Service Disabled Veterans Insurance

[paulstrgn]

I am 100% P&T. I have called the toll free number for the VA life insurance and have been given conflicting information. The first person I spoke to said I am not eligible to apply for the waiver of premiums on a $10,000 life policy because I am working, the second person said I need to apply for the waiver and see what they say. He said I may or may not be given the waiver, he said you won't know until you apply.

Does anyone have the SDVI for $10,000 and is employed get the premiums waived? I only want to apply if the premiums will be waived. I am also under 65 and it has been less than 2 years since my last new disability.

Thanks

 

[Vync]

12 hours ago, jbasser said:

SDVI waiver of Premium is based on Permanent and Total. The case of a Veteran working or not is moot and should not be a discussion item. VA disability is based on the loss of earnings ability your disability has caused. It is not like SSDI as that is all or nothing.  

Go ahead and file the paperwork.  The Permanent and Total is law. If these people would only do their job and quit confusing veterans about life insurance. 

I agree completely

[Vync]

Hello everyone,
Yesterday, a very nice lady at the VA insurance center called. I had placed a White House hotline complaint about the VA not granting waivers for P&T veterans who are still employed. Of course, I was told the same thing as before. 

She pointed me to https://www.law.cornell.edu/uscode/text/38/1912 and said for insurance purposes the VA does not consider P&T to be the same as total disability, which she said was being unable to work.

She then referred me to the insurance application form https://www.vba.va.gov/pubs/forms/VBA-29-357-ARE.pdf

 

She also referred me to the online VA benefits book: https://www.va.gov/opa/publications/benefits_book/Chapter_2_non_healthcare_benefits.asp#VA-Life-Insurance

Quote

Service-Disabled Veterans’ Insurance (S-DVI):

Veterans who separated from service on or after April 25, 1951, under other than dishonorable conditions who have VA rated service-connected disabilities, even disabilities that are zero percent disabling, but are otherwise in good health, may apply to VA for up to $10,000 in life insurance coverage under the S-DVI program. Applications must be submitted to the VA Insurance Center in Philadelphia within two years from the date of being notified of the approval of a new service-connected disability by VA. Veterans who are totally disabled (i.e. unable to work due to disability (ies) or have certain statutory conditions) may apply for a waiver of their S-DVI premiums. If approved for waiver of premiums, the Veteran can apply for additional supplemental S-DVI coverage of up to $30,000. However, premiums cannot be waived on the additional supplemental S-DVI.
To be eligible for this type of supplemental insurance, Veterans must meet all three requirements below:
1. be under age 65;
2. be eligible for a waiver of S-DVI premiums due to total disability; and
3. apply for additional insurance within one year from the date of notification of approval of waiver of premiums on the basic S-DVI policy.

And finally: https://www.benefits.gov/benefit/4759

Quote

Waiver of Insurance Premiums for Disabled Veterans

Some Veterans Affairs (VA) life insurance policyholders may have their premiums waived, if they become totally disabled.

Many VA life insurance policies provide for a waiver of premiums if you become totally disabled. However, the following policies do not:

• Supplemental Service-Disabled Veterans Insurance (SRH)
• Servicemembers' Group Life Insurance (SGLI)
• Veterans' Group Life Insurance (VGLI)
• Veterans' Mortgage Life Insurance (VMLI)

If your policy allows for a waiver, you must meet the following requirements:

1. You must have a mental or physical disability that prevents you from substantial gainful employment.
2. Your total disability must begin before your 65th birthday, and must continue for at least six consecutive months.

Your total disability may not begin prior to the effective date of the policy. There is one exception: A waiver may be granted if your total disability began prior to the effective date on a Service-Disabled Veterans Insurance policy. The total disability must be due to a service-connected disability.

 

She said this is where total disability is defined. I asked her to show me where in the US Code or 38 CFR that the VA makes that definition. She could not locate that, but still insisted that is the way the VA has always done it.

 

I decided to search through 38 CFR to see if I can find an official definition of total disability. I found it in 

https://www.law.cornell.edu/cfr/text/38/3.340

Quote

§ 3.340 Total and permanent total ratings and unemployability.

(a) Total disability ratings -

(1) General. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. Total ratings will not be assigned, generally, for temporary exacerbations or acute infectious diseases except where specifically prescribed by the schedule.

(2) Schedule for rating disabilities. Total ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent evaluation or, with less disability, where the requirements of paragraph 16, page 5 of the rating schedule are present or where, in pension cases, the requirements of paragraph 17, page 5 of the schedule are met.

(3) Ratings of total disability on history. In the case of disabilities which have undergone some recent improvement, a rating of total disability may be made, provided:

(i) That the disability must in the past have been of sufficient severity to warrant a total disability rating;

(ii) That it must have required extended, continuous, or intermittent hospitalization, or have produced total industrial incapacity for at least 1 year, or be subject to recurring, severe, frequent, or prolonged exacerbations; and

(iii) That it must be the opinion of the rating agency that despite the recent improvement of the physical condition, the veteran will be unable to effect an adjustment into a substantially gainful occupation. Due consideration will be given to the frequency and duration of totally incapacitating exacerbations since incurrence of the original disease or injury, and to periods of hospitalization for treatment in determining whether the average person could have reestablished himself or herself in a substantially gainful occupation.

(b) Permanent total disability. Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. The permanent loss or loss of use of both hands, or of both feet, or of one hand and one foot, or of the sight of both eyes, or becoming permanently helpless or bedridden constitutes permanent total disability. Diseases and injuries of long standing which are actually totally incapacitating will be regarded as permanently and totally disabling when the probability of permanent improvement under treatment is remote. Permanent total disability ratings may not be granted as a result of any incapacity from acute infectious disease, accident, or injury, unless there is present one of the recognized combinations or permanent loss of use of extremities or sight, or the person is in the strict sense permanently helpless or bedridden, or when it is reasonably certain that a subsidence of the acute or temporary symptoms will be followed by irreducible totality of disability by way of residuals. The age of the disabled person may be considered in determining permanence.

(c) Insurance ratings. A rating of permanent and total disability for insurance purposes will have no effect on ratings for compensation or pension.

[26 FR 1585, Feb. 24, 1961, as amended at 46 FR 47541, Sept. 29, 1981]

I also found it defined here, too: https://www.law.cornell.edu/cfr/text/38/4.16

Quote

§ 4.16 Total disability ratings for compensation based on unemployability of the individual.

(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities...

 

My non-official opinion
38 CFR appears to define 100% schedular P&T as "total disability". It looks like the VA insurance center elected to use 4.16(a) and 3.340(a)(1) as their definition of "total disability", but chose to ignore 3.340(a)(2) and 3.340(b) when authoring the instructions section on the application and authoring a couple of web sites. 

What does everyone think about the resources I found?

Suggestions? Ideas?

 

[Vync]

I reached out to the VA insurance center again and provided the following observations:

1. Both the insurance application and the benefits.gov link define the total disability criteria as being unemployable.

2. 38 CFR § 3.340(a) defines "total disability" as both unemployable and 100% schedular veterans.

3. 38 CFR § 1912 states the waiver applies to totally disabled veterans, but does not limit application to unemployable veterans only

 

No clue on what is going to happen. Waiting to hear back. It would be nice if the VA admits their error, corrects the resources, and makes good on the error to all eligible veterans who were wrongfully denied.

[Vync]

The nice lady at the VA Insurance Center responded and reiterated the same statements as before. We later spoke on the phone and discussed it at length. She began to realize that I may be correct and referred my concerns to their lawyers for review.

I could be right or wrong. But if I am right, just imagine, oh boy... Will find out soon.

[Vync]

This is humorous. I received a decision letter from the VA and it didn't help clear anything up. They referenced the following laws:

38 U.S. Code § 1922 - Service disabled veterans’ insurance
38 U.S. Code § 1912 - Total disability waiver
38 CFR § 8.0 - Definitions of terms used in connection with title 38 CFR, part 8, National Service Life Insurance
38 CFR § 8.6 - Payment of premiums
38 CFR § 8.2 - Calculation of time period
38 CFR § 8.19 - Beneficiary and optional settlement changes
38 CFR § 8.29 - Policy provisions

They just vaguely stated, "..based on the definition of total disability, you are not eligible for a waiver of premiums due to being gainfully employed."

Here's the problem. I checked (read/searched) each of the laws they referenced, but none contained a definition of total disability, let alone limiting to unemployable vets for insurance purposes.

Again, the only place I found the definition of "total disability" was here:

Quote

38 CFR § 3.340 Total and permanent total ratings and unemployability.

(a) Total disability ratings -

(1) General. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. Total ratings will not be assigned, generally, for temporary exacerbations or acute infectious diseases except where specifically prescribed by the schedule.

(2) Schedule for rating disabilities. Total ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent evaluation or, with less disability, where the requirements of paragraph 16, page 5 of the rating schedule are present or where, in pension cases, the requirements of paragraph 17, page 5 of the schedule are met.

Ironically, they did not reference the definition at all.

Of course, they said I can appeal via supplemental, HLR, or BVA.

 

Edited December 22, 2019 by Vync

[GBArmy]

Vync  Submit appeal to BVA and get a hobby.