VA CLAIM DENIED! What to do next...

FINANCES & LEGALITIES May 17, 2013, 1:57 pm 17 Comments

After the Denial Letter Arrives

By SUSAN SELIGER

If you’ve been rejected for the Department of Veterans Affairs Aid and Attendance (A&A) benefit, there are steps you can take to get your application reconsidered. But first, a warning: Do not do what the V.A. denial letter suggests you do, as that may only bring you years more of delays. And second, you’ll need to invoke the spirit of Winston Churchill in his 1941 speech to the Harrow School: “Never give in — never, never, never, never, in nothing great or small, large or petty, never give in.”

The V.A.’s Caregiving Benefit

Veterans’ families struggle to qualify for the Aid and Attendance pension benefit.

• A Little-Known Benefit
• The Long Wait

Patsy Jones, the widow of a Vietnam veteran, had to go back to the V.A. five times over the course of a year before she finally qualified for the benefit, which reimburses veterans and their families for the costs of caregivers working in the home or can be used to pay for assisted living or nursing home care. Mrs. Jones, 64, had so many ailments (a stroke, dialysis three times a week, dementia, diabetes and hypertension) that she needed constant care in an assisted living facility, which her family struggled to pay for.

“They had my gas turned off in my house,” said her daughter, Tamara Jones. “I couldn’t pay car insurance. A&A was our last hope. When we were denied, it felt like somebody had killed our last hope.” Now, one year later, the Jones’s family received their first A&A pension benefit check, for $800, in April.

This week, the V.A. acknowledged the criticism over long delays in handling disability claims and announced that claims processors in all 56 regional offices would have to work at least 20 hours of overtime per month until the end of 2013 in an effort to eliminate the backlog. Unfortunately, this may not much help those awaiting decisions on A&A, who are often in their 80s and 90s and running out of time.

So here are the steps you should take if you or a family member has been turned down.

If possible, don’t go it alone. Although the V.A. does not allow you to pay someone to help you fill out the application right from the start, the department does allow applicants to pay for a V.A.-accredited professional to handle an appeal.

Tamara Jones turned to Patty Servaes, an eligibility consultant, for help getting her mother’s benefits approved. “I don’t understand how anyone gets through the process alone,” she said. “Getting denied through the V.A. was emotional, and you’re already emotionally messed up taking care of a sick person like my mom. I would have thrown in the towel long ago without Patty.”

Be warned: A lot of the organizations that claim to help get you the A&A benefit turn out to be less than scrupulous. Some specialize in selling annuities or moving assets into a trust to hide them for heirs and to help applicants qualify who are not genuinely in need — practices that skirt the edge of legality.

And not everyone has the money to pay a consultant. You can get free help from your local V.A. office or veteran service officers in various nongovernmental organizations for veterans. But they are not always as well trained as you might hope.

“I had one V.S.O. from Polk County, Tex., come to my Web site asking some very basic questions about the financial qualifications because he said he had gotten only one or two days of training,” said Debbie Burak, founder of VeteranAid.org, a nonprofit that helps veterans wade through the A&A application and appeals.

It is easy to go off in the wrong direction if you follow the somewhat misleading language the V.A. uses in the standard letter denying a claim. The letter says you can file a formal appeal, but if you do that, you could be waiting nearly three years in limbo. The average time for disposition of a “substantive appeal” was 1,040 days in fiscal year 2012, according to the 2012 Report of the Chairman of the Board of Veterans’ Appeals.

What the V.A. does not mention anywhere in those denial letters is that there are other steps you can take to get a speedier resolution of your claim.

For example, you can file a “statement in support of claim.” This is a mostly blank form in which you can submit new information that you forgot to include, or resubmit information that you may not have presented clearly, so that the claim will be reconsidered.

“You can call, if you feel like being on hold for an hour, but you also need a paper trail,” advised Ms. Burak.

If that does not work, the next step is to file a “notice of disagreement,” which is simply a letter stating that you disagree with the V.A. decision, and explaining why. The V.A. will respond by assigning a decision review officer to review your claim. Oddly, only then will the V.A. tell you specifically why your application was denied so you know how to respond.

If all else fails, you can file the full-scale “substantive appeal,” which may require mounds of paperwork and in-person interviews. But then, of course, you’ll have to brace for a slog lasting years. It may go faster if you can afford to hire expert counsel.

Even that can be perilous, though. In the next post, we will tell you how to identify and avoid “pension poachers” and other perpetrators of fraud. And if you’ve got suggestions that might help readers, please share them in the comments section.