IntroductionIntroduction

Not a tool for use with contractual Not a tool for use with contractual issuesissues

Nothing to do with MSPB or OWCPNothing to do with MSPB or OWCP A tool for organizingA tool for organizing Help veterans obtain medical Help veterans obtain medical

assistance and compensation through assistance and compensation through department of veterans affairs.department of veterans affairs.

ObjectiveObjective

Familiarize APWU reps with DVA Familiarize APWU reps with DVA procedures.procedures.

Educate membership in need of Educate membership in need of assistance with DVA.assistance with DVA.

Assist members obtain benefits from Assist members obtain benefits from DVA.DVA.

What is the VA ?What is the VA ?

Cabinet level government agencyCabinet level government agency Applies federal law concerning Applies federal law concerning

veteransveterans Provides medical treatment to Provides medical treatment to

veteransveterans Awards compensation to veterans Awards compensation to veterans

injured in the performance of duty.injured in the performance of duty.

What does VA offer ?What does VA offer ?

Disability BenefitsDisability Benefits Educations and Training benefitsEducations and Training benefits Vocational Rehab and employment Vocational Rehab and employment

assistanceassistance HealthcareHealthcare Life insuranceLife insurance More…More…

Who is Eligible?Who is Eligible?

VeteranVeteran Spouse Spouse DependantDependant Surviving spouse or dependantSurviving spouse or dependant Guard, reserves, regular military Guard, reserves, regular military

serviceservice

What is the Source ?What is the Source ?

Title 38 Code of Federal Regulations Title 38 Code of Federal Regulations is the act which provides for all of the is the act which provides for all of the benefits provided by VAbenefits provided by VA

We will Focus on 2 different We will Focus on 2 different types of benefit…types of benefit…

Disability Compensation applies if Disability Compensation applies if veteran is at least 10% disabled as veteran is at least 10% disabled as a result of military servicea result of military service

Disability pension applies if Disability pension applies if veteran is a wartime veteran with veteran is a wartime veteran with LIMITED INCOME, NO LONGER ABLE LIMITED INCOME, NO LONGER ABLE TO WORK, OR IS 65 OR OLDER TO WORK, OR IS 65 OR OLDER

What does Service Connection What does Service Connection mean, why is it importantmean, why is it important

When VA grants When VA grants service connection:service connection: It acknowledges that a condition/injury is the result It acknowledges that a condition/injury is the result

ofof or has been or has been aggravatedaggravated by military service by military service

Determinations about service connection will Determinations about service connection will be based on a review of the entire evidence be based on a review of the entire evidence in the record, with due consideration to the in the record, with due consideration to the VA’s policy of administering the law under a VA’s policy of administering the law under a liberal interpretation consistent with the liberal interpretation consistent with the facts in each case.facts in each case.

What is the Criteria to establish What is the Criteria to establish Service ConnectionService Connection

Discharge type (first thing researched Discharge type (first thing researched by VA)by VA)

EligibilityEligibility Medical Diagnoses of Medical Diagnoses of currentcurrent

disabilitydisability Evidence of service occurrence or Evidence of service occurrence or

aggrevationaggrevation NexusNexus

EligibilityEligibility requires discharge or released from military service requires discharge or released from military service under conditions other than dishonorable.under conditions other than dishonorable.

Honorable discharge (HD);Honorable discharge (HD);

Discharge under honorable conditions (UHC), or general discharge Discharge under honorable conditions (UHC), or general discharge (GD);(GD);

Discharge under other than honorable conditions (UOTHC), or Discharge under other than honorable conditions (UOTHC), or undesirable discharge (UD);undesirable discharge (UD);

Bad conduct discharge (BCD) (which can be issued by sentence of Bad conduct discharge (BCD) (which can be issued by sentence of either a special court-martial or a general court-martial); andeither a special court-martial or a general court-martial); and

Dishonorable discharge (DD) or a dismissal, the latter in the case Dishonorable discharge (DD) or a dismissal, the latter in the case of an officer (both are issued only by a general court-martial).of an officer (both are issued only by a general court-martial).

Honorable discharges and discharges under honorable conditions are, with Honorable discharges and discharges under honorable conditions are, with some rare exceptions, considered by the VA as discharges under some rare exceptions, considered by the VA as discharges under ““conditions other than dishonorable” and therefore are sufficient conditions other than dishonorable” and therefore are sufficient to qualifyto qualify the claimant as a veteran under the first part of the eligibility the claimant as a veteran under the first part of the eligibility test. Bad conduct discharges from a special court-martial and discharges test. Bad conduct discharges from a special court-martial and discharges under other than honorable conditions may or may not make a veteran under other than honorable conditions may or may not make a veteran and the veteran’s dependents ineligible for benefits. If a claimant for and the veteran’s dependents ineligible for benefits. If a claimant for benefits has one of these types of discharge, the VA will first adjudicate the benefits has one of these types of discharge, the VA will first adjudicate the issue of the character of service by making a special “character of service issue of the character of service by making a special “character of service determination,” based on the facts in each case, to decide whether the determination,” based on the facts in each case, to decide whether the veteran was separated from service under “dishonorable conditions” or veteran was separated from service under “dishonorable conditions” or “other than dishonorable conditions.“other than dishonorable conditions.

Three Fundamental Requirements Three Fundamental Requirements to Obtaining Service-Connected to Obtaining Service-Connected

Disability CompensationDisability CompensationA veteran seeking service-connected disability compensation A veteran seeking service-connected disability compensation

must satisfy three fundamental requirements before VA will must satisfy three fundamental requirements before VA will grant compensation benefits. grant compensation benefits.

First, there must be a medical diagnosis of current First, there must be a medical diagnosis of current disability. disability.

Second, there must be medical, or in certain Second, there must be medical, or in certain circumstances, lay evidence of in-service occurrence circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury.or aggravation of a disease or injury.

Finally, there must be medical evidence of a link or Finally, there must be medical evidence of a link or nexus between the in-service occurrence or nexus between the in-service occurrence or aggravation of a disease or injury and the current aggravation of a disease or injury and the current disability.disability.

Existing Disability…Existing Disability…

VA requires evidence that the veteran had a VA requires evidence that the veteran had a “presently existing disability” on the date “presently existing disability” on the date that the veteran filed the claim for that the veteran filed the claim for compensation benefits. The U.S. Court of compensation benefits. The U.S. Court of Appeals for the Federal Circuit and the U.S. Appeals for the Federal Circuit and the U.S. Court of Appeals for Veterans Claims have Court of Appeals for Veterans Claims have upheld this “presently existing disability” upheld this “presently existing disability” requirement. Evidence that a veteran had a requirement. Evidence that a veteran had a service-related disability at some point in the service-related disability at some point in the past does not satisfy this requirement.past does not satisfy this requirement.

Getting StartedGetting Started

Like the grievance procedure…Like the grievance procedure…documentation is criticaldocumentation is critical

Several sources for informationSeveral sources for information

Military medical documentation is best Military medical documentation is best info,but not the only info acceptableinfo,but not the only info acceptable

Absolutely Positively…Absolutely Positively…

Military Service Records (MUST)Military Service Records (MUST) DD – 214 (MUST)DD – 214 (MUST) Private medical historyPrivate medical history Marriage certificate / divorce Marriage certificate / divorce

documentationdocumentation Birth certificatesBirth certificates Other evidence that is relevantOther evidence that is relevant

Where/How to get recordsWhere/How to get records

DD 214 and Medical RecordsDD 214 and Medical RecordsNational Personnel RecordsNational Personnel Records

Room 230 OR WWW.archives.govRoom 230 OR WWW.archives.gov

9700 Page Blvd9700 Page Blvd

St Louis, MO 63132St Louis, MO 63132

Include your name at the time of military Include your name at the time of military service, social security number, service service, social security number, service number (if different), the approximate number (if different), the approximate dates of service and branch of service.dates of service and branch of service.

Please allow minimum of 6 weeks for Please allow minimum of 6 weeks for processing.processing.

The Duty to Assist VeteransThe Duty to Assist Veterans VA is required to obtain:VA is required to obtain:

Claimant’s service medical records,Claimant’s service medical records,

Relevant medical treatment or examination of Relevant medical treatment or examination of

the claimant, either at VA facilities or at the the claimant, either at VA facilities or at the expense of the VA (i.e., “fee basis treatment”), expense of the VA (i.e., “fee basis treatment”),

Other relevant records” held by a federal Other relevant records” held by a federal department or agency, that the claimant department or agency, that the claimant adequately identifies and authorizes the VA to adequately identifies and authorizes the VA to obtain. obtain.

Duty to Assist in Obtaining Medical Duty to Assist in Obtaining Medical Examinations / Medical OpinionsExaminations / Medical Opinions

The VA is to provide a medical examination or opinion The VA is to provide a medical examination or opinion “when such an examination or opinion is necessary to “when such an examination or opinion is necessary to make a decision on the claim.”make a decision on the claim.”

Statutes further provide that a medical examination or Statutes further provide that a medical examination or opinion shall be considered necessary to make a decision on opinion shall be considered necessary to make a decision on a claim if the evidence of record, taking into consideration all a claim if the evidence of record, taking into consideration all information and lay or medical evidence (including the information and lay or medical evidence (including the claimant’s statements): claimant’s statements):

(1) contains competent evidence that the claimant has a (1) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of current disability, or persistent or recurrent symptoms of disability; anddisability; and

(2) indicates that the disability or symptoms may be associated (2) indicates that the disability or symptoms may be associated with the claimant’s active service; but with the claimant’s active service; but

(3) does not contain sufficient medical evidence for the VA to (3) does not contain sufficient medical evidence for the VA to make a decision on the claim. make a decision on the claim.

Claimant’s BurdenClaimant’s Burden The standard of proof used by the VA in deciding The standard of proof used by the VA in deciding

claims (found in 38 U.S.C.S. § 5107(b)), is a claims (found in 38 U.S.C.S. § 5107(b)), is a unique standard. The claimant unique standard. The claimant is not requiredis not required to demonstrate that he or she should be granted to demonstrate that he or she should be granted benefits by even a “preponderance of the benefits by even a “preponderance of the evidence.” evidence.”

VA can deny the claim VA can deny the claim onlyonly if the preponderance if the preponderance of the evidence is against the claim. If there is an of the evidence is against the claim. If there is an “approximate balance of positive and negative “approximate balance of positive and negative evidence regarding any issue material to the evidence regarding any issue material to the determination of a matter,” the determination of a matter,” the claimant wins claimant wins and the claim is granted.and the claim is granted.

SEE CHART IN HAND OUT PAGES STARTING ON SEE CHART IN HAND OUT PAGES STARTING ON PAGE 9 FOR MORE DETAILSPAGE 9 FOR MORE DETAILS

Benefit of the Doubt DoctrineBenefit of the Doubt Doctrine38 C.F.R. pt. 4, the rating schedule: 38 C.F.R. pt. 4, the rating schedule:

““When, after careful consideration of all procurable and When, after careful consideration of all procurable and assembled data information, a reasonable doubt arises assembled data information, a reasonable doubt arises regarding the degree of disability such doubt will be regarding the degree of disability such doubt will be resolved in favor of the claimant.” resolved in favor of the claimant.”

An approximate balance of positive and negative evidence An approximate balance of positive and negative evidence regarding the merits of a material issue, the claimant will regarding the merits of a material issue, the claimant will be given the benefit of the doubt in resolving each of these be given the benefit of the doubt in resolving each of these issues.issues.

It is the defined and consistently applied policy of the It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be regarding the degree of disability such doubt will be resolved in favor of the claimant resolved in favor of the claimant

Now What…Now What…

VA has a form 21-526 that can be VA has a form 21-526 that can be completed to initiate a claim. completed to initiate a claim. However, any format may be used so However, any format may be used so long as:long as:

It is completeIt is complete

Contains Vets ID such as SSN, Service Contains Vets ID such as SSN, Service numbernumber

States a claimStates a claim

Evidence needed to substantiate a claimEvidence needed to substantiate a claim VA is required to inform the claimant:VA is required to inform the claimant:

(3)(3) of the information and evidence not of record of the information and evidence not of record that is necessary to substantiate the claim;that is necessary to substantiate the claim;

(4)(4) of the information and evidence that VA will of the information and evidence that VA will obtain;obtain;

(5)(5) of the information and evidence that the of the information and evidence that the claimant must submit;claimant must submit;

(4) to provide any evidence in the claimant’s (4) to provide any evidence in the claimant’s possession that pertains to the claim.possession that pertains to the claim.

give us everything you’ve got pertaining to give us everything you’ve got pertaining to your claim(s),’ or something to that effect.”your claim(s),’ or something to that effect.”

The Rating ProcessThe Rating Process First, the VA determines if the veteran is eligible to receive First, the VA determines if the veteran is eligible to receive

VA benefits, including whether the veteran was discharged VA benefits, including whether the veteran was discharged or separated under other than dishonorable conditions.or separated under other than dishonorable conditions.

Second, if the veteran survives the first step, the VA then Second, if the veteran survives the first step, the VA then decides whether the veteran qualifies for disability decides whether the veteran qualifies for disability compensation under the rules discussed in this chapter.compensation under the rules discussed in this chapter.

Third, if steps one and two are satisfied, the VA then Third, if steps one and two are satisfied, the VA then determines the severity of the disability and assigns a determines the severity of the disability and assigns a percentage evaluation from 0 to 100 based on the Schedule percentage evaluation from 0 to 100 based on the Schedule for Rating Disabilities.for Rating Disabilities.

Fourth, the VA sets the effective date for the award of Fourth, the VA sets the effective date for the award of service-connected disability compensationservice-connected disability compensation

Notice of DisagreementNotice of Disagreement

Written communication expressing Written communication expressing disagreement with an adjudicative disagreement with an adjudicative determination by the agency and a determination by the agency and a desire to contest the result. desire to contest the result.

Special wording is not required. Special wording is not required. Notice of Disagreement must be in Notice of Disagreement must be in terms which can be reasonably terms which can be reasonably construed as disagreement and a construed as disagreement and a desire for appellate review. desire for appellate review.

Appeals AvailableAppeals Available

What is an appeal to the Board of Veterans’ What is an appeal to the Board of Veterans’ Appeals?Appeals?

An appeal is a request for a review of a VA An appeal is a request for a review of a VA determination on a claim for benefits issued by a determination on a claim for benefits issued by a local VA office.local VA office.

Who can appeal?Who can appeal? Anyone who has filed a claim for benefits with Anyone who has filed a claim for benefits with

VA and has received a determination from a local VA and has received a determination from a local VA office is eligible to appeal to the Board of VA office is eligible to appeal to the Board of Veterans’ Appeals.Veterans’ Appeals.

When can I file an appeal?When can I file an appeal?

You may file an appeal up to one year You may file an appeal up to one year from the date the local VA office mails you from the date the local VA office mails you its initial determination on your claim. its initial determination on your claim.

What can I appeal to the Board?What can I appeal to the Board? You may appeal any determination issued by a You may appeal any determination issued by a

VA regional office (RO) on a claim for benefits. VA regional office (RO) on a claim for benefits. Some determinations by VA medical facilities, Some determinations by VA medical facilities, such as eligibility for medical treatment, may also such as eligibility for medical treatment, may also be appealed to the Board.be appealed to the Board.

You may appeal a complete or partial You may appeal a complete or partial denial denial of of your claim or you may appeal the your claim or you may appeal the level level of benefit of benefit granted. For example, if you filed a claim for granted. For example, if you filed a claim for disability and the local office awarded you a 10% disability and the local office awarded you a 10% disability, but you feel you deserve more than disability, but you feel you deserve more than 10%, you may appeal that determination to the 10%, you may appeal that determination to the Board.Board.

How do I file an appeal?How do I file an appeal? No special form is required to begin the No special form is required to begin the

appeal process. All that’s needed is a written appeal process. All that’s needed is a written statement that:statement that:

(1) you disagree with your local VA office’s (1) you disagree with your local VA office’s claimclaim

determination and determination and (2) you want to appeal it. (2) you want to appeal it.

More specific info is available in the VA More specific info is available in the VA booklet:booklet:

““The Board of Veterans Appeals” and The Board of Veterans Appeals” and “How do I appeal”“How do I appeal”

DISABILITY PAYMENTSDISABILITY PAYMENTS10% $106.0010% $106.0020% 20% $205.00$205.0030%30% $316.00$316.0040%40% $454.00$454.0050%50% $646.00$646.0060%60% $817.00$817.0070%70% $1029.00$1029.0080%80% $1195.00$1195.0090%90% $1344.00$1344.00100%100% $2239.00$2239.00

Between 30 and 100 there are allowances for a spouse Between 30 and 100 there are allowances for a spouse and each minor child. The amount depends on the and each minor child. The amount depends on the disability rating.disability rating.

Commonly filed ClaimsCommonly filed ClaimsAGENT ORANGEAGENT ORANGE

After years of struggles, VA has begun recognizing and helping After years of struggles, VA has begun recognizing and helping Vietnam era vets with conditions presumptively related to Agent Vietnam era vets with conditions presumptively related to Agent Orange (aka herbicdes) exposure.Orange (aka herbicdes) exposure.

A number of pamphlets and programs are available dedicated A number of pamphlets and programs are available dedicated exclusively to Agent Orange issues.exclusively to Agent Orange issues.

Gulf War VeteransGulf War Veterans Gulf War veterans who suffer from chronic disabilities resulting Gulf War veterans who suffer from chronic disabilities resulting

from undiagnosed illnesses, medically unexplained chronic multi-from undiagnosed illnesses, medically unexplained chronic multi-symptom illnesses (such as chronic fatigue syndrome, symptom illnesses (such as chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome) that are defined by a fibromyalgia, or irritable bowel syndrome) that are defined by a cluster of signs or symptoms, and any diagnosed illness that the cluster of signs or symptoms, and any diagnosed illness that the Secretary of Veterans Affairs determines warrants a presumption Secretary of Veterans Affairs determines warrants a presumption of service-connection may receive disability compensation. The of service-connection may receive disability compensation. The undiagnosed illnesses must have appeared either during active undiagnosed illnesses must have appeared either during active duty in the Southwest Asia Theater of Operations during the Gulf duty in the Southwest Asia Theater of Operations during the Gulf War or to a degree of at least 10 percent at any time since then War or to a degree of at least 10 percent at any time since then through Dec. 31, 2006. through Dec. 31, 2006.

PTSDPTSD Post-traumatic stress disorder (PTSD) is a mental disorder Post-traumatic stress disorder (PTSD) is a mental disorder

characterized by the American Psychiatric Association’s characterized by the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders, Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) as an anxiety disorder. It appears in Fourth Edition (DSM-IV) as an anxiety disorder. It appears in the VA Schedule for Rating Disabilities under 38 C.F.R. § the VA Schedule for Rating Disabilities under 38 C.F.R. § 4.130 (2005) as diagnostic code 9411. 4.130 (2005) as diagnostic code 9411.

UNEMPLOYABLEUNEMPLOYABLE A veteran may be considered as A veteran may be considered as

unemployable upon termination of unemployable upon termination of employment which was provided on employment which was provided on account of disability, or in which account of disability, or in which special consideration was given on special consideration was given on account of the same, when it is account of the same, when it is satisfactorily shown that he or she is satisfactorily shown that he or she is unable to secure further unable to secure further employment. employment.

SERVICE AGGREVATED CONDITIONSERVICE AGGREVATED CONDITION

In cases involving aggravation by In cases involving aggravation by active service, the rating will reflect active service, the rating will reflect only the degree of disability over and only the degree of disability over and above the degree existing at the above the degree existing at the time of entrance into the active time of entrance into the active service, whether the particular service, whether the particular condition was noted at the time of condition was noted at the time of entrance into the active service, or it entrance into the active service, or it is determined upon the evidence of is determined upon the evidence of record to have existed at that time. record to have existed at that time.

RATING SCHEDULE EXAMPLERATING SCHEDULE EXAMPLE5056 Ankle replacement (prosthesis).5056 Ankle replacement (prosthesis). Prosthetic replacement of ankle joint:Prosthetic replacement of ankle joint: For 1 year following implantation of prosthesis For 1 year following implantation of prosthesis

100 100 With chronic residuals consisting of severe painful motionWith chronic residuals consisting of severe painful motion or weakness or weakness

4040 With intermediate degrees of residual weakness, pain orWith intermediate degrees of residual weakness, pain orlimitation of motion rate by analogy to 5270 or 5271.limitation of motion rate by analogy to 5270 or 5271. Minimum rating Minimum rating

2020

5256 Knee, ankylosis of:5256 Knee, ankylosis of: Extremely unfavorable, in flexion at an angle of 45[degrees] or more 60Extremely unfavorable, in flexion at an angle of 45[degrees] or more 60 In flexion between 20[degrees] and 45[degrees] 50In flexion between 20[degrees] and 45[degrees] 50 In flexion between 10[degrees] and 20[degrees] 40In flexion between 10[degrees] and 20[degrees] 40 Favorable angle in full extension, or in slight flexion betweenFavorable angle in full extension, or in slight flexion between0[degrees] and 10[degrees] 300[degrees] and 10[degrees] 30 5257 Knee, other impairment of:5257 Knee, other impairment of: Recurrent subluxation or lateral instability:Recurrent subluxation or lateral instability: Severe 30Severe 30 Moderate 20Moderate 20 Slight 10Slight 10

Service OrganizationsService Organizations Disabled American VeteransDisabled American Veterans Veterans of Foreign WarsVeterans of Foreign Wars American LegionAmerican Legion Paralyzed Veterans of AmericaParalyzed Veterans of America Many more…Many more…

Helpful Telephone NumbersHelpful Telephone NumbersVA Benefits1-800-827-1000VA Benefits1-800-827-1000

Health Benefits 1-877-222-8387Health Benefits 1-877-222-8387

Education Benefits 1-888-442-4551 Education Benefits 1-888-442-4551

Life Insurance 1-800-669-8477Life Insurance 1-800-669-8477

Telecommunication Device for the Deaf (TDD)1-800-Telecommunication Device for the Deaf (TDD)1-800-829-4833829-4833

CHAMPVA 1-800-733-8387 Headstones and Markers 1-CHAMPVA 1-800-733-8387 Headstones and Markers 1-800-697-6947800-697-6947

Gulf War &Agent Orange Helpline 1-800-749-8387Gulf War &Agent Orange Helpline 1-800-749-8387Debt Management1-800-827-0648Debt Management1-800-827-0648