was entitled to aid and attendance established effective 10/30/14, the date of receipt of the original claim. (LESSON LEARNED- even though her assets were too high from 10/30/14 to 10/30/15, once her assets declined and we could show that she required this aid and assistance, they back dated her pay-out to some point. We can't exactly figure out how they made the calculation, but at least she'll get something. The VSO rep thinks it will be about $10,000. We learned that it never hurts to ask, keep trying, send in whatever information they ask for, and follow the lists that are shown in this blog.)

    This pension will help our Mom stay comfortably in the assisted living that she feels safe in. It's not enough to cover her assisted living, even when added to her Social Security check, but her savings won't dwindle as fast as they once were.

    Last piece of advice, we asked the VSO, now that she gets this award, what do we need to keep track of?

    He responded:
    "The VA will request updated expenses annually although it may not be exactly on a calendar year. Please wait for that letter and let me know when you receive it. I would be happy to help you complete it if you like. Remember, you don't want to send in unsolicited information unless you are certain it will help your case or there has been a substantial change in income or expenses."

    "Keeping the invoices from assisted living, track of how many times you or your brother drive her to an off-site medical facility, copays/medical supplies that are purchased by you our out of pocket by your Mom should be sufficient. Is it necessary to manage what, of the pension, is being spent to the penny? No. Just make sure you have an idea of where the money is going and in general, how much is being spent."

    We hope this information is helpful to those of you who are just starting out, or even who are mid-stream like we were for 2 years. Be patient and respectful in your communications and it may turn out well for you.
    Kaylin likes this.
  2. Kaylin

    Kaylin Hero Member Staff Member

    I'm so glad you had a great success story with a VSO as well. I have heard of good and bad stories working with them but this gentleman you worked with seemed to really know his stuff. So happy for you and your family - especially your mother!
    Sunshine likes this.

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