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Basic Service Officer Claims

Basic Service Officer Claims. Brian Mullican Department Service Officer American Legion Department of Virginia. Before we Begin here are some terms you need to know. CFR = Code of Federal Regulations S/C = Service Connected SSB = Special Separation Benefit

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Basic Service Officer Claims

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  1. Basic Service Officer Claims Brian Mullican Department Service Officer American Legion Department of Virginia

  2. Before we Begin here are some terms you need to know CFR = Code of Federal Regulations S/C = Service Connected SSB = Special Separation Benefit VSI = Voluntary Separation Benefit STRs = Service Treatment Records NEXUS = Medical statement of condition linking condition to Military Service

  3. MORE ACCRONYMS NOD = NOTICE OF DISAGREEMENT BCMR = BOARD OF CORRECTION FOR MILITARY RECORDS DCR = DISCHARGE REVIEW BOARD CUE = CLEAR AND UNMISTAKABLE ERROR

  4. Photo by Alfred EisenstadtTimes Square, 1945

  5. BASICTRAINING VETERANS' BENEFITS CHAPTER1INTRODUCTION

  6. THE ADVOCACY NETWORK POST SERVICE OFFICER DISTRICT SERVICE OFFICER NOT ALLOWED TO CHARGE A FEE MOST HAVE LIIVIITED I<NOWLEDGE & RESOURCES NOT ALLOWED TO WORK WITH VA DIRECTLY PROVIDE SERVICE & SUPPORT AND REFER THE I INDIVIDUAL TO AN ACCREDITED SERVICE OFFICER ALL PAPER WORK IS SENT NOT TO VA BUT THE SERVICE OFFICER THAT THE INDIVIDUAL IS WORKNG WITH SERVICE OFFICERS ARE NOT OBLIGATED TO SEND NEGATIVE INFORMATION TO VA UNLESS THEY ASK FOR IT

  7. ( I OVER.VIEW:VA CLAIMS SYSTEM • NEARLY 1/3OFTHEUSPOPULATION ISPOTENTIALLY ELIGIBLE FORFEDERALVETERANS'BENEFITiS • - 26MILIJONVETERANS, 48MILLION FAMILYMEMBERS • VAISAFRlEND OF.THEVETERAN BUTITMUST • GUARDTHETAXPAYER'SMONEY • NOTHIN'G ISEVERFINALINTHEVASYSTEM • ALLCASESCANBEREOPENED • NEWMATERlALWILLBEREVIEWEDWITHTHEOLDAFRESff (ALLOVER AGAIN) • IFITISNOTNEWTHENVAHASTOINFORMTHE INDIVI:DUALOFHIS/HERRlGHTSOFAPPEAL

  8. OVER.VIEW:VA CLAIMSSYSTEM • INSOMECASES,ANDRODECISIONCANBECHANG-EDIFTHEVETERANCANSHOWTHATTHEDECISIONWASBASEDONCLEARANDUNMISTAKABLE ERROR • ALSOBASED ONTHELAW ATTHETIME THECASE • WASDENIED • ORTHEVAWASWRONG • VACLAIMSTHATTHE SYSTEMISNONADVERSARIAL (THATISVAISSUPPOSEDTO BEFAIRANDHELPTHECLAIMANT,ANDNOONEISSUPPOSEDTO BEARGUINGAGAINSTTHECLAIM

  9. BENEFITOFDOUBT • IFTHEEVIDENCEISEVENLY BALANCEDTHECLAIMISAWARDED • VAHASTHERESPONSIBILITY TOASSISTTHECLAIMANTWITH OBTAININGMEDICALRECORJ)S SOCIALSECURITYRECORDSGOVERNMENT DOCUMENTS • CONDUCTMEDICALEXAMINATIONSTOACCESSTHECLAIMANTSPHYSICALANDMENTAL CONDITIONS

  10. VETERANSARENOTAUTOMATICALLY ENTITLEDTO VAHOSPITAL CARE,NURSINGHOMECAREOROUTPATIENTTREATMENTSIMPLYBECAUSETHEYAREVETIERANS. • VAMEDICALCAREISPRINCIPALLY DIRECTEDTOWARDTREATINGMEDICALPROBLEMSTHATOCCURREDINTHESERVICE • HOWEVER,VETERANSARESOMETIMESELIGIBLEFORCAREFOROTHERPROBLEMS • - SOME\TETERANSMEDICALCAREISFREEAND OTHERS • HAVETOPAY ACO-PAY(PAYPARTOFTHECOS'TOFTHEIRCARE)

  11. ELIGIBILITY REQUIREMENTSCHAPTER2 DEFINITION OFA VETERAN VADEFINESAVETERANASSOMEONEWHOSERVEDINTHEACTIVEMILITARY,NAVAL, ORAIRSERVICE, ANDWASDISCHARGEDORRELEASEDTHEREFROM"UNDERCONDITIONS OTHERTHANDISHONORABLE.'' RESERVISTS IN ANYPERIODOFACTIVEDUTY FORTRAININ-G HOWEVER ,AVETERANNEEDNOTHAVESERVEDINWARTIME ORHAVEENGAGEDINCOMBATTOBEELIGBLEFORMANYVABENEFITS

  12. DISCHARGEREQUIREMENTS HONORABLEDISCHARGEORADISCHARGEUNDERHONORABLECONDITIONS, OFTEN CALLED A GENERAL DISCHARGE WILL QUALIFY FOR BENEFITS

  13. FAMILYMEMBERS' ELIGIBILITY • THEVETERAN MUSTFIRSTMEETTHEVA'SELIGIBILITY REQUIRElv1ENTS • SPOUSES-MUSTHAVELIVEDWITHTHEVETERAN FROMDATEOFMARRIAGE UNTILDEATH (EXCEPT INTHECASEOFSPOUSAL_A_BUSEORTHEHUSBAND SEPERATESFROMTHE SPOUSEAJ'.JD THEVETERAN ISATFAULT • - ACOMN.[ON LAWMARRIAGEISONEWHERENOWEDDINGCEREMC)NYTOOK PLACE,BUT THEYLIVEDTOGETHERANDSTOOD10UT ASHUSBANDANDWIFE • CHILDREN • LEGITIMATE • ILLEGI1T1MATE • ADOPTED • STEPCHILDREN

  14. ELIGIBILITYBYTYPEOFBENEFIT AVETERAN WITHASERVICE­CONNECTED DISABILITYRATED30PERCENT ORMOREISELIGIBLEFORADDITIONALMONTHLYPAYMENTS F01R ASPOUSE, ACHILD,ANDADEPENDENT PARENT

  15. WILLFULMISCONDUCT • THEVA WILLNOTAWARDBENEFITSFORAVETERAN'S INJURYORDISEASEIFTHEDISABILITYWASARESULTOFTHEVETERANS OWNWILLFULLMISCONDUCT

  16. APPORTIONMENT • INSOMECASESALLORPARTOFTHEPENSIONORCOMPENSIONPAYMENTSAREDIVIDEDUPAMONGFAMILYMEMBERS • OCCURSWHENFAMILYMEMBERSARENOTLIVINGWITHAND/ORTHEVETERAN IS NOT SUPPORTINGTHEM

  17. SE.RVICE-CONNECTEDCOMPENSATIONCHAPTER3 SERVICECONNECTEDCOMPENSATIONISAMONTHLYPAYMENTMADEBYTHEVATOAVETERANWITHAPHYSICAL ORMENTALDISABILITYTHATWASINCURREDORWASAGGRAVATED BYMILITARY SERVICE

  18. FIVEWAYSTOESTABLISH SERVICECONNECTION • DIRECTSERVICECONNECTION • SERVICECONNECTIONTHROUGH AGGRAVATION • PRESUMTIVE SERVICECONNECTION • SERVICECONNECTION FORINJURIESCAUSEDBY VAHEALTHCARE

  19. SERVICECONNECTION BASED ONVAMEDICALCARE ANINJURYORAGGRAVATIONOFANINJURYCAUSEDBYVA HOSPITALIZATIONMEDICALORSURGICALTREATMENT,VAEXAMS,OR VAVOCATIONALREHABILITATION CANBJESERVICECONNECTED

  20. SERVICECONNECTION BASEDONVAMEDICALCARE • SECTION 1151CLAIMS • DIDTHEINDIVIDUALSUFFERANINJURYTHAT WAS VA’S FAULT • CLAIMANTMUSTESTABLISHTHATVA FAULTOR ACCIDENTCAUSEDTHEINJURY • USUALLLY ONCETHISISDONETHEVETERAN RECIEVESAPERCENTAGERATINGANDTHEVETERANISPAIDCOMJPENSATION BENEFITS

  21. SERVICECONNECTION BASEDONVAMEDICAL CARE • IFTHESECTION1151ISBASEDONDEATH OFAVETERANTHENTHESURVIVINGSPOUSEIS AWARDEDDIC

  22. HOWTHEVARATESDISABILITYCHAPTER4 • LEVELS OFDISABILITY • ONCEVADECIDESTHATTHEDISABILYISSERVICECONNECTED,IFMUST·DECIDETHELEVELOFTHATDISABILITY,WHICH • WILLDETERMINE HOWMUCHTHEVETERAN WILLRECEIVE

  23. TO'TAL100°/oDISABILITY THEREARETWOWAYSINWHICHA VETERAN CANBERATED 100PERCENT -BYQUALIFYING UNDERTHERATING SCHEDULE -BYQUALIFYING FOR"INDIVIDUAL UNEMPLOYABILITY"

  24. SPECIALTYPESOFCLAIMS • MENTALDISORDERS • _· MOSTCOMMONISPTS(POST-TRAMATICSTRESS) • ANXIETY DISORDER • INDIVIDUALSHOWSONE ORMORECHARACTERISTIC SYMPTOMSAFTEREXPERlENCINGAVERYTRAUMATICEVE,NTORSTRESSOR • INTENSEFEAR • HORRORHELPLESSNESS • DOESNOTHAVETOBECOMBATRELATED

  25. SERVICE-CONNECTED DEATH BENEFITSCHAPTER 5 • DEPENDENCY ANDCOMPENSATION • -MONTHLYPAYMENTTOSPOUSE, • CHILDRENANDDEPENDENTPARENTS • -DEATHMUSTBESERVICECONNECTED • -SPOUSEMUSTBELEGALLYMARRIEDTOANDLIVINGWITHTHEVETERAN ATTHETIMEOFDEATH

  26. SERVICE-CONNECTED DEATH BENEFITSCHAPTER 5 • VETERAN'SDEATH SHOULDBE SERVICECONNECTEDANDWASTHECONTRIBUTING FACTORORPRINCIPALCAUSE • ITMAYNOTBEENOUGHTHATTHESERVICECONNECTIONCONTRIBUTEDTOTHEDEATH

  27. SERVICE-CONNECTEDDEATH BENEFITSCHAPTER 5 • DICHASTWOPROGRAMS • SURVIVORS OFVETERANSWHODIEDBEFOREJAN 1,1993 • BASED ONTHEHIGHESTMILITARYRANK HELD • SURVIVORS OFVETERANSWHODIEDAFTERJAN • 1, 1993 • ALl,SURVIVINGSPOUSESAREPAIDTHESAME • PAYMENTS CANBEINCREASED ONLY • -VETERANWASRECEIVING 100°/oFORTHELAST8YEARS • -THESPOUSEWASMARRIED TOTHEVETERAN FORTHOSEEIGHTYEARS

  28. RESTORED ENTITLEMENT PROGRAM FORSURVIVORS • STARTEDIN 1982TOSUPPLEMENT SOCIALSECURl'TY • NOTREALLYAVABENEFITBUT ASOCIALSECURITYBENEFITANDMANAGEDBYTHEVA • PAIDTOSPOUSESOFSOLDIERSTHATDIEDONACTIVEDUTYPRIORTO1981 • PAIDTOSPOUSES OF SERVICEMEMBERSASTHEDIRECTRESULTOFSERVICE-CONNECTEDDISAB ILITY ORAGGRAVATEDINTHELINEOF . DUTY • VAMAKES THELINEOFDUTYDECISIONS

  29. NON-SERVICE-CONNECTED CHAPTER6 PENSION • NON-SERVICE-CONNECTEDVAPENSION ISAMONTHLYPAYMENTAVAILABLE TOCERTAINWARTIMEVETERANSWHOAREPERMANENTLYANDTOTALLYDISABLEDANDFINANCIALLY NEEDY • ELIGIBILITY FORVAPENSION BENEFITS • MUSTHAVE SERVICEDURINGWARTIME • DISCHARGED UNDERCONDITIONS OTHERTHAN • DISHONORABLE • BEPERMANENTLYANDTOTALLYDISABLED • MEETANDINCOMEANDNETWORTHTEST

  30. INCOMEANDNETWORTH LIMITS • AVETERANSNETWORTHIS CONSISTSOFREALPROPERTY(LAND) • PERSONALPROPERTY (MATERIAL POSSESSIONS) • DOESNOTENCLUDETHEVETERANSHOME • DOES INCLUDE FAMILYINCOME

  31. PENSION PROGRAMS • OLDLAWPENSION • ENDEDJULY 1,1960 • DID NOTCOUNTTHESPOUSESINCOME • SECTION306PENSION • -JULY1,1960-DECEMBER31,1978 • -DOESCOUNTTHE SPOUSESUNEARNEDINCOME SUCH ASSOCIALSECURITYBENEFITS

  32. PENSION PROGRAMS ''IMPROVEDPENSION'' -ONLY PROGRAMCURRENTLY AVAILABLE -EFFECTIVEJANUARY 1,1979 -COUNTSALLOFTHESPOUSESINCOME

  33. PENSIONPROGRAMS • CALCULATINGIMPROVED PENSION • -TWOSTEPS • VETERANSMAXIMUMANNUALPENSION RATE(MAPR) • TYPEOFVETERAN,SPOUSE,CHILDREN • INCREASED BYTOTALNUMBERS OFEACH • INCREASED BENEFITSDEPENDING ONTHESEVERITYOFTHEDISABILITY • DEPENDENT PARENTSARENOT COUNTED • •VETERANSCOUNTEDINCOMECANNOTEXCEEDTHEVETERANSMAXIMUMANNUALPENSION

  34. PENSIONPROGRAMS • SPECIALMONTHLYPENSION (SMP) • -TWOTYPES • HOUSEBOUND BENEFITS • 100°/oPERMANENTDISABILITY-CONFINED TOTHEIR HOMES • 100°/oPERMANENTDISABILITYAND ANOTHER60°/oFOR ASECONDDISABILITY • AIDANDATTENDANCE • -.AVAILABLETOVETERANSTHATNEEDASSISTANCEINDAILYLIVING IE:DRESSING, BATHING, COOKING,E'TC. THINK QUALITY OF LIFE

  35. PENSIONPROGRAMS • NON-SERVICE CONNECTEDDEATHPENSION • FORLOWINCOMESPOUSESANDSPOUSESWITH • CHILDREN • ELIGIBILTY • .-VETERAN MUSTMEETTHEELIGIBILTYFORVABENEFITS • THESURVIORMUSTDEMONSTATE FINANCIALNEEDAND MUSTNOTHAVEEXCESSIVEWORTH

  36. THEVACLAIMSPROCESSCHAPTER 7 • APPLYING FORBENEFITS • EARLYCLAIMSFILING • DATEDANDSIGNED LETTER -SHOULD STATETHATDOCUMENTATION TOSUPPORTTHECLAIMWILLFOLLOW • EVENAHANDWRITTEN NOTE ISENOUGHTOGETA • CLAIMSTARTED • USINGEITHER OFTHESETWOMETHODSWILLGETTHECLAIMBACK DATEDTOTHEDATEOFEITHERTHELETTER OR THENOTE • VETERANWILLBESENTTHEFORMALAPPLICATION VAFORM21-526"APPLICATION FORCOMPENSATION ANDPENSION OR 21-526 EZ (THISIS KNOWNASTHEEFFECTIVEDATE)

  37. COMPLETING FORM21-526 OR 21-526EZ • SHOULDBECOMPLETEDWITHTHEASSISTANCEOFAREPRESENTATIVE • NEEDSTOBECOMPLETEANDACCURATE • CANBEDONEONLINE • -VETERANS ON-LINEAPPLICATION • VAISTOINFORMYOUOFEVERYTHINGYOUNEEDTOWINTHECLAIM

  38. OBTAININGEVIDENCE • VAWILLATTEMPTTOOBTAINALLMEDICALANDFEDERALFORMS • THEINDIVIDUALANDTHEIR • REPRESENTATIVE SHOULDDOTHESAME • MILITARYMEDICALRECORDS CANBE OBTAINED BYCONTACTING NATIONALPERSONNELRECORDS CENTER(NPRC) USINGSTANDARDFORM180REQUESTPERTAININGTOMILITARYRECORDS

  39. FOR FULLY DEVELOPED CLAIMS USING 21-526EZ VA HAS OBLIGATION TO OBTAIN SERVICE TREATMENT RECORDS. THIS DOES NOT INCLUDE RECORDS FOR RESERVE OR NATIONAL GUARD. VA HAS OBLIGATION TO GET VA MEDICAL RECORDS. IF A VA FORM 21-4142 (RELEASE OF RECORDS) IS INCLUDED WITH CLAIM IT WILL NOT BE TREATED AS A FULLY DEVELOPED CLAIM BUT PUT WITH THE TRADITIONAL CLAIMS INCLUDE THE FDC FORM STATING THAT THIS IS A FULLY DEVELOPED CLAIM AND INCLUDES EVERYTHING NEEDED TO ADJUDICATE THE CLAIM ALONG WITH THE INCLUSION OF FEDERAL RECORDS

  40. VA DECISION LETTERS VETERANS CAN APPEAL ANY DECISION MADE BY VA THEY NEED TO SUBMIT A LETTER TO THE RO, THAT STATES THEY DISAGREE AND SEEK APPELLATE REVIEW ( THIS IS KNOWN AS A NOTICE OF DISAGREEMENT OR NOD) VA WILL RESPOND WITH A STATEMENT OF THE CASE (SOC) AND SHOULD SEND A VA FORM 9 USED FOR A SUBSTANTIVE APPEAL

  41. SUBSTANTIVEAPPEAL • THEVETERAN HAS60DAYSFROMTHEDATEOFTHESOCORONEYEAROFTHERODECISIONTO APPEAL • IFDEADLINE ISMISSEDTHEDECISIONISFINALANDTHEVETERAN CANNO LONGERAPPEALTHECASE • THEVETERAN CANALWAYSREOPEN • THECASE

  42. BOARD OFVETERAN'SAPPEALS • BVAREMANDS • BVACANOBTAINNEW • EVIDENCE,CLARIFYEVIDENCE,CURE APROCEDURAL DEFECTORPERFOM OTHERACTIONSASNECESSARY • THEBOARD CANSENDBACKTOTHEROFORADDITIONAL DEVELOPMENT • AREMANDISNEITHERAGRANTORDENIAL

  43. RECONSIDERATION • AMOTIONFORRECONSIDERATIONMUSTBEFILEDATTHEBOARD'SWASHINGTON OFFICE • BVAWILLNOTIFYTHEVETERANIF THECLAIMISDENIEDORGRANTED • -YOUHAVE 60DAYS TOPRESENT ADDITIONARGUMENTS • IFTHEMOTIONISGRANTED,THEEARLIERBVADECISION ISVACATED

  44. NEWANDMATERIALEVIDENCE • ANYDECISION OFVABENEFITS CANBE REOPENED IFTHEVETERAN HASNEWANDMATERIALEVIDENCE • -MATERIALEVIDENCE= RELATESTOAN UNESTABLISHED FACTNECESSARY TOPROVETHECLAIM • -ITRAISESTHEPOSSIBILYTHAT,WITHALLTHEOTHEREVIDENCE OFRECORD,ITWOULD SUBSTANTIATE THECLAIM

  45. NEWANDMATERIALEVIDENCE • IFTHECLAIMISREOPENEDTHENVAMUSTCONSIDERALLEVIDENCEINREFERENCETOTHECLAIM • THEREISNOLIMITTOTHENUMBEROFTIMES ACLAIMANTMAYATTEMPTTOREOPENACLAIMWITHNEWANDMATERIALEVIDENCE

  46. CUECLAIM • CLAIMTHATSHOWSTHATTHEROORTHEBVAMADEANERRORANDTHATIFITWASN'TMADETHENTHECLAIM WOULDHAVEBEENGRANTED

  47. VADEBTCOLLECTIONCHAPTER9 • OVERPAYMENT • WRONGAMOUNTSENT • PERSONS ONPENSIONSINHERITLARGEAMOUNTS OFMONEY • DIVORCES • NOTREPORTING INCOME • ETC.

  48. STEPS THEVAWILLTAKE • SEND ADEMANDLETTER • MUSTEXPLAIN HOWTHEDEBTOCCURRED • INFORMTHE VETERAN OF THE RIGHT CHALLENGETHEOVERPAYMENT

  49. VETERANS OPTIONS 1. CHALLENGETHEDEBT CHALLENGETHEAMOUNTOFDEBT ASK FORVATERMINATION,ORWRITEOFF---WHERETHE DEBTORHASBEEN PAYING OFFTHEDEBTANDENCOUNTERS FINANCIAL CHANGESSUCHASRETIREMENT ASKTHEVATOFORGIVETHEDEBTDUETOFINANICAL HARDSHIP

  50. VAWILLFOLLOWUP WITHSECONDANDTHIRDDEMANDSFORTHEDEBT TOBEPAID • CANNOTIFY CONSUMER REPORTING AGENCIES • HIREAPRIVATEDEBTCOLLECTOR • ASKINTERNALREVENUE TOSEIZEANYTAXREFUNDSDUETHEVETERAN • REDUCETHEAMOUNT OFVETERANSBENEFITSTHEYARERECEIVING • FINALL YCANFILEALAWSUIT

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