Benefits

Information on VA benefits, Social Security benefits, how to files claims, and how to appeal denials.

CHAMPVA?

Question:


I am going on Medicare in a few months and have recently been awarded CHAMPVA. I hear CHAMPVA does not pay claims timely and therefore should I also sign up for a Medigap plan also?

 

Jim's Reply:

How much insurance you want and need is a very personal and individualized decision. My personal experience with CHAMPVA via my wife using it is that it's simply great insurance. In many years of using CHAMPVA we've had only a small handful of problems that we resolved pretty quickly. I believe they pay as quickly as most any insurer does.
 

I urge veterans to set up the accounts at doctors offices by visiting their insurance billing staff long before seeing the doctor. Paperwork glitches don't go well at CHAMPVA so you need to be sure all the t's are crossed and all the i's are dotted. For procedures or specialists referrals, call CHAMPVA ahead of time and get your preapprovals in line. Patience!
 

CHAMPVA and Medicare have unique rules and coverages so as you blend the two policies together, you should spend enough time learning about who covers what and when that you won't have any issues.
 

I've never thought much of Medigap and similar policies. They're expensive and don't really help that much. Rather than sending my money to an additional insurer I set aside an amount equal to that for use with any out of pocket expenses I may incur. I'm way ahead at this point.
 

I'm glad you're putting thought into this. If done right the combo of Medicare and CHAMPVA puts you in one of the most insured groups in America...well worth sorting through any details.
 

Your next task...what do you do in an emergency? Where do you go? If you aren't conscious, what do family members tell paramedics about where to take you? Do you know which hospital you want to go to? You can save a bundle of money, and maybe your life, with planning. Good luck!

 

TDIU

Question:

 

Multiple questions:
 

  1. What would be the exact term in my documents or benefits that would let me know that I am 100% PTIU? The wording is confusing and would like an expert on the matter.

     
  2. If I am 100% PTIU... does that means I can NEVER work? Is this true even if I go to medical school and graduate as a medical doctor? If so, what are the work arounds on this?

     
  3. If I hold the 100% PTIU for 10 yrs... could I go and find gainful employment through the government to buy back my 14 years I had before I left the service and collect both retirement and 100% PTIU after doing an additional 6-7 yrs as a civilian?

 

Thank you for the help and advice!

 

Jim's Reply:

The term is TDIU...Total Disability Individual Unemployability. TDIU is a shortcut to a 100% rating for the veteran who is too disabled to hold gainful employment but who doesn't hold a 100% schedular rating.

Your ratings letter will indicate that you are TDIU by informing you that you have 2 ratings, one an underlying rating of 60% or more and the TDIU rating of 100%.

You can work. You are allowed to earn up to the federal poverty level in income before VA will take notice. You can go to school...going to school isn't gainful employment. If you get a job and it pays you more than the poverty wage, you'll likely lose the TDIU benefit. Thinking it through...if the benefit is for the unemployable vet and that vet becomes employable, he or she doesn't need the benefit.

More about TDIU is here.

 

Liver Cancer & Remission

Question:

I have had surgery for liver cancer. I am in remission. My doctor at the transplant clinic wants me to have a transplant as I will have cancer again. The VA wants to drop my disability to 0%. What can I do to keep partial disability till the cancer returns? What disability would I have if I get the transplant?

 

Jim's Reply:

Your VA rates all service connected cancer at 100% as a temporary disability rating award. When the cancer is cured the rating can no longer be 100% for cancer since you no longer have that disease. 
 

Thus you will be rated on any remaining disabling conditions, 'residuals', left from the treatment of the cancer. I'll assume you've had a partial hepatectomy and that your doctors believe that there will be a significant chance of a return of the cancer without a transplant. The residual effects of your treatment, scarring, complications from anesthesia and any complications of the surgery itself must be accounted for in your final evaluation. Cirrhosis of the liver is a frequent complication that must be rated as a residual. This would be much the same after transplant surgery.
 

If I were you I'd begin making contact with a veterans law attorney and prepare to appeal a final rating that may be too low. In the end you should pay close attention to the doctors and follow their instructions...your health is the #1 consideration. Good luck.

 

VA Disability Compensation and Divorce: Facts and Fallacies

Frequently asked questions about VA disability compensation and how the court handles it in divorce, family support, garnishment and military pension divisions.

TDIU and Taxes

Question:

Hello, I'm a Navy veteran who lives in New Jersey with a 70% service connected disability. According to my VA letter that states my benefit information it says that I 1) have a disability evaluation of 70%, 2) I am being paid at the 100% rate because of being unemployable due to me service connected disability and 3) that I am also considered to be totally and permanently disabled due to me service connected disability. I also have no further evaluations in the future. I was told that I should qualify for a 100% property tax exemption.


When I filed my paper work and sent it to the tax assessor it was denied. The tax assessors returned a form stating it was denied because my application failed to satisfy the requirements because of, "Certification of 100% P&T from the US VA and because my VA letter benefit stated I was 70% according to my combined service connected evaluation. According to my ratings decision letter from the VA I am pretty much entitled to the same benefits as someone having a 100% evaluation. Including be eligibility to Chapter 35 from my children. So my question is... am I not entitled to a property tax exemption in NJ or am I entitled and there an error on the tax assessors past in denying my application? Thank you!

 

Jim's Reply:

This is a very common occurrence. The trick to getting past this is to print your own letter in eBenefits. If you don't have an eBenefits account you'll need to take the time to establish one and then give it time to update your data.
 

Once you've done that you can explore and find the section that allows you to print your own benefits letter. When you do you simply leave out the 70% part and keep the 100%...easily done since the letter was designed for this. Once you get into your account you'll get the idea of how to do this. 
 

VA Letters: Download and modify VA letters, including Civil Service Preferences, Commissary and Exchange Privileges, Service Benefit Verification, and Proof of Service Card.
 

It works, I've used this myself and each state has accepted the letter, no problems. Good luck!

 

eBenefits

Question:

Good morning Jim,


I have a 100% P&T scheduler rating since October 2020, however when I print out my award letter it still says that I am being paid at the 100% rate because of my unemployability. I became unemployable in November of 2016. My October 2020 100% schedular rating was back dated to July of 2011, but it does not reflect that in my award letter either. Will VA update my information in the system? Thanks.

 

Jim's Reply:

Yes, VA should update your information in the system. No, they don't always do that in a timely way. The only thing I can suggest that you do is to seek help at the VA toll free number or better yet, call the veterans hotline at (855) 948 - 2311. Good luck!

 

PUA & a rating?

Question:

Hello,


If I presently get 90% VA permanent disability benefits can I still apply for Pandemic Unemployment Assistance (PUA)  with no drawbacks from the VA? Thank you for your help.

 

Jim's Reply:

Yes you may. Be sure to check the details of such with your state...each state has different rules.

 

IHD

Question:

I was diagnosed with nonobstructive CAD and mild hypertrophy. I served in Vietnam from 1967 to 1969. Is this something I can file for with the VA?

 

Jim's Reply:

CAD or Coronary Artery Disease is called Ischemic Heart Disease (IHD) by the VA. IHD is a presumptive condition for the Vietnam veteran who served with boots on the ground in the country of Vietnam.
 

You should proceed to file a claim at your earliest convenience. How to file a claim.

 

CHAMPVA?

Question:

I’m a 100% DV who uses both VA and Medicare. My wife was just approved by CHAMPVA. Are there any impediments to her using this as her primary healthcare? Assuming she can use it as her primary, does she just provide her info when she goes to see her doctor? Thanks.

 

Jim's Reply:

What you use doesn't count in the equation. What counts is whether or not your dependent has any other health care insurance available? If she also has Medicare there may be some competing provisions.
 

If CHAMPVA is to be her primary insurer, that's fine. My wife has used CHAMPVA for many years and we think it's the best insurance ever. The only cautions I'd offer are to head to the doctor she chooses early, before she needs an appointment. She should speak with the insurance billing staff to get her account set ahead of time. 
 

Any procedures and complex referrals that may need authorization should be taken care of ahead of time. CHAMPVA pays for many preventive procedures as well as specialty consults but to ensure prompt payment, get a preauthorization.
 

Patience and preparation are the key to success with CHAMPVA. Good luck.

 

Travel Pay?

Question:

What going on with our travel pay? Some of us have not received any travel pay since September.

 

Jim's Reply:

I don't know. Travel pay is produced locally when you sign in to your appointment. I sign in at a self serve kiosk and I have to remember to complete Part 2 if I want travel pay. It's easy to skip over that part. But...I've been getting my little bonus, no problems.
 

You'll need to speak to your clinic administrator to see if mistakes have been made.