WEEK SEVEN

Disability Pension

Death Pension

Special Monthly Pension

PENSIONvs

COMPENSATION

Compensation

Monthly benefit paid based on a disability incurred in or

aggravated by military service.

Income from other sources is

not a factor.

Pension

Monthly benefit paid based on a disability not incurred in or

aggravated by military service.

Income based benefit.

Pension Requirements

• Service Time: Veteran must have served 90 days with at least ONE day during war time.

• Veteran totally disabled by age or facts shown

• Net worth determination- estate under $80,000 excluding family home

• Limited household income

War Time Periods• World War I: April 6, 1917, through November 11, 1918,

inclusive. If the veteran served with the United States military forces in Russia, the ending date is April 1, 1920. Service after November 11, 1918 and before July 2, 1921 is considered World War I service if the veteran served in the active military, naval, or air service after April 5, 1917 and before November 12, 1918.

• World War II: December 7, 1941, through December 31, 1946, inclusive. If the veteran was in service on December 31, 1946, continuous service before July 26, 1947, is considered World War II service.

War Time continued• Korean War: June 27, 1950, through January 31, 1955,

inclusive.

• Vietnam War: The period beginning on February 28, 1961 and ending on May 7, 1975, inclusive, in the case of a veteran who served in the Republic of Vietnam during that period. The period beginning on August 5, 1964, and ending on May 7, 1975, inclusive, in all other cases.

• Persian Gulf War: August 2, 1990, through date to be prescribed by Presidential proclamation or law.

Veteran or Surviving Spouse?

• Veteran’s basic entitlement requires determination of total disability by age or facts shown

• Widow(er)’s basic entitlement is presumed regardless of age or factual disability

3 Levels of Disability Pension• Basic - Permanent and total (P&T):

– The veteran is deemed unemployable by age or facts shown

• Housebound (HB):– The veteran or surviving spouse is deemed totally disabled

PLUS is demonstrated to be unable to leave the residence without assistance of another person

• Aid and Attendance (A&A):– The veteran or surviving spouse requires assistance with

activities of daily living (bathing, dressing, toileting, meal preparation, etc or is a resident in state licensed nursing home)

Disability Determination

If the veteran is under age 65 total disability must be proven unless in the receipt of Social Security Disability, or similar other federal or state benefit, in which case total disability is presumed and no medical determination is necessary.

Disability Determination

If the veteran is over age 65, total disability is presumed and no medical determination is necessary.

Housebound Benefits

Intermediate rate of pension.

Housebound benefits are granted when the claimant (veteran or surviving spouse) is essentially confined to the home.

Entitlement to Housebound benefits requires a factual determination by the VA Rating Board evaluating all disabilities.

Aid & Attendance BenefitsHighest rate of pension.

A&A is granted when the medical shows that the claimant is so disabled as to require the aid and attendance of another person to protect them from the hazards of daily life and to assist with activities of daily life OR is a resident in a state licensed nursing home and certified to be receiving nursing care.

Estate Assets• The VA has an $80,000 asset threshold:

– Bank accounts– CD, IRA, money market– Real Property (not including the family home)

• Cases involving assets over the threshold, require an administrative decision.

• Lower asset limits may be applied in special cases such as advanced age or terminal case.

Income

• Pension is a claim for an income-based benefit AND must be denied if countable income exceeds the applicable income limit.

• The level of countable income determines the rate of VA benefits. VA benefits are reduced dollar for dollar by countable income.

Types of Income

• Employment wages

• Social Security

• Retirements

• Annuities

• Interest

• All other income except SSI or General Assistance (State or Federal)

Adjusted Income = IVAP

• The VA may reduce the countable annual income for any non-reimbursed medical expenses which exceed $612 annually for a single vet ($802 vet w/ 1 Dep). Some medical expenses may be projected as recurring.

- = IVAP

Examples of Medical Expenses

• Medicare Deductions• Private Health

Insurance Premiums• Rx Co-payments• Meal Supplements

and/or Vitamins (if order by Doctor)

• Mileage to Doctor Appointments

• Dental Work• Eyeglasses

How Much $ Does VA Pay ?

VA pays the difference between countable family income and the yearly income limit based on the number of dependents.

This difference is generally paid in 12 equal monthly payments rounded down to the nearest dollar.

2012 Disability Pension Maximum

• Veteran without dependent $12,256 ($1021 per mo)• Veteran with one dependent $16,051 ($1337 per mo)• Veteran permanently housebound - no dependents

$14,978 ($1248 per mo)• Veteran permanently housebound - one dependent

$18,773 ($1564 per mo)• Veteran needing regular aid and attendance - no

dependents $20,447 ($1703 per mo)• Veteran needing regular aid and attendance - one

dependent $24,239 ($2019 per mo)

2012 Survivor’s Pension Maximum

• Widow(er) $8,219 ($684 per mo)

• Widow(er) with Housebound $10,046 ($837 per mo)

• Widow(er) with Aid & Attendance $13,138 ($1094 per mo)

• Medical expense exclusion - $410 per year

Evidence Requirements?

• Discharge

• Marriage Certificate

• VA Form 21-526 – veteran application

• VA Form 21-534 – widow(er) application

• VA Form 21-2680 – medical evaluation

• VA Form 21-8416 – medical expenses

• VA Form 21-8049 – family household expenses

• Home Care provider statement

Benefit CalculationThe formula calculation is:

•Reportable medical expenses – deductible = allowable medical expenses.

•Reported income – allowable medical expenses = income for VA purposes (IVAP)

•Maximum benefit – IVAP = annual payable benefit

•Annual payable benefit / 12 = monthly benefit

Lets look at a realistic situation:

Veteran is married, 87 years old, has Alzheimer's and suffers from the residuals of stroke. Vet has been prescribed by his doctor to be in the need of HOME BASED nursing care due to his disabilities. His doctor has completed VA Form 21-2680 which describes his needs, abilities and limitations. Based on the evidence the VA has determined in a rating board decision that the veteran is in need of the aid & attendance of another person in his home.

What evidence does the VA need?

VA must have complete application, VA Form 21-526, with household income, net worth and medical expense data.

Income: month annualVet Social Security $1,199.90 $14,398.80Vet retirement 615.00 7,380.00Spouse Social Security 879.90 10,558.80Spouse retirement 443.00 5,316.00Interest on investment 150.00 1,800.00

Total household income $39,453.60

Problem??

Maximum income limit for veteran in need of A&A with one dependent??

$24,239 annually

Vet’s household income is $39,453.60

Vet is $15,214.60 over income for pension.

Now what do we do?

Vet and his wife have medical expenses:monthly annual

Vet Medicaid premium $ 99.90 $1,198.80Wife Medicaid premium 99.90 1,198.80Supplemental insurance policy premium

210.00 2,520.00Vet prescriptions copays 310.00 3,720.00Wife prescriptions copays 42.50 510.00MD visit co-pays 50.00 600.00 Vet diapers 144.00 1,728.00Non prescription med needs 32.00 384.00Nursing Aid (12x6x30) 2,160.00 25,920.00

Total $ 37,779.60

Remember our formula?

Reportable medical expenses – deductible = allowable medical expenses.

Reported income – allowable medical expenses = income for VA purposes (IVAP)

Maximum benefit – IVAP = annual payable benefit

Annual payable benefit / 12 = monthly benefit

Reportable medical expenses $37,779Deductable (vet w/one dep) 802Allowable medical expenses 36,977

Reported Household Income 39,453Allowable Medical Expenses 36,977Income for VA Purposes 2,476

Max VA benefit (vet A&A w/one dep) 24,239IVAP 2,476Annual Payable Benefit 21,763

Monthly Benefit to veteran $1,813

Claimants requiring nursing care but not in a licensed nursing home must be able to document the services provided and the cost of those services. Nursing (medical) services must be separated from housekeeping services or room & board such as in an Assisted Living or Adult Foster Care facility. Depending on demonstrated need VA may allow all or partial of paid expenses.

Certification that a claimant is receiving nursing services as a patient in a state licensed nursing home will be accepted as evidence of the need for aid & attendance. In such cases the full cost of nursing home care will be accepted as medical expense for pension purposes

Another Case of Veteran with spouse. Vet living in Assisted Living Facility. Requires medical determination that veteran requires A&A which has been granted.

Income: month annualVet Social Security $1,199.90 $14,398.80Vet retirement 615.00 7,380.00Spouse Social Security 879.90 10,558.80Spouse retirement 443.00 5,316.00Interest on investment 150.00 1,800.00

Total household income $39,453.60

Vet and his wife have medical expenses:monthly annual

Vet Medicaid premium $ 99.90 $1,198.80Wife Medicaid premium 99.90 1,198.80Supplemental insurance policy premium

210.00 2,520.00Vet prescriptions copays 310.00 3,720.00Wife prescriptions copays 42.50 510.00MD visit co-pays 50.00 600.00 Vet diapers 144.00 1,728.00Non prescription needs 32.00 384.00Assisted Living charges (30x$125) 3,750.00 45,000.00

Total Medical Expenses: $56,859.00

Reportable medical expenses $56,859Deductible (vet w/one dep) 802Allowable medical expenses 56,057

Reported Household Income 39,453Allowable Medical Expenses 56,057Income for VA Purposes -0-

Max VA benefit (vet A&A w/one dep) 24,239IVAP -0-Annual Payable Benefit 24,239

Monthly Benefit $2,019

Single Claimant(veteran or surviving spouse)

The process above is the same using the appropriate income limits in the calculations

Annually, the first of each year, the VA solicits an income and medical expense report from the veteran (claimant).

Based on this information the VA will make a retroactive adjustment on past pension entitlement and either pay a retroactive benefit or create an overpayment.

The VA will also make an annual decision of continued pension entitlement based on any changes which may have occurred.

Maximum benefit payable to either veteran with no dependents on pension or surviving spouse on death pension with no dependents in a MEDICAID nursing care bed is $90.00 monthly.

MEDICAID and VA Pension

Questions?