CVSO Fall TrainingCVSO Fall Training

• Who’s Next?

Arkansas Department of Veterans Arkansas Department of Veterans AffairsAffairs

• We are a state agency representing veteransWe are a state agency representing veterans• We do not decide claimsWe do not decide claims• We assist veterans in claims preparationWe assist veterans in claims preparation• We assist veterans in claims appeal processWe assist veterans in claims appeal process• We provide information on state benefits for veterans We provide information on state benefits for veterans

http://www.veterans.arkansas.gov• You are our first line of defense and play a vital role You are our first line of defense and play a vital role

in helping claimants secure their benefitsin helping claimants secure their benefits• Promote E-BenefitsPromote E-Benefits

Interview the ClaimantInterview the Claimant

• Introduce yourself to the claimant.Introduce yourself to the claimant.• Determine veteran status (DD214)Determine veteran status (DD214)• Obtain/Confirm representation (VA Form 21-22)Obtain/Confirm representation (VA Form 21-22)• Form 80 or NACVSO1Form 80 or NACVSO1• Ask what is it you can do for him/herAsk what is it you can do for him/her• Listen!Listen!• Determine eligibility of benefit sought; be specificDetermine eligibility of benefit sought; be specific• Ask about medical records and other evidenceAsk about medical records and other evidence• Do Not Smile and File!Do Not Smile and File!

Service OrganizationService Organization

• Arkansas Department of Veterans AffairsArkansas Department of Veterans Affairs

• American LegionAmerican Legion

• Veterans of Foreign WarsVeterans of Foreign Wars

• American Ex Prisoners of WarAmerican Ex Prisoners of War

• Marine Corp LeagueMarine Corp League

• Catholic War Veterans of the USACatholic War Veterans of the USA

• This is not an all inclusive listThis is not an all inclusive list

EligibilityEligibility

• A veteran who served in the active military, naval A veteran who served in the active military, naval or air service, and wasor air service, and was

• Discharged or released under conditions other than Discharged or released under conditions other than dishonorabledishonorable

• ““VETERAN OF ANY WAR”VETERAN OF ANY WAR” means any veteran means any veteran who served in the active military, naval or air who served in the active military, naval or air service during a period of war as set forth in 38 service during a period of war as set forth in 38 CFR 3.2”CFR 3.2”

• Proof of Service (DD Form 214 or equivalent)Proof of Service (DD Form 214 or equivalent)

Compensation & PensionCompensation & Pension

• The term “Compensation and pension” is the VA The term “Compensation and pension” is the VA Monetary Benefit Programs paid on account of a Monetary Benefit Programs paid on account of a veteran’s disability or death.veteran’s disability or death.

• Compensation is related to a service connected Compensation is related to a service connected disabilitydisability

• Pension is an income based benefit for veterans Pension is an income based benefit for veterans who served during a period of war and is totally who served during a period of war and is totally disabled not related to servicedisabled not related to service

Service ConnectionService Connection

• Service connection for a disability requires proof Service connection for a disability requires proof that the injury/disease began during service that the injury/disease began during service (documented in medical records)(documented in medical records)

• Must have a current diagnosisMust have a current diagnosis• Confirmation that current injury is linked to the Confirmation that current injury is linked to the

injury that incurred during military service.injury that incurred during military service.• If one element is missing, service connection is If one element is missing, service connection is

denied.denied.

Service ConnectionService Connection

Current Diagnosis

Nexus linking in service event to current diagnosis

Injury, Illness, Disease in Service

Service ConnectionService Connection

• Incurred during serviceIncurred during service• Aggravated during serviceAggravated during service• Presumptive Condition (Presumed to have begun Presumptive Condition (Presumed to have begun

during service if they manifest to a compensable during service if they manifest to a compensable degree within a specified time (generally one year) degree within a specified time (generally one year) after service, even though there is no evidence of after service, even though there is no evidence of disease during service (Gulf War Illness)disease during service (Gulf War Illness)

• Secondary (a result of service connected disability)Secondary (a result of service connected disability)

Type of ClaimType of Claim

• Benefits Delivery at Discharge (BDD) 60-180 daysBenefits Delivery at Discharge (BDD) 60-180 days

- Must have all documentation when submitted- Must have all documentation when submitted

- Claim managed off site: UT, NC, CA- Claim managed off site: UT, NC, CA• Quick Start: 1- 59 DaysQuick Start: 1- 59 Days• Fully DevelopedFully Developed

- Must have all documentation when submitted- Must have all documentation when submitted

- Claim managed in Arkansas- Claim managed in Arkansas• Fully developed recommended!Fully developed recommended!

Informal ClaimInformal Claim

• Claimant must identify the benefit he/she is Claimant must identify the benefit he/she is seekingseeking

• All informal communications must be in writing or All informal communications must be in writing or transcribed into written formtranscribed into written form

• The VA has NO “duty to assist” in development of The VA has NO “duty to assist” in development of such a claimsuch a claim

• Provisions of 38 CFR 3.155 are applied. Once Provisions of 38 CFR 3.155 are applied. Once filed and accepted as valid, VA has the initial filed and accepted as valid, VA has the initial responsibility to send a formal applicationresponsibility to send a formal application

Formal ClaimFormal Claim

• Application intended for the claim of specific benefit. Application intended for the claim of specific benefit. Examples: Examples:

• VA Form 21-526 – Initial Compensation, Pension or VA Form 21-526 – Initial Compensation, Pension or Both Both

• VA Form 21-527 – Initial PensionVA Form 21-527 – Initial Pension

• VA Form 21-534 – DIC VA Form 21-534 – DIC

• VA Form 21-8940 – IU or UnemployabilityVA Form 21-8940 – IU or Unemployability

• Is the application substantially complete? What does that Is the application substantially complete? What does that mean? 38 CFR 3.159mean? 38 CFR 3.159

Formal ClaimFormal Claim

Substantially complete application means an application Substantially complete application means an application containing the claimant's name; his or her relationship to the containing the claimant's name; his or her relationship to the veteran, if applicable; sufficient service information for VA to veteran, if applicable; sufficient service information for VA to verify the claimed service, if applicable; the benefit claimed verify the claimed service, if applicable; the benefit claimed and any medical condition(s) on which it is based; the and any medical condition(s) on which it is based; the claimant's signature; and in claims for non-service-connected claimant's signature; and in claims for non-service-connected disability or death pension and parents 'dependency and disability or death pension and parents 'dependency and indemnity compensation, a statement of incomeindemnity compensation, a statement of income. .

Original ClaimOriginal Claim

• First time an application is made for Compensation First time an application is made for Compensation or Pensionor Pension

• Specific end products assigned for the original or Specific end products assigned for the original or (in this instance) first claim(in this instance) first claim

• Considerable development is usually required in Considerable development is usually required in original claims.original claims.

• Claims folders createdClaims folders created• Options for the specific effective date for the start Options for the specific effective date for the start

of paymentsof payments

New ClaimNew Claim

• First time an issue is presentedFirst time an issue is presented• It may include an original, reopened claim or claim It may include an original, reopened claim or claim

for increase when a disability is identifiedfor increase when a disability is identified• Nexus to military service?Nexus to military service?• Evidence is determined once the purpose of the Evidence is determined once the purpose of the

claim is known. For example – reopened NSC claim is known. For example – reopened NSC pension? Secondary service connection?pension? Secondary service connection?

Re-Opened ClaimRe-Opened Claim

• Previous denial of claim greater than 1 yearPrevious denial of claim greater than 1 year• Requirement for new and material evidence Requirement for new and material evidence

addressing the previous deficiencyaddressing the previous deficiency• Discourage immediate appeals without thorough Discourage immediate appeals without thorough

reviewreview• Get the claims folderGet the claims folder• Controversy over “well grounded claims”Controversy over “well grounded claims”

Claim for IncreaseClaim for Increase

• Need for supporting evidence – medical and layNeed for supporting evidence – medical and lay• The “Proscelle” argument in the absence of The “Proscelle” argument in the absence of

medical evidencemedical evidence• Detailed description of “credible symptoms”Detailed description of “credible symptoms”• Absolutely no guarantee of a medical examinationAbsolutely no guarantee of a medical examination• Secondary Service Connection for a new issue?Secondary Service Connection for a new issue?

Individual Unemployability (IU)Individual Unemployability (IU)DefinitionDefinition

Individual Unemployability (IU) is a part of VA’s Individual Unemployability (IU) is a part of VA’s disability compensation program that allows VA to disability compensation program that allows VA to pay certain Veterans compensation at the 100% rate, pay certain Veterans compensation at the 100% rate, even though VA has not rated their service-connected even though VA has not rated their service-connected disabilities at the 100% level. disabilities at the 100% level.

A Veteran must be unable to maintain substantially A Veteran must be unable to maintain substantially gainful employment as a result of his/her service-gainful employment as a result of his/her service-connected disabilities. Additionally, a Veteran must connected disabilities. Additionally, a Veteran must have: have:

Individual Unemployability (IU)Individual Unemployability (IU)CriteriaCriteria

A Veteran must be unable to maintain substantially A Veteran must be unable to maintain substantially gainful employment as a result of his/her service-gainful employment as a result of his/her service-connected disabilities. Additionally, a Veteran must connected disabilities. Additionally, a Veteran must have: have:

• One service-connected disability ratable at One service-connected disability ratable at 60 60 percent or more, percent or more, OR OR

• Two or more service-connected disabilities, at least Two or more service-connected disabilities, at least one disability ratable at one disability ratable at 40 40 percent or more with a percent or more with a combined rating of combined rating of 70 70 percent or more.percent or more.

SummarySummary

• Determine Veteran StatusDetermine Veteran Status• Obtain Representation or Review FileObtain Representation or Review File• Complete / Review RepresentationComplete / Review Representation• ADVA Form 80 or NACVSO1ADVA Form 80 or NACVSO1• Get a clear understanding of reason for visitGet a clear understanding of reason for visit• Determine EligibilityDetermine Eligibility• File a fully developed claim!File a fully developed claim!• Urge Claimants to use E-BENEFITS!Urge Claimants to use E-BENEFITS!