Introduction

1. Introduction Not a tool for use with contractual issues Nothing to do with MSPB or OWCP A tool for organizing Help veterans obtain medical assistance and compensation through department of veterans affairs.

2. Objective Familiarize APWU reps with DVA procedures. Educate membership in need of assistance with DVA. Assist members obtain benefits from DVA.

3. What is the VA ? Cabinet level government agency Applies federal law concerning veterans Provides medical treatment to veterans Awards compensation to veterans injured in the performance of duty.

4. What does VA offer ? Disability Benefits Educations and Training benefits Vocational Rehab and employment assistance Healthcare Life insurance More…

5. Who is Eligible? Veteran Spouse Dependant Surviving spouse or dependant Guard, reserves, regular military service

6. What is the Source ? Title 38 Code of Federal Regulations is the act which provides for all of the benefits provided by VA

7. We will Focus on 2 different types of benefit… Disability Compensation applies if veteran is at least 10% disabled as a result of military service Disability pension applies if veteran is a wartime veteran with LIMITED INCOME, NO LONGER ABLE TO WORK, OR IS 65 OR OLDER

8. What does Service Connection mean, why is it important When VA grants service connection: It acknowledges that a condition/injury is the result of or has been aggravated by military service Determinations about service connection will be based on a review of the entire evidence in the record, with due consideration to the VA’s policy of administering the law under a liberal interpretation consistent with the facts in each case.

9. What is the Criteria to establish Service Connection Discharge type (first thing researched by VA) Eligibility Medical Diagnoses of current disability Evidence of service occurrence or aggrevation Nexus

10. Eligibilityrequires discharge or released from military service under conditions other than dishonorable. Honorable discharge (HD); Discharge under honorable conditions (UHC), or general discharge (GD); Discharge under other than honorable conditions (UOTHC), or undesirable discharge (UD); Bad conduct discharge (BCD) (which can be issued by sentence of either a special court-martial or a general court-martial); and Dishonorable discharge (DD) or a dismissal, the latter in the case of an officer (both are issued only by a general court-martial). Honorable discharges and discharges under honorable conditions are, with some rare exceptions, considered by the VA as discharges under “conditions other than dishonorable” and therefore are sufficient to qualify the claimant as a veteran under the first part of the eligibility test. Bad conduct discharges from a special court-martial and discharges under other than honorable conditions may or may not make a veteran 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 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 veteran was separated from service under “dishonorable conditions” or “other than dishonorable conditions.

11. Three Fundamental Requirements to Obtaining Service-Connected Disability Compensation A veteran seeking service-connected disability compensation must satisfy three fundamental requirements before VA will grant compensation benefits. First, there must be a medical diagnosis of current disability. Second, there must be medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury. Finally, there must be medical evidence of a link or nexus between the in-service occurrence or aggravation of a disease or injury and the current disability.

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

13. Getting Started Like the grievance procedure…documentation is critical Several sources for information Military medical documentation is best info,but not the only info acceptable

14. Absolutely Positively… Military Service Records (MUST) DD – 214 (MUST) Private medical history Marriage certificate / divorce documentation Birth certificates Other evidence that is relevant

15. Where/How to get records DD 214 and Medical Records National Personnel Records Room 230 OR WWW.archives.gov 9700 Page Blvd St Louis, MO 63132 Include your name at the time of military service, social security number, service number (if different), the approximate dates of service and branch of service. Please allow minimum of 6 weeks for processing.

16. The Duty to Assist Veterans VA is required to obtain: Claimant’s service medical records, Relevant medical treatment or examination of the claimant, either at VA facilities or at the expense of the VA (i.e., “fee basis treatment”), Other relevant records” held by a federal department or agency, that the claimant adequately identifies and authorizes the VA to obtain.

17. Duty to Assist in Obtaining Medical Examinations / Medical Opinions The VA is to provide a medical examination or opinion “when such an examination or opinion is necessary to make a decision on the claim.” Statutes further provide that a medical examination or opinion shall be considered necessary to make a decision on a claim if the evidence of record, taking into consideration all information and lay or medical evidence (including the claimant’s statements): (1) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; and (2) indicates that the disability or symptoms may be associated with the claimant’s active service; but (3) does not contain sufficient medical evidence for the VA to make a decision on the claim.

18. Claimant’s Burden The standard of proof used by the VA in deciding claims (found in 38 U.S.C.S. § 5107(b)), is a unique standard. The claimant is not required to demonstrate that he or she should be granted benefits by even a “preponderance of the evidence.” VA can deny the claim only if the preponderance of the evidence is against the claim. If there is an “approximate balance of positive and negative evidence regarding any issue material to the determination of a matter,” the claimant wins and the claim is granted. SEE CHART IN HAND OUT PAGES STARTING ON PAGE 9 FOR MORE DETAILS

19. Benefit of the Doubt Doctrine 38 C.F.R. pt. 4, the rating schedule: “When, after careful consideration of all procurable and assembled data information, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant.” An approximate balance of positive and negative evidence regarding the merits of a material issue, the claimant will be given the benefit of the doubt in resolving each of these issues. It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant

20. Now What… VA has a form 21-526 that can be completed to initiate a claim. However, any format may be used so long as: It is complete Contains Vets ID such as SSN, Service number States a claim

21. Evidence needed to substantiate a claim VA is required to inform the claimant: of the information and evidence not of record that is necessary to substantiate the claim; of the information and evidence that VA will obtain; of the information and evidence that the claimant must submit; (4) to provide any evidence in the claimant’s possession that pertains to the claim. give us everything you’ve got pertaining to your claim(s),’ or something to that effect.”

22. The Rating Process First, the VA determines if the veteran is eligible to receive VA benefits, including whether the veteran was discharged or separated under other than dishonorable conditions. Second, if the veteran survives the first step, the VA then decides whether the veteran qualifies for disability compensation under the rules discussed in this chapter. Third, if steps one and two are satisfied, the VA then determines the severity of the disability and assigns a percentage evaluation from 0 to 100 based on the Schedule for Rating Disabilities. Fourth, the VA sets the effective date for the award of service-connected disability compensation

23. Notice of Disagreement Written communication expressing disagreement with an adjudicative determination by the agency and a desire to contest the result. Special wording is not required. Notice of Disagreement must be in terms which can be reasonably construed as disagreement and a desire for appellate review.

24. Appeals Available What is an appeal to the Board of Veterans’ Appeals? An appeal is a request for a review of a VA determination on a claim for benefits issued by a local VA office. Who can appeal? Anyone who has filed a claim for benefits with VA and has received a determination from a local VA office is eligible to appeal to the Board of Veterans’ Appeals.

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

26. What can I appeal to the Board? You may appeal any determination issued by a VA regional office (RO) on a claim for benefits. Some determinations by VA medical facilities, such as eligibility for medical treatment, may also be appealed to the Board. You may appeal a complete or partial denial of your claim or you may appeal the level of benefit granted. For example, if you filed a claim for disability and the local office awarded you a 10% disability, but you feel you deserve more than 10%, you may appeal that determination to the Board.

27. How do I file an appeal? No special form is required to begin the appeal process. All that’s needed is a written statement that: (1) you disagree with your local VA office’s claim determination and (2) you want to appeal it. More specific info is available in the VA booklet: “The Board of Veterans Appeals” and “How do I appeal”

28. DISABILITY PAYMENTS 10% $106.00 20% $205.00 30% $316.00 40% $454.00 50% $646.00 60% $817.00 70% $1029.00 80% $1195.00 90% $1344.00 100% $2239.00 Between 30 and 100 there are allowances for a spouse and each minor child. The amount depends on the disability rating.

29. Commonly filed Claims AGENT ORANGE After years of struggles, VA has begun recognizing and helping Vietnam era vets with conditions presumptively related to Agent Orange (aka herbicdes) exposure. A number of pamphlets and programs are available dedicated exclusively to Agent Orange issues. Gulf War Veterans Gulf War veterans who suffer from chronic disabilities resulting from undiagnosed illnesses, medically unexplained chronic multi-symptom illnesses (such as chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome) that are defined by a cluster of signs or symptoms, and any diagnosed illness that the Secretary of Veterans Affairs determines warrants a presumption of service-connection may receive disability compensation. The undiagnosed illnesses must have appeared either during active 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 through Dec. 31, 2006.

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

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

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

33. RATING SCHEDULE EXAMPLE 5056 Ankle replacement (prosthesis). Prosthetic replacement of ankle joint: For 1 year following implantation of prosthesis 100 With chronic residuals consisting of severe painful motion or weakness 40 With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to 5270 or 5271. Minimum rating 20

34. 5256 Knee, ankylosis of: Extremely unfavorable, in flexion at an angle of 45[degrees] or more 60 In flexion between 20[degrees] and 45[degrees] 50 In flexion between 10[degrees] and 20[degrees] 40 Favorable angle in full extension, or in slight flexion between 0[degrees] and 10[degrees] 30 5257 Knee, other impairment of: Recurrent subluxation or lateral instability: Severe 30 Moderate 20 Slight 10

35. Service Organizations Disabled American Veterans Veterans of Foreign Wars American Legion Paralyzed Veterans of America Many more…

36. Helpful Telephone Numbers VA Benefits1-800-827-1000 Health Benefits 1-877-222-8387 Education Benefits 1-888-442-4551 Life Insurance 1-800-669-8477 Telecommunication Device for the Deaf (TDD)1-800-829-4833 CHAMPVA 1-800-733-8387 Headstones and Markers 1-800-697-6947 Gulf War &Agent Orange Helpline 1-800-749-8387 Debt Management1-800-827-0648