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CVSO Fall Training

CVSO Fall Training. Who’s Next?. Arkansas Department of Veterans Affairs. We are a state agency representing veterans We do not decide claims We assist veterans in claims preparation We assist veterans in claims appeal process

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CVSO Fall Training

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  1. CVSO Fall Training Who’s Next?

  2. Arkansas Department of Veterans Affairs • We are a state agency representing veterans • We do not decide claims • We assist veterans in claims preparation • We assist veterans in claims appeal process • We provide information on state benefits for veterans http://www.veterans.arkansas.gov • You are our first line of defense and play a vital role in helping claimants secure their benefits • Promote E-Benefits

  3. Interview the Claimant • Introduce yourself to the claimant. • Determine veteran status (DD214) • Obtain/Confirm representation (VA Form 21-22) • Form 80 or NACVSO1 • Ask what is it you can do for him/her • Listen! • Determine eligibility of benefit sought; be specific • Ask about medical records and other evidence • Do Not Smile and File!

  4. Service Organization • Arkansas Department of Veterans Affairs • American Legion • Veterans of Foreign Wars • American Ex Prisoners of War • Marine Corp League • Catholic War Veterans of the USA • This is not an all inclusive list

  5. Eligibility • A veteran who served in the active military, naval or air service, and was • Discharged or released under conditions other than dishonorable • “VETERAN OF ANY WAR” means any veteran who served in the active military, naval or air service during a period of war as set forth in 38 CFR 3.2” • Proof of Service (DD Form 214 or equivalent)

  6. Compensation & Pension • The term “Compensation and pension” is the VA Monetary Benefit Programs paid on account of a veteran’s disability or death. • Compensation is related to a service connected disability • Pension is an income based benefit for veterans who served during a period of war and is totally disabled not related to service

  7. Service Connection • Service connection for a disability requires proof that the injury/disease began during service (documented in medical records) • Must have a current diagnosis • Confirmation that current injury is linked to the injury that incurred during military service. • If one element is missing, service connection is denied.

  8. Service Connection

  9. Service Connection • Incurred during service • Aggravated during service • Presumptive Condition (Presumed to have begun during service if they manifest to a compensable degree within a specified time (generally one year) after service, even though there is no evidence of disease during service (Gulf War Illness) • Secondary (a result of service connected disability)

  10. Type of Claim • Benefits Delivery at Discharge (BDD) 60-180 days - Must have all documentation when submitted - Claim managed off site: UT, NC, CA • Quick Start: 1- 59 Days • Fully Developed - Must have all documentation when submitted - Claim managed in Arkansas • Fully developed recommended!

  11. Informal Claim • Claimant must identify the benefit he/she is seeking • All informal communications must be in writing or transcribed into written form • The VA has NO “duty to assist” in development of such a claim • Provisions of 38 CFR 3.155 are applied. Once filed and accepted as valid, VA has the initial responsibility to send a formal application

  12. Formal Claim • Application intended for the claim of specific benefit. Examples: • VA Form 21-526 – Initial Compensation, Pension or Both • VA Form 21-527 – Initial Pension • VA Form 21-534 – DIC • VA Form 21-8940 – IU or Unemployability • Is the application substantially complete? What does that mean? 38 CFR 3.159

  13. Formal Claim Substantially complete application means an application containing the claimant's name; his or her relationship to the veteran, if applicable; sufficient service information for VA to verify the claimed service, if applicable; the benefit claimed and any medical condition(s) on which it is based; the claimant's signature; and in claims for non-service-connected disability or death pension and parents 'dependency and indemnity compensation, a statement of income.

  14. Original Claim • First time an application is made for Compensation or Pension • Specific end products assigned for the original or (in this instance) first claim • Considerable development is usually required in original claims. • Claims folders created • Options for the specific effective date for the start of payments

  15. New Claim • First time an issue is presented • It may include an original, reopened claim or claim for increase when a disability is identified • Nexus to military service? • Evidence is determined once the purpose of the claim is known. For example – reopened NSC pension? Secondary service connection?

  16. Re-Opened Claim • Previous denial of claim greater than 1 year • Requirement for new and material evidence addressing the previous deficiency • Discourage immediate appeals without thorough review • Get the claims folder • Controversy over “well grounded claims”

  17. Claim for Increase • Need for supporting evidence – medical and lay • The “Proscelle” argument in the absence of medical evidence • Detailed description of “credible symptoms” • Absolutely no guarantee of a medical examination • Secondary Service Connection for a new issue?

  18. Individual Unemployability (IU)Definition Individual Unemployability (IU) is a part of VA’s disability compensation program that allows VA to pay certain Veterans compensation at the 100% rate, even though VA has not rated their service-connected disabilities at the 100% level. A Veteran must be unable to maintain substantially gainful employment as a result of his/her service-connected disabilities. Additionally, a Veteran must have:

  19. Individual Unemployability (IU)Criteria A Veteran must be unable to maintain substantially gainful employment as a result of his/her service-connected disabilities. Additionally, a Veteran must have: • One service-connected disability ratable at 60 percent or more, OR • Two or more service-connected disabilities, at least one disability ratable at 40 percent or more with a combined rating of 70 percent or more.

  20. Summary • Determine Veteran Status • Obtain Representation or Review File • Complete / Review Representation • ADVA Form 80 or NACVSO1 • Get a clear understanding of reason for visit • Determine Eligibility • File a fully developed claim! • Urge Claimants to use E-BENEFITS!

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