Champva Qualification Question

[JAB]

I understand that I'm required to be permanent & totally disabled for my wife to be eligible for CHAMPVA, and after several phone calls, I'm still confused about this.

I was originally granted 100% compensation in the 1990s under 38 USC 1151 which was non-service connected. Several years later, as my health declined, I received a new rating which continued the original rating and added an additional illness which was also evaluated at 100%. At that time, I started receiving a special monthly compensation for being above 160%.

I don't see P&T on any of my papers, but I did receive a letter from the VARO in 2007 stating that I'm not scheduled for a future exam since improvement of my disabilities is not expected. Then in 2012 I received a VARO letter saying that information used to establish my benefits had recently changed, and that I was enrolled in priority group 1 and that I was now rated 100% "Service connected".

Should I send champva an application and let them figure all this out, or should I ask my VARO to readdress my case. My wife and I are a little apprehensive about stirring up any trouble with the VARO, and we wonder if we should just let sleeping dogs lie. :) Any help would be greatly appreciated.

[jbasser]

Ask the VA to clarify the no future exams. It usually means P and T. Ask about chapter 35 and ChampVA.

Do you use e benefits? Log onto there and look at the download letters section. If it says you are entitled to commissary privileges then you are P and T

You can also call champVA directly. They are good people to deal with.

1-800-733-8387

[Berta]

Jbasser is right.

The 100% “as if” service connected disability does Not render any ancillary benefits like CHAMPVA and Chapter 35.

That additional 100% ( I assume is SC and not additional 1151) ,when deemed P & T by the VA, will render Chap 35 and CHAMPVA to your dependents.

I have a similar situation.

1151 death of my husband 1998 award for DIC (they had deemed him as 100% P & T for SC PTSD.in 1997 for my accrued benefits claim.

I was awarded CHAMPVA and Chapter 35 and used it up for my AMU degree.(but awarded it under the PTSD rating, not the 1151 100%..

Recently I had some DEA info here as, in 2009 the VA awarded my claim for direct SC death due to AO.

That gave me a better limiting entitlement date for the Chap 35. I had no problem at all getting the new DEA certificate

and minimal problems getting the tuition I paid after my DEA ran out, reimbursed to me.

My point is that a 100% P & T or TDIU P & T SC award will render the veteran's dependents eligible for these 2 wonderful VA benefits.

And that a Direct SC 100% P & T award ,if claimed and if successful ,will trump a prior Sec 1151, 38 USC 100% P & T award ,

and involve additional ancillary benefits.

CHAMPVA also has a good web site on line.

http://www.va.gov/hac/forbeneficiaries/champva/champva.asp

Edited September 24, 2013 by Berta

[Berta]

PS I forgot to add......

If the 1151 has caused any additional secondarys, that,with medical evidence could be attributed directl;y to your 1151 disabilioty, there is no time limit on claiming anything under 1151. Even if you found a new 1151 disability ,you could still claim it.

What I mean is my husband died 19 years ago this October.

It was a 1151 death and also I won under FTCA.

Last year I filed an additional 1151 claim on his medical evidence for a disability that VA Central stated was malpracticed on, but not a disability I had claimed in the original 1151 claim ( a re open of his 1151 claim after he died.)

This disability had been rated by VA as NSC in subsequent awards.

Also when I filed my AO IHD Nehmer claim in 2010 I reminded the VA that I had filed a CUE claim ( 3 CUES stated in the claim regarding the 1998 DIC Section 1151 award letter) which in 2010 that was still sitting at the Buffalo RO (Phila RO was handling my Nehmer claim)

In the Nehmer award, the VA granted the CUE ,which was an 1151 issue, and the monetary award from the 1151 award CUE claim was greater then the retro for the AO IHD claim.

My long point is there is no time limit on 1151 claims.

They should be filed ASAP however, when the medical evidence in the med recs is fresh and VA hasn't had time to 'manipulate' it.

FTCAs however have a 2 year Statute of Limits.

Edited September 24, 2013 by Berta

[JAB]

Thanks for the replies. jbgasser, I registered at ebenefits and didn't see commisary privileges. It just shows that I'm 100% SC. The site is helpful though, and I appreciate the heads up.

Berta, your stories are interesting and encouraging. I'm amazed at your understanding of the VAs inner workings. It's great to have you on here helping out. It sorta helps to level the playing field a bit. ;)

I will be contacting my VRO, actually tried today without success, but will leave a call back number tomorrow. On a side note, eBenefits "historic claims" show that there have been 2 rating reviews in the past year and they appear to be completed, and it says that letters were sent to me, but I didn't receive them. On the same page it states "We apologize that your claim is past due". I haven't got a clue what that's all about. thanks

[JAB]

I called the regional office to ask questions, and I left my call-back number. They returned my call on time from 800-827-1000, so I figure it was from a national call center. The lady was very polite, but she wasn't able to answer my questions, so she put me on hold while she and her supervisor researched my case. When she finally returned, she said that since my original claim (many years ago), was a 1151 claim and non-SC, that my second claim was a direct result of the first claim, and that I shouldn't even be rated service-connected.

I immediately wished that I hadn't even made this call and I didn't agree with what she was saying. Actually, my first claim should have been SC and not a 1151, but I didn't appeal it, and won't go into that can of worms here. Anyway, I politely thanked her and told her that I had to go, and that I didn't need anything else.

Now, I am concerned that they will send info about this "so-called mistake" to my regional office, which could cause a review, possibly including a new exam, along with all the unpleasant medical tests, etc...... For lack of better words, that would suck! I don't think there's any way they could lower my percentage, since I'm not getting better, but the idea of reopening my case is very unsettling, at this stage.

I wonder if the fine folks on the help lines are trained to look for mistakes, report to supervisors, make changes to my status, or forward the info to regional office.

I know now that I don't qualify for CHAMPVA, and that's the info I originally posted about,.........BUT,

My new question to the forum is........Do I have a reason to be concerned about that phone call, or am I being paranoid?

[Berta]

I dont get this.....

“I was originally granted 100% compensation in the 1990s under 38 USC 1151 which was non-service connected. Several years later, as my health declined, I received a new rating which continued the original rating and added an additional illness which was also evaluated at 100%. At that time, I started receiving a special monthly compensation for being above 160%. “

“added an additional illness which was also evaluated at 100%”

I thought you meant an additional 100% but rated as SC.

You also had posted:

“Then in 2012 I received a VARO letter saying that information used to establish my benefits had recently changed, and that I was enrolled in priority group 1 and that I was now rated 100% "Service connected".

and

"When she finally returned, she said that since my original claim (many years ago), was a 1151 claim and non-SC, that my second claim was a direct result of the first claim, and that I shouldn't even be rated service-connected."

“and that I shouldn't even be rated service-connected. “ ??????

“I wonder if the fine folks on the help lines are trained to look for mistakes, report to supervisors, make changes to my status, or forward the info to regional office.”

Not really, that is why we call them Peggy. They usually don't have a clue.

In this case however, they might be looking into this.

“My new question to the forum is........Do I have a reason to be concerned about that phone call, or am I being paranoid? “

We all get VAOLA paranoia.

Do you have a vet rep who can look into this on your behalf?

“Then in 2012 I received a VARO letter saying that information used to establish my benefits had recently changed, and that I was enrolled in priority group 1 and that I was now rated 100% "Service connected".

The letter might mean you are SC at 100% but not P & T ….yet...and you can request a P & T status.

However, I had a problem with CHAMPVA, due to the VARO, if you do get a 100% SC P & T status, that I hope no one else ever has.

I called CHAMPVA (who is excellent by the way) as to a question in the CHAMPVA pamphlet many years ago and somehow the woman popped up my VA stuff. My 1151 award appeared,so she called the RO and they said Yes, my award was under 1151 and I was not CHAMPVA eligible.

Both the CHAMPVA woman and the VA were reading the wrong award letter.

My CHAMPVA was already established and awarded by VA due to my accrued benefits award.It had nothing to do with a 1151 award.They corrected this all right away but it was awful to hear someone say I was not eligible for CHAMPVA and I had my CHAMPVA award letter and other CHAMPVA stuff right in front of me.

Do you feel comfortable telling us what you get the 1151 for and then what is the 100% SC disability?

BTW, VA paid me 100% under 1151 for my husband's stroke IN ADDITION TO all other awards under SC.

1151 comp is Separate from direct SC. And distinctly different when a veteran such as my husband, had both 100% P & T SC and then 100% P & T plus SMC under 1151.

They dont add together or combiine 100% awards in that case.They pay the cash for each disability...no offset.

I explained all that here in maybe the 1151 FTCA forum. with the regs.

In other words they paid 100% as accrued on my husbands PTSD in 1997.

In 2010 they paid 100% under 1151 for the 1151 stroke, in addition to the 100% past paid award SC for PTSD.

Question....in 2012 did the VA pay you separate additional compensation,as retro, for the SC they deemed as 100%?