Veterans Benefits Blog

On May 5, 2011, a bill was introduced in the U.S. Senate to provide a cost-of-living adjustment in the benefits paid to those receiving disability compensation, compensation for dependents, clothing allowances, dependency and indemnity compensation benefits, and dependency and indemnity compensation benefits for children.

U.S. Senator Patty Murray of Washington, the chairperson of the Senate Committee on Veterans’ Affairs, and every member of the Committee co-sponsored the legislation.

If enacted, this legislation would not establish a set amount paid. Rather, the amount paid would be increased based on increases in the Consumer Price Index, which is the leading indicator of cost of living in America. That is, if the cost of living in America increases by 3% then VA compensation benefits will be increased by 3% automatically. The payment rates would be calculated yearly, rounded down to the nearest whole dollar. Any increases in compensation would be based on the rates in effect on November 30, 2011.

The bill would remove from the political process adjustments in compensation paid to veterans and their dependents and guarantee an adjustment in compensation that keeps pace with the cost of living.

The text of the legislation may be found at http://thomas.loc.gov/cgi-bin/query/z?c112:S.894: .

Todd M Wesche Veterans Benefits Claims, Veterans Benefits Legislation Veterans Benefits Claims, Veterans Benefits Legislation, Veterans legislation

A key part of VA benefits for many veterans is access to free VA medical care for any condition that is service connected or, for certain veterans, additional health care for additional disabilities for themselves and health care for spouses and dependents.

On January 6, 2011, VA released its 2010 Veterans Health Administration Facility Quality and Safety Report. In the lengthy report, VA discusses the quality of the facilities, staffing, and care provided at each VA medical center and across the entire VA health system. It includes many metrics that can be used to compare the care provided from one medical center to another, including treatment for specific conditions, such as diabetes mellitus, and overall satisfaction with both inpatient and outpatient care.

The report card can be found at http://www1.va.gov/health/HospitalReportCard.asp

Todd M Wesche Veterans Benefits Claims, veterans health care Add new tag

A question we often hear from our clients regards what happens to a claim that has not yet been decided or is still pending at his or her death. Fortunately, Congress recently changed the rules regarding how the Department of Veterans Affairs (VA) handles such claims. The rules are less clear for claims that are on appeal to the U.S. Court of Appeals for Veterans Claims.

Congress now allows for survivors of the person filing a claim (known as a “claimant”) to pick up the claim where the claimant left it upon his or her death if the claim is pending before VA at either the VA regional office (or Agency of Original Jurisdiction) or the Board of Veterans’ Appeals. This process is known as “substitution.” In effect, the survivor is permitted to continue pursuing the original claim at exactly the same point where it was upon the claimant’s death, and this allows VA to pay to the survivor any benefits that otherwise would have been paid to the original claimant. The law permitting substitution is at 38 U.S.C. § 5121A.

In order for VA to allow substitution, there are some basic requirements that must be met. First, a survivor must ask VA to be substituted for the deceased claimant within one year of death. If this deadline is missed, substitution will not be permitted. Second, the survivor must meet certain criteria to be deemed eligible. Generally, the survivor must be the deceased claimant’s legal spouse, a child, or a dependent parent. The full list of eligible persons is available at 38 U.S.C. § 5121(a).

The Court of Appeals for Veterans Claims has now decided that a survivor may be substituted in a case that is pending at the Court at the time of the claimant’s death.

Todd M Wesche FAQs, Veterans Benefits Claims, Veterans Benefits Legislation Veterans Disability claims

One of the most common complaints we hear is that it appears that VA took away part of a veteran’s service connected disability compensation benefits when it granted an award. That is, VA awarded an increased disability rating, but the overall compensation did not change, or the disability ratings assigned do not “add up” correctly. So it appears VA granted more benefits with one hand, but took away all or part of them with the other.

This normally occurs when VA awards a veteran a compensable (greater than 0%) disability rating for two or more disabilities. For example, a veteran may be awarded compensation at the 60% rate for one disability and the 50% rate for another disability. Simple math dictates that the veteran is entitled to a 110% disability rating. However, VA did not award a 110% rating; rather, it awarded an 80% disability rating, which appears to be a 30% reduction.

Congress permits VA to award disability ratings from 10% to 100%, in 10% increments, for a “schedular” disability rating. No award can be greater than 100% on a schedular basis. To know if a disability has been rated as “schedular,” – that is, based on VA’s Schedule of Rating Disabilities – there usually is a four or eight digit code numeric and a percentage assigned to the disability within the rating decision. (VA may assign extraschedular ratings or special monthly compensation, which are benefits generally beyond those permitted by the Schedule, but these benefits are outside the scope of this post.)

Because Congress does not allow disability ratings greater than 100%, VA cannot assign a higher disability rating. In other words, this is the upper limit of what VA can award on a schedular basis. When a veteran carries a 100% rating, he or she is considered totally disabled; the law uses the phrase “a total rating” to describe a 100% disability rating. Regardless of the number of disabilities or how great the aggregate disability ratings, no veteran may be assigned a disability rating greater than 100% or be more disabled than “total” for VA rating purposes.

The “110% disabled” veteran may then ask why VA did not simply award him 100% disability, since the ratings show him to be more than 100% disabled? VA uses a somewhat complicated formula to determine how each of these disabilities affects the veteran, and that formula is what is responsible for “VA math” – that is, the apparent reduction in the overall disability rating.

Disabled veterans, of course, may have multiple disabilities. Independently rated, the sum of each disability rating is often larger than what VA actually awards. This is so because VA uses the Combined Ratings Table at 38 C.F.R. § 4.25 to calculate how various disability ratings are combined into an award. According to § 4.25, VA considers the effects of the most disabling condition to the least disabling condition on the veteran.

This is how it works, for example: If a veteran carries a 60% disability rating, he or she is 40% efficient (non-disabled). Stated another way, this veteran retains 40% of the ability to work. If that same veteran also carries an additional separate 30% disability rating, of the 40% of his or her original efficiency that previously remained, he or she lost 30% of that 40% (that is, he or she retains only 70% of that 40%). This leaves the veteran only 28% efficient, or 72% disabled.

It may be easier to think of it this way: Presume you have a 10 ounce glass of water, and you pour out 60% of that water. What is left is 4 ounces, or 40% of the water. Of that water that remains, you pour out another 30%. That is, only 70% of the 4 ounces remains. There is now only 2.8 ounces, or 28%, of the water that was in the full 10 ounce glass; 7.2 ounces, or 72%, of the water is now gone.

Analogous to the glass of water is a veteran’s disabilities. In this scenario, ordinary math would result in a 90% disability rating, but when the ratings are combined using the formula in § 4.25, the veteran is considered 72% disabled.

Because Congress only authorized disability ratings in 10% increments, VA rounds the final calculation to the nearest 10%, rounding the end number of 1-4 down and of 5-9 up. Therefore, VA will award our veteran a 70% disability rating.

The same considerations apply for the “110% disabled” veteran as those who have ratings of less than 100%. Using VA’s combined ratings formula, the 60% and 50% disability ratings combine to create an 80% disability rating. If the veteran is service connected for another disability, then that disability will be factored into the overall award. In the alternative, had the veteran already obtained a 100% rating, VA would ignore the additional award out of necessity.

Because of “VA math,” not every award will result in additional compensation. Say VA awards this same veteran, who has an 80% disability rating, an additional 20% disability rating for another disability. The overall compensation award would remain the same! VA takes the 80% rating and factors the 20% additional disability onto that, resulting in an 82% rating, which rounds down to 80%. Therefore, it appears that VA ignored the new 20% award! It did not; that is just the way VA math works.

The Combined Ratings Table can be found here: http://edocket.access.gpo.gov/cfr_2005/julqtr/pdf/38cfr4.25.pdf

Todd M Wesche FAQs, Veterans Benefits Claims

We frequently hear complaints from our clients that VA is taking a long time to render a decision on a claim for VA benefits. Given the enormous backlog and understaffing from which VA suffers, this is to be expected.

In fact, delay is inherent in the VA system. After a claim is filed, VA must provide notice to each claimant regarding the information and evidence necessary to substantiate the claim. VA must allow claimants one full year for the submission of that information and evidence before it can decide the claim, although it may decide it faster if the claimant indicates that there is no additional information or evidence to submit. Further, VA must obtain certain records possessed by the federal government and other records that are relevant to the claim if adequately identified by the claimant. Also, if necessary to make a decision on the claim, VA must also provide the claimant with a VA examination or obtain a VA medical opinion. VA must then review all of the evidence and determine whether there is enough to decide the claim and, if not, it must continue working to develop that evidence.

Of course, each step in the process takes time. Ideally, VA should also provide claimants with notification of what is happening on the claim, but it does not always do so.

At some point, it becomes clear that VA is not taking any action on a claim. This may become apparent through the passage of an extraordinary amount of time since the last VA action on a claim, or VA may expressly say that it will not take a particular action, despite repeated requests for it to do so.

As a first step for prompting VA to act, sending a letter to VA asking for a status on the claim or asking it to take the next step may work. At a minimum, the letter requires VA to pull the claimants file from the shelf and look at it. This may be sufficient for VA to realize the next step that needs to be taken and to do so.

A single letter however may not prompt VA to act. When this happens, we have a tool we can use to prompt VA to act. This tool is called a “Petition for Extraordinary Relief in the Nature of a Writ of Mandamus.” Or, simply, a writ petition. Writ petitions are separate actions that are filed in the U.S. Court of Appeals for Veterans Claims that assert that the Secretary of Veterans Affairs, through his personnel, is refusing to take an action that legally must be taken. Such refusal can be shown through the passage of time or through other proof that VA is not acting on a claim in the way it is legally required to do. Notably, writ petitions cannot be used as a substitute for an appeal of an unfavorable VA decision, and they cannot be used to force VA to grant a claim that was otherwise denied.

Before filing a writ petition, a letter should be sent to VA threatening to file a writ petition. The letter should be sent by certified mail, return receipt requested, to prove VA received the letter. The letter should state that, unless VA responds within a certain amount of time (for example, 10 days), a writ petition will be filed in the Court.

If VA fails to respond to that letter, then a writ petition may be necessary. Before involving the Court, it must be determined whether there is a legal basis for filing the petition. Such a circumstance would be where VA has expressly stated it will not take a particular legally required action. If delay is the basis of the petition, then that delay must be so extraordinary as to amount to an arbitrary refusal to act. A few months will not generally suffice, but a delay of more than a year may, depending on the circumstances.

A writ petition must provide a facially valid basis for the Court to grant the petition. If so, the Court will require VA to respond to the writ within a short period of time – generally one month.

Ordinarily, VA will then take some action on the claim. That action may be as little as sending a letter to the claimant or it could be as much as a grant of benefits, or whatever the next legally-required action on the claim may be. If so, this will make the writ petition unnecessary (that is, moot), because VA has taken the action it had refused previously to take. Although not technically a win on the petition, VA’s response to the petition by acting on the claim amounts to a successful resolution.

Sometimes, however, VA will defend its actions and continue to refuse to act. In those circumstances, the judges on the Court will decide whether VA’s defense is valid. If not, the judges will order VA to take the action requested. VA is then under a court order to do so.

Although many writ petitions are filed, the Court grants very few. In fact, since the Court’s creation in November 1988, it has granted fewer than five writ petitions. Even though this represents only a small fraction of the number of writ petitions filed, the writ petition remains a useful tool for prompting VA to act.

As always, it is wise to consult with a legal professional before filing a writ petition. This blog is not intended to provide legal advice, and it should not be relied upon as such.

Todd M Wesche FAQs, Veterans Benefits Claims veterans disability benefits