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

 

[GBArmy]

Just spitballin', but what if you just call Peggy and ask if there is a dedicated group that you can be transferred to in Benefits for insurance. Ask to speak to a lead or manager. Just guessing there has to be some guru to get to.

[GBArmy]

or use IRIS and get a written reply.

[Guest]

 

On 11/7/2019 at 9:33 AM, paulstrgn said:

He said I may or may not be given the waiver, he said you won't know until you apply.

That is the best answer a person can give, never take the word of someone.  Always file a claim and make them put it in writing and if the answer is no, make them tell you why and how you can appeal.

[Vync]

14 hours ago, GBArmy said:

Just spitballin', but what if you just call Peggy and ask if there is a dedicated group that you can be transferred to in Benefits for insurance. Ask to speak to a lead or manager. Just guessing there has to be some guru to get to.

Tried that already and even got a response in writing from the S-DVI section chief, who was actually a very polite lady. She referred my concerns to their legal team. Eventually, I received a response in writing basically regurgitating the same thing I was told over the phone.

I decided to consolidate my research in the following article that I just posted. It goes into all the background details, each step I have attempted, and where I am at in my research.

 

 

 

[Vync]

@paulstrgn and anyone else who has been following my S-DVI waiver research. I recently learned some very interesting things. Please review and let me know your opinions.

In brief:

Until 1995, the VA relied on 38 CFR 8.43 to redefine "total disability" as unemployable, but this regulation no longer exists.

After the Paperwork Reduction Act of 1995, that regulation was eliminated and the definition was moved to M29-1, Chapter 16, 16.01(a), which is a policy. The VA claims the policy is still backed by Federal case law history.

Prior to 1995, there were Federal district court 70 references (per Westlaw) which referred to 38 CFR 1912 Total Disability Waiver. Most of those cases involve something other than "total disability" and employment, such as beneficiary rights, timely application, and circumstances beyond a veterans control.

Five of the Federal district court cases granted the waiver in favor of the veteran, despite being employed either part or full-time. 

Quote

Existence of work record following failure of insured to pay premiums for National Service Life Insurance policy is not necessarily decisive of question as to whether policy matured by reason of insured's total and permanent disability prior to its becoming lapsed, and question is whether or not extent and character of insured's work record completely refutes evidence tending to show that he was totally and permanently disabled before date when his policy lapsed. Langley v. U.S., S.D.Ala.1957, 155 F.Supp. 458 . Armed Services 79(29)

The court granted a win because work record alone cannot refute "total disability" status.

 

Quote

A person may be totally and permanently disabled so as to be entitled to waiver of premiums of National Service Life Insurance policy even though he is working full time. Sauer v. U.S., E.D.Wis.1954, 119 F.Supp. 137 . Armed Services 65 ; Insurance 2035

The court granted a posthumous win after the veteran succumbed to a brain tumor he learned about before it was too late, despite continuing to work to some degree. 

 

Quote

In determining whether or not insured was “permanently and totally disabled” for purpose of waiver of premiums, test was not whether insured worked but whether he was able to work continuously at some substantially gainful occupation without material injury to his health. Makowski v. U. S., M.D.Pa.1952, 105 F.Supp. 575 . Armed Services 65

The court granted a win. Despite being P&T, the veteran continued to work in peril to his health and eventually committed suicide. The court deemed that the question of total and permanent disability a question for the jury. They also found totally and permanently disabled still applies if working.

 

Quote

Where insured had been continuously and totally disabled as result of gunshot wound through chest and brain disease, which was either brain tumor or abscess, for period of more than six months, and where such period had commenced subsequent to date of application for insurance and while insurance was in force, fact that insured had attempted, despite advice of physician, to work in order to alleviate dire financial condition, did not preclude right to waiver of premiums and recovery on policy. Sims v. U.S., M.D.Tenn.1952, 101 F.Supp. 700 . Armed Services 65

The court granted a win. Despite being told by his physician that he should not work, he continued to work part time out of economic necessity. Employment does not preclude right to a waiver of premiums.

 

Quote

Where insured was suffering from endocarditis and his condition was such from October 1945 until his death in January 1946 that for him to have engaged in any work continuously would have endangered his life, insured was “totally disabled” within National Service Life Insurance policy. Stephens v. U.S., E.D.Ky.1949, 85 F.Supp. 620 . Armed Services 73(1)

The court granted a win. They found "total disability" is not to be interpreted to as not being able to work, helplessness, or complete disability. They found working could aggravate the danger from the disease from which the insured is suffering.

 

The regulation defining "total disability" is 38 CFR 3.340. (a) defines it by default as unemployable, (b) extends it to 100% rated vets, and (c) extends it to P&T veterans (if I am reading it all correctly).

It is my understanding that a VA policy cannot supersede a law or regulation (which carries the weight of law).

I assume this may be Clear and Unmistakable Error (CUE) because the VA is incorrectly citing a policy (M29-1) to supersede a law (38 CFR 3.340).

I'm still doing more research and bouncing it off of a couple of more resources before I submit my appeal.

 

 

Full details, the letter received from the VA, the 70 court case waiver references, and additional documentation can be found in my blog article.

 

 

[CapnHaddock]

I am 100% P&T and following this like a hawk.  I would like nothing more than 10K in insurance funded under my status.  However, the financial implications to the VA are large.  778K veterans are 100% - lets say 400K accept the new free insurance.  That is $4 Billion dollars that they must plan for because they will have to pay it.  The VA will fight this all the way.