Looking for advice

[Pacrat2014]

12 minutes ago, broncovet said:

I "smell" a service connection for PTSD, and, its possible you are "blocking out" a bad event that happened to you, such as a sexual assault.  Dont make stuff up, ever, but dont try to cover stuff up, either.  

Unfortunately, I'm not someone who blocks things out and actually have a good memory even of events during my "rowdy" days when I partook of the liquid refreshments enough that I should have no memory of them.  I do admit I would like to block out my more idiotic moments though.  But, I don't recall any hints or events that could of caused PTSD.  I'm not someone who thinks that PTSD is only service related, I know of too many people who had gone through traumatic events who came down with it as well who never wore the uniform.  Closest to traumatic was the loss of my knee at work, and even then I was joking about being "peg legged" not even an hour after the incident.  I've never allowed something to get me down even though it would throw many people for a loop.

As to leaving service, my exit date was Feb, 2001 months before 9/11.  As to life after my time in, I've had stressful times but I'm the type of person that finds the best out of situations and don't dwell on either the good or bad after it is in the past.

As to mental issues, my fear is of people and the situations that may cause me to go to extremes and end up on the floor.  And it was gradual.  A civilian doctor, I saw for a second opinion as the doctor the VA assigned was "too busy" to go into details, I talked to said my issues usually hits after the age of 25 and are usually gradual.  So he said I could of started to have symptoms back when I was still in the service but they would of been things I would of shrugged off.  It is only at a certain point where I would actually notice it enough to notate it.  And that happened when I was working logistics offshore and started having issues at meetings due to the crowded areas.  That was roughly about early 2006.  It had gotten bad enough to the point that in 2009, I had started working at onshore bases working with people over the radio and phone.  Ironically, it was being onshore that led to the accident that got my knee.  I've had both the civilian doctor and the 3 VA doctors assigned to me grill me over stressful situations in my past.  But, I don't have issues with loud noises or firecrackers, I don't get fearful of people to the point that I lash out, I don't go running for cover from people or situations.  My body just panics (sweating, major increase in blood pressure, headache, eyes go blurry, trembling, and trouble breathing) until I find a nice quiet spot as far away from people as I can or I pass out.  Whichever comes first.  As to a temper, I admit I've always had a temper since I was a kid but I've had rules I've followed to keep it under control and actually haven't had a public or private display of anger in decades.

[Berta]

I hope you realize that whatever disability you file for- you will need a service nexus for each of them.

"As to PTSD, they keep suggesting that my problems may be related to PTSD but there isn't anything personal or military that would account for it.  I had a pretty quiet duty as well as a boring life. "

Who is "they" ?

 This is not a diagnosis of PTSD.But the VA is supposed to consider any MH issue you have.

[Pacrat2014]

I do realize that, but it's a side concern for me right now with the trouble I'm having to keep/find work and the VA putting me on pension.  So I'm just looking for advice as to what I should do next and what I may be eligible for as the pension isn't enough to live on, I actually want to get back to some sort of work, and it seems that every VA rep I've talked to can't even agree on what I can do and what the VA would help me with.

As to the "they" part, both the VA doctors I saw as well as the civilian ones explained that it was possible that I didn't notice my slide while still in the service, it's just the civilian doctor that went fuller into details before trying to go on to another topic we were discussing for what they do have me currently diagnosed for at the moment.  PTSD, with little clue on what would of caused it, there is nothing they can link that would fulfill a PTSD diagnosis.  So I'm left with my fear of people.

Sorry it took so long to reply.

[Berta]

I thought a VA pension restricts working.

Reason is one former vet rep I had called me up to see if I could help him get out of a jam.

He called a vet  he repped to tell them they had been awarded 100% SC.

He mis read the award letter the VA had sent to him.I thik he wanted me t tell the veteran.

It was for a VA pension , not compensation.

I told him to call the vet himself and tell him-then he asked me to nterview the vet and try to see if he had PTSD ( the VA had already stated he had a Personality disorder.This same rep had already supported 2 claims for him, trying to get the PD SCed????? (BTW this rep was the boss at a state VA claims office ) He left when he found out I had sent a complaint to the VA OGC on him. He was messing up my AO DMII claim, while asking me to help some of the vets he repped.

Long story- the veteran continued to work as a landscaper full time  and I told the rep he better tell him of the pension requirements-again he asked me to do that but I said do it yourself.(I think the rep had actually hired him to do work at his home)------

In 1982 the VA denied my DIC claim for my other Army husband ,not my USMC husband and our baby was still in diapers when he died and I had no idea what a VA claim involved.

But in time they did send me a nice letter, that husband was a Korean Era vet (wartime- 2 HDs)that I was eligible for a VA pension but I made too much money.

I hope others chime in- I dont have time to find the pension regulations but they are here,

maybe those regulations changed.

Edited July 31, 2018 by Berta
spelling

[Pacrat2014]

There lies the problem I'm having.  I had one VA rep say that it restricts working and to file for SS.  I had another tell me that it doesn't restrict working and that I was eligible for retraining, I had yet another tell me that I wasn't eligible for job retraining and to file for SS, etc...  So far, I haven't gotten the same story twice.  And going through the webpages doesn't really answer my question as you have to jump page to page and where it directs you to is contradictory to what you read before or has no information pertinent to the situation.

And trying to get a rep through the VA website has been a waste of time for me....   I've requested one multiple times but never hear anything back.

[Vync]

Here is a link to the main VA Pension site: https://www.benefits.va.gov/PENSION

Here is the VA pension rating regulations as of May 2018: M21-1, Part V, Subpart i, Chapter 2 - Original Disability Pension Claims

Quote

Overview

---

 

In This Chapter

This chapter contains the following topics:   Topic Topic Name 1 General Information on Original Disability Pension Claims 2 Developing for Permanent and Total (P&T) Disability and Age  3 Developing for Income and Net Worth 4 Developing for the Willful Misconduct Aspect of an Injury 5 Referring Pension Claims to the Rating Activity

---

 
 

1.  General Information on Original Pension Claims

 

---

Introduction

This topic contains general information on eligibility and development for original pension claims, including elements of pension eligibility claims processor pension development guidelines Veterans Pension effective dates and payment dates, and Survivors Pension effective dates and payment dates.

---

Change Date

May 2, 2018

---

V.i.2.1.a.  Elements of Pension Entitlement

In order to establish entitlement to Veterans Pension, the following elements must be shown: qualifying service a permanent and total (P&T) disability, or age of 65 years or older countable income is below the maximum annual pension rate (MAPR), and net worth limitations are met. In order to establish entitlement to Survivors Pension, the following elements must be shown: qualifying service relationship to the Veteran for a surviving spouse, the spouse is not remarried for a surviving child, the child is unmarried and under 18, and became permanently helpless before 18, or is between 18 and 23 and is in school countable income is below the MAPR, and net worth limitations are met. References:  For more information on Veterans Pension, see 38 U.S.C. 1521 Survivors Pension for surviving spouses, see 38 U.S.C. 1541, and Survivors Pension for surviving children, see 38 U.S.C. 1542.

---

V.i.2.1.b.  Claims Processor Pension Development Guidelines

It is the responsibility of the claims processor to develop the evidence needed to establish entitlement to pension.  If a claim does not meet one or more of the eligibility requirements, deny the claim.  Do no develop or rate the claim.   Use the table below to find information on developing for each pension entitlement element.   For procedures for developing for ... See... service M21-1, Part III, Subpart ii, 6. disability and age M21-1, Part V, Subpart i, 2.2. Social Security  (SS) disability M21-1, Part III, Subpart iii, 3.A.2. income and net worth M21-1, Part V, Subpart i, 2.3. the willful misconduct aspect of an injury M21-1, Part V, Subpart i, 2.4. relationship M21-1, Part III, Subpart iii, 5.   Notes: If a fully developed claim (FDC) that is accepted as substantially complete as noted in M21-1, Part I, 1.B.b requires additional development to the claimant, exclude the claim from the FDC Program and develop as necessary.  A claims processor cannot deny an FDC claim from a claimant that meets basic eligibility criteria without first developing for any information or evidence needed to support the claim. If pension benefits can not be granted or denied upon initial review of a claim, and a Section 5103 notice was not provided on the application, a Section 5103 notice must be included in any development letter.  A Veteran may need to report for any Department of Veterans Affairs (VA) medical examinations VA determines are necessary to decide his or her claim. Reference:  For more information regarding FDC processing, see M21-1, Part III, Subpart i, 3.A and B.

---

V.i.2.1.c.  Veterans Pension Effective Dates and Payment Dates

In general, the effective date for an original Veterans Pension claim is the date the claim was received, per 38 CFR 3.400.  The payment date is the first day of the month following the date the claim was received, per 38 CFR 3.31.   References:  For more information on retroactive Veterans Pension effective dates, see M21-1, Part V, Subpart ii, 1.B.7, and  M21-1, Part V, Subpart iii, 1.A.4, and retroactive Veterans Pension effective dates associated with a receipt of an intent to file, see M21-1, Part III, Subpart ii, 2.C.1.

---

V.i.2.1.d.  Survivors Pension Effective Dates and Payment Dates

Use the table below to determine the effective date and payment date of an original Survivors Pension claim.   If the application was received … Then the effective date of the award is … And the award payment date is … within one year after the Veteran's date of death the first day of the month of death the first day of the month following death. more than one year after the Veteran's date of death the date the claim was received the first day of the month following the date the claim was received.   Notes: When the Survivors Pension award effective date is the first day of the month of the Veteran’s death, the first day of the initial year is the date of the Veteran’s death. VA does not count income that a surviving spouse or child received before the Veteran’s death. In an original surviving spouse award, claims processors should also pay the month of death payment if it was not paid automatically. See 38 CFR 3.20 and M21-1, Part IV, Subpart iii, 3.A.5. References:  For more information on the effective date based on the non-service-connected death of a Veteran after separation from service, see 38 CFR 3.400(c)(3), and the definition of initial year, see M21-1, Part V, Subpart iii, 1.A.3.

---

 

2.  Developing for P&T Disability and Age

 

---

Introduction

This topic contains information on developing for P&T disability and age, including when a rating determination of P&T disability is not required acceptable evidence of age SS disability evidence and Share verification determining disability effective date based on SS information when a rating determination of P&T disability is required acceptable medical evidence and definition of adequate medical evidence for pension rating purpose VA examination authorization obtaining evidence before referring a claim to the rating activity action to take when medical evidence is not received, and developing for unemployability.

---

Change Date

August 4, 2017

---

V.i.2.2.a. When a Rating Determination of P&T Disability Is Not Required

A rating determination of P&T disability is not required to establish eligibility for Veterans Pension when a Veteran is age 65 or older, or presumed to be P&T disabled for pension purposes because he/she is a patient in a nursing home for long-term care because of disability, or disabled, as determined by the Commissioner of SS. Note:  A medical foster home that VA has recognized and approved under 38 CFR 17.73 is equivalent to a nursing home.

---

V.i.2.2.b.  Acceptable Evidence of Age

Age is a factor in Veterans Pension claims.  If the Veteran is age 65 or older, a rating determination of P&T disability is not required.   If the date of birth as given by the Veteran agrees with other dates of birth shown in the records, no further development is necessary.  Otherwise, per 38 CFR 3.208, accept the youngest age shown in the records, pending receipt of acceptable evidence of birth as listed in 38 CFR 3.209.   Per 38 CFR 3.208, accept statements of age if they agree with those shown at enlistment by official records.  In addition, comparison may be made with statements made at other times for other purposes.   Reference:  For information on how to obtain acceptable evidence as listed in 38 CFR 3.209, see M21-1, Part III, Subpart iii, 1.A.

---

V.i.2.2.c.  SS Disability Evidence and Share Verification

If a Veteran is younger than age 65, but the Social Security Administration (SSA) has determined he or she is disabled, the Veteran may be presumed P&T disabled for pension purposes from the date of disability onset.   The information provided in the Share SSA Data screen may be used to determine eligibility for VA pension.  The following table provides information on handling SSA information obtained from Share.   Reference:  For more information on using Share, see the Share User Guide.   SS Title Status Nature of SS Benefit Title XVI Status has a “Y” indicator A "Y" in this field indicates that SSA data is available.  View the "SSI basic Info" tab to determine if SSI is payable.  View the SSA Basic Info tab to review the Disability Onset Date field.   Note: If a Veteran is found entitled to Supplemental Security Income (SSI), he or she meets the disability requirement for VA pension. Title II Status has a “Y” indicator Either SS retirement or SS disability is payable. If the Veteran’s age is under 62, SS is based on a disability.  Presume that the VA pension disability requirement is met. If the Veteran’s age is 62, 63 or 64, SS may be based on retirement or on disability. If the date in the Date of Initial Ent field is exactly six full months after the date in the Disability Onset Date field, then presume that the VA Pension disability requirement is met. If the date in the Date of Initial Ent field is not shown or is not exactly six full months after the date in the Disability Onset Date field, then develop to the claimant and the Social Security AdministrationSSA for a disability award letter and medical evidence of disability. Reference:  For more information on determining the effective date of disability, see M21-, Part V, Subpart i, 2.2.d.

---

V.i.2.2.d.  Determining Disability Effective Date Based on SS Information

Unless VA pension eligibility is based on age, a Veteran must be disabled to be eligible. VA pension eligibility based on an SSA finding of disability should be effective from the later of the date of the pension application, or the date of disability. The SS information available through Share may be used to determine eligibility for VA pension.   SS Benefit Effective Date of Disability for Pension Purposes SSI under Title XVI If Share confirms payment of SSI, presume the Veteran was disabled from the date of receipt of the Pension application unless the Disability Onset Date field shows more than one year after the date of receipt of the VA pension application. If Share confirms payment of SSI, but the Disability Onset Date field shows more than one year after the date of receipt of the Pension application, initially establish entitlement from the onset date and develop for an earlier effective date. Note: SSA pays SSI from a date no earlier than the first month eligibility is established following receipt of the SSI application. Disability may exist for several months before the date SSI is paid. Disability Insurance Benefits (DIB) under Title II If the Veteran’s age is under 62, then presume the Veteran was disabled from the date in the Disability Onset Date field. If the date is on or before the first day of the month following the date of receipt of the VA pension application, establish eligibility from the date of claim. If the date is later than the first day of the month following the date of receipt of the VA pension application, initially establish eligibility from the onset date and develop for an earlier effective date. If the Disability Onset Date field does not contain a date, develop to the Veteran and SSA for evidence of a disability and the effective date of disability. If the Veteran’s age is 62, 63 or 64, then only presume the Veteran was disabled from the date in the Disability Onset Date field when the date is exactly 6 full months before the Date of Initial Ent field. Otherwise, develop to the Veteran and SSA for evidence of a disability and the effective date of disability. Reference:  For more information on when the  If evidence indicates payment of SSI, see M21-1, Part V, Subpart i, 2.2.c.

---

V.i.2.2.e.  When a Rating Determination of P&T Disability Is Required

If the Veteran is not age 65 or older, or presumed to be P&T disabled because he/she is a patient in a nursing home or VA approved medical foster home, or disabled as determined by the Commissioner of SS, then he/she must be shown by a rating to meet the disability percentage requirements set forth in 38 CFR 4.16 and 4.17 or have an extra-schedular evaluation approved under 38 CFR 3.321(b)(2), and be unable to secure and follow a substantially gainful occupation (unemployable) by reason of disabilities which are likely to be permanent. Note:  For pension claims that require a P&T disability determination, a general medical examination is necessary for all claims when there is insufficient medical evidence available to decide the claim. References:  For more information on acceptable medical evidence for rating purposes, see M21-1, Part V, Subpart i, 2.2.f, and when a VA examination is authorized, see M21-1, Part V, Subpart i, 2.2.g.

---

V.i.2.2.f.  Acceptable Medical Evidence and Definition of Adequate Medical Evidence for Pension Rating Purposes

Medical evidence is adequate for pension rating purposes as long as it addresses all medical or mental conditions provided by the Veteran and can be used to evaluate the impact of each condition on the Veteran’s employability.   The following types of medical evidence may be accepted for rating purposes if they are adequate: a statement from a physician, Certified Nurse Practitioner (CNP), Clinical Nurse Specialist (CNS) or a Physician Assistant (PA), or a hospital or examination report from any government or private institution. Evidence of current disability may be contained in reports from a VA or a non-VA medical facility, or in evidence already of record showing the existence of a chronic condition likely to interfere with employability.  If such evidence is obtained, or is already of record, submit the claim to the rating activity.  If this evidence does not support a grant of P&T, and adequate medical evidence is not available, has not been provided, or is not of record, then a medical examination must be scheduled.

---

V.i.2.2.g.  VA Examination Authorization

Per 38 CFR 3.326(a), if the submitted medical evidence or medical evidence of record is not adequate for rating purposes, a VA examination will be authorized.   If the medical evidence … And the medical evidence supports a … Then … is adequate for pension rating purposes grant of pension benefits grant pension by rating decision.  No VA examination is required. is adequate for pension rating purposes denial of pension benefits deny pension by rating decision.  No VA examination is required. does not address the conditions claimed by the Veteran grant of pension benefits grant pension by rating decision.  No VA examination is required. is not adequate for pension rating purposes denial of pension benefits request a VA examination.   Note:  Claims processors have the authority to request an examination for any claim for which special circumstances may warrant it even if an examination is not required based on this topic.   Reference:  For the definition of adequate for pension rating purposes, see M21-1, Part V, Subpart i, 2.2.f.

---

V.i.2.2.h.  Obtaining Evidence Before Referring a Claim to the Rating Activity

If no medical evidence of the claimed disability is of record, request medical evidence from the claimant.   If medical evidence is of record, but is not adequate for rating purposes, schedule the claimant for a VA examination.   Once adequate medical evidence is of record, refer the claim to the rating activity.   Note:  When questions of doubt arise in determining if medical evidence is adequate for rating purpose, refer claim to rating activity.   References:  For more information on VA's duty to assist, see M21-1, Part I, 1.B the definition of competent medical evidence, see 38 CFR 3.159(a)(1) when to schedule a VA examination, see 38 CFR 3.326, and the definition of adequate for pension rating purposes, see M21-1, Part V, Subpart i, 2.2.f.

---

V.i.2.2.i.  Action to Take When Medical Evidence Is Not Received

If no medical evidence of the claimed disability has been received and 30 days have passed from the date of request deny the claim, and notify the Veteran that the evidence must be provided in order to reconsider the claim. No additional development is needed and no rating decision is completed.   Notes:  An examination may be needed, depending on the information provided on a lay statement. Follow the guidance outlined in 38 CFR 3.326(a) when ordering examinations when the medical evidence accompanying the claim is not adequate for rating purposes, where appropriate. When questions of doubt arise involving having adequate medical information, refer the claim to the rating activity. Do not immediately deny the claim if medical evidence necessary to decide the claim is located at a Federal facility. References:  For more information on VA’s duty to assist in obtaining Federal records and VA’s responsibility to obtain them  see M21-1, Part I, C.1, and non-Federal or private treatment records, see M21-1, Part I, C.2.

---

V.i.2.2.j.  Developing for Unemployability

In order for VA to make an unemployability decision, a Veteran must provide his/her work history for the one year period before he/she became disabled. Use the table below to determine which form to send the Veteran when additional information is needed.   If ... Then send ... the employment information provided by a Veteran on an original claim is incomplete VA Form 21-4138, Statement in Support of Claim, and ask him/her to provide the missing information on the form. the Veteran is self-employed as a farmer VA Form 21P-4165, Pension Claim Questionnaire for Farm Income. the Veteran is self-employed VA Form 21P-4185, Report of Income from Property or Business. the Veteran is not self-employed, and additional evidence is required to determine the issue of unemployability or income Note:  Only develop for additional evidence when the Veteran’s employment status is unclear. VA Form 21-4192, Request for Employment Information in Connection With Claim for Disability Benefits, to employers for whom the Veteran has worked in the past 12 months, or from whom he/she is receiving unemployment or retirement payments. If the completed form is not received from the employer within 30 days, and the evidence is still material to the claim, inform the Veteran and ask him/her to obtain the completed form.   Note:  Use Modern Awards Processing-Development (MAP-D) for development whenever possible.   Reference:  For more information on development with MAP-D, see the MAP-D User’s Guide.

---

 

 

3.  Developing for Income and Net Worth

 

---

Change Date

April 21, 2015

---

V.i.2.3.a.  Requesting Necessary Evidence for Income and Net Worth

Do not develop in a piecemeal manner.  Develop for income information at the same time as for other evidence needed to determine entitlement. Use the table below to find information on developing for various kinds of evidence.   For information on ... See ... developing for evidence of income and net worth M21-1, Part V, Subpart i, 3.A. requesting information from sources such as the Railroad Retirement Board (RRB) SSA, and Office of Personnel Management (OPM) M21-1, Part III, Subpart iii, 4.

---

 

4.  Developing for the Willful Misconduct Aspect of an Injury

 

---

Introduction

This topic contains information on developing for the willful misconduct aspect of an injury, including when to develop for willful misconduct, and where to find information on administrative determinations of insanity.

---

Change Date

April 21, 2015

---

V.i.2.4.a.  When to Develop for Willful Misconduct

Pension is not payable for any condition due to the Veteran’s own willful misconduct.   Develop the willful misconduct aspect of an injury in a pension case only when the residual disability from that injury would be a material factor in the grant or denial of a claim.  If there is doubt on this point, obtain advice from the rating activity. Generally, if the facts of record are relatively clear as to the innocent incurrence of an injury, suggesting no element of willful misconduct, do not develop for this aspect of the claim.   Example:  Unless there is a reasonable probability of willful misconduct, the mere fact that the injury was incurred in an automobile accident is not sufficient reason to initiate development.   Reference:  For more information on willful misconduct, see M21-1, Part III, Subpart v, 1.D, and 38 CFR 3.301.

---

V.i.2.4.b.  Where to Find Information On  Administrative Determinations of Insanity

If there is a question as to whether a Veteran was insane at the time he/she committed an act that would otherwise be considered misconduct, see M21-1, Part III, Subpart v, 1.E.

---

 

5.  Referring Pension Claims to the Rating Activity

 

---

 

Introduction

This topic contains information on referring pension claims to the rating activity, including general information on referring claims to the rating activity, and action to take in cases in which the Veteran does not meet the minimum service requirement.

---

 

Change Date

April 21, 2015

---

 

V.i.2.5.a.  General Information on Referring Pension Claims to the Rating Activity

Refer a claim to the rating activity, provided that medical evidence adequate for rating has been received, or evidence or allegations of record are sufficient to create a rating issue, and the claimant meets all the criteria (service, income and net worth, and, for survivor claims, relationship).  References:  For information on when Survivors Pension claims would need a rating determination, see M21-1, Part V, Subpart ii, 2, and 3, and the definition of adequate medical evidence for pension rating purposes, see M21-1, Part V, Subpart i, 2.2.f.

---

 

V.i.2.5.b.  Action to Take in Cases in Which the Veteran Does Not Meet the Minimum Service Requirement

If the Veteran does not meet the minimum service requirement, refer the claim to the rating activity for a determination of basic eligibility only if military service department records indicate that the Veteran was discharged because of disability.   References:  For information on the minimum service requirements for pension, see M21-1, Part V, Subpart i, 1.2 exceptions to the minimum service requirements, see M21-1, Part III, Subpart ii, 6.4, and calculating travel time, see M21-1, Part III, Subpart ii, 6.5.