Special Claims
Compensation is not always based on an in-service event. Additionally, other benefits may be available after disability compensation has been awarded. An overview of these VA benefits is provided below,
Title 38 U.S.C. 1151 Claims
Title 38 U.S.C. Section 1151 allows VA to pay compensation for death or disability "as if service-connected." Don't be confused with this subtle difference. The disability is not considered service-connected. Under Section 1151, benefits may be paid for:
Injuries incurred or aggravated while receiving VA-sponsored medical treatment.
Injuries incurred or aggravated while pursuing a course of vocational rehabilitation under 38 U.S.C. Chapter 31 or participating in compensated work therapy under 38 U.S.C. 1718.
If eligibility is established under Section 1151, the disability is considered service-connected for payment purposes ONLY.
Eligibility Requirements
You must be a Veteran
You must have a disabling condition that is the result of or has been aggravated due to VA sponsored medical treatment or training
Evidence Requirements
As a result of VA hospitalization, medical or surgical treatment, examination, or training, the evidence must show you have:
An additional disability or disabilities, OR
An aggravation of an existing injury or disease, AND
The disability was:
The direct result of VA fault such as carelessness, negligence, lack of proper skill, or error in judgment, OR
Not a reasonably expected result or complication of the VA care or treatment OR
The direct result of participation in a VA Vocational Rehabilitation and Employment or compensated work therapy program.
Example
A Veteran was pursuing training under VA's Chapter 31 Vocational Rehabilitation and Employment program. He was receiving on-the-job training as a car mechanic. During training, a jack slipped from a car and crushed his left foot. Disability compensation may be paid for his foot injury because the injury occurred while the Veteran was pursuing training under a VA Vocational Rehabilitation and Employment program.
How to Apply
Apply online using VONAPP Direct Connect on eBenefits OR
Work with an accredited representative or agent OR
Go to a VA regional office and have a VA employee assist you.
Automobile Allowance
Servicemembers and Veterans may be eligible for a one-time payment of not more than $20,114.34 toward the purchase of an automobile or other conveyance if you have certain service-connected disabilities. The grant is paid directly to the seller of the automobile and the Servicemember or Veteran may only receive the automobile grant once in his/her lifetime.
Certain Servicemembers and Veterans may also be eligible for adaptive equipment. Adaptive equipment includes, but is not limited to, power steering, power brakes, power windows, power seats, and special equipment necessary to assist the eligible person into and out of the vehicle.
VA may provide financial assistance in purchasing adaptive equipment more than once. This benefit is payable to either the seller or the Veteran or Servicemember.
Important: You must have prior VA approval before purchasing an automobile or adaptive equipment.
Eligibility Requirements (Automobile Grant)
You must be either a Servicemember who is still on active duty or a Veteran, AND
You must have one of the following disabilities that are either rated as service-connected or treated as if service-connected under 38 U.S.C 1151 or, for a Servicemember, the result of disease incurred or injury contracted in or aggravated by active duty:
Loss, or permanent loss of use, of one or both feet, OR
Loss, or permanent loss of use, of one or both hands, OR
Permanent impairment of vision in both eyes to a certain degree, OR
Severe burn injury, OR
Amyotrophic Lateral Sclerosis (ALS).
Eligibility Requirements (Adaptive Equipment)
You must be either a Servicemember who is still on active duty or a Veteran, AND
meet the disability requirements for the automobile grant (see above), OR
have ankylosis (immobility of the joint) of one or both knees or hips that VA recognizes as being service-connected or treats as if service-connected under 38 U.S.C. 1151.
Evidence Requirements
To support a claim for automobile allowance, the evidence must show that you are service-connected or are treated as if service-connected under 38 U.S.C 1151 or, for a Servicemember, the result of disease incurred or injury contracted in or aggravated by active duty, for a disability resulting in:
The loss, or permanent loss of use, of one or both feet, OR
The loss, or permanent loss of use, of one or both hands,OR
Permanent impairment of vision in both eyes, resulting in
Central Visual acuity of 20/200 or less in the better eye with glasses, OR
Central Visual acuity that is greater than 20/200, if there is a visual field defect in which your peripheral field has contracted to such an extent that the widest diameter of visual fields subtends an angular distance no greater than 20 degrees in the better eye, OR
Severe burn injury: Deep partial thickness or full thickness burns resulting in scar formation that cause contractures and limit motion of one or more extremities or the trunk and preclude the effective operation of an automobile, OR
Amyotrophic Lateral Sclerosis (ALS).
To support a claim for adaptive equipment, the evidence must show that you have a disability as shown above, OR you have ankylosis of at least one knee or one hip due to service-connected disability.
Birth Defects
Children who have spina bifida or certain other birth defects and are biological children of Veterans with qualifying service in the Republic of South Vietnam or Republic of Korea may be eligible for various VA benefits, to include monthly monetary compensation, health care and vocational training depending on the child's degree of disability. The monetary compensation may be paid at one of three disability levels, based on the severity of the disability.
Eligibility Requirements (Spina Bifida)
A male or female Veteran's child may be eligible if:
The Veteran parent served in the Republic of South Vietnam during the period from January 9, 1962 through May 7, 1975, OR
The Veteran parent served in or near the Korean demilitarized zone (DMZ) during the period from September 1, 1967 through August 31, 1971 and was exposed to herbicides (service between April 1, 1968 and August 31, 1971 in or near the DMZ presumes exposure to herbicides.), AND
The child was conceived after the date on which the Veteran parent served in either the Republic of South Vietnam or the Republic of Korea, AND
The child has been diagnosed with a form of Spina Bifida other than Spina Bifida Occulta.
NOTE: VA has no requirements regarding the character of the parent's discharge or the length of his or her service.
Eligibility Requirements (Birth Defects)
A female Veteran's child may be eligible if:
The female Veteran served in the Republic of South Vietnam during the period from February 28, 1961 through May 7, 1975, AND
The child was conceived after the date on which the mother served in either the Republic of South Vietnam, AND
The child has a covered birth defect that resulted in a permanent physical or mental disability.
Evidence requirements
Service records prove that the biological Veteran parent has qualifying Vietnam or specific Korean service dates and duty assignments, AND
Evidence shows a biological relationship between the child and the Veteran parent with qualifying Vietnam or specific Korean service, AND
A birth certificate determines date of conception, AND
Medical evidence reflects a diagnosis of spina bifida or a covered birth defect.
Clothing Allowance
Veterans who have unique clothing needs as a result of a service-related disability or injury may receive a supplement to their disability compensation. The clothing allowance reimburses you if your clothing gets permanently damaged by a prosthetic or orthopedic appliance you wear, or by a prescribed medication you use on your skin. If eligible, you can receive a one-time or yearly allowance for reimbursement.
Eligibility
You may receive a clothing allowance as a Veteran who uses either of the following:
Prosthetic or orthopedic appliance, such as a wheelchair or crutches, because of a service-connected disability (Note: soft and flexible devices, such as an elastic stocking, are not included)
Medication prescribed by a physician for a service-connected skin condition that causes permanent stains or otherwise damages outer garments
Additional clothing allowances may be provided if more than one prosthetic or orthopedic appliance, or medication described above, is used and/or affects more than one type of clothing garment.
Benefit
Payments are based on the rate table set by law. You can view the current rate table to determine the benefit amount.
To receive annual payment, you must establish eligibility by August 1 of the year for which you claim payment.
Convalescence
Temporary Rating (Surgery/Immobilization)
A temporary 100% rating is for convalescence based on surgery or immobilization of a joint by a cast without surgery for a service-connected disability. The temporary 100% rating may continue for 1 to 3 months depending on individual circumstances. Extensions up to an additional 3 months may be granted in severe cases.
Eligibility Requirements
You must be a Veteran.
You must have had a surgical or other treatment performed by a VA or other approved hospital or outpatient facility for a service-connected disability.
Evidence Requirements
The evidence must show the surgery or treatment was for a service-connected disability, AND
The surgery required convalescence of at least one month, OR
The surgery resulted in severe postoperative residuals, such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilizations, house confinement, or required the use of a wheelchair or crutches, OR
One major joint or more was immobilized by a cast without surgery.
If the surgery or procedure was at a VA facility, simply tell us when you apply and we will obtain the records for you.
Example
A Veteran has a left knee condition rated 30% disabling. His VA physician has discussed the knee's deterioration and they have decided to operate. Since the success of the surgery won't be known for 3 months following the 1 week of hospitalization, the Veteran is granted a temporary 100% evaluation for three months, and his disability compensation is increased accordingly.
How to Apply
Apply online using eBenefits, OR
Work with an accredited representative or agent, OR
Go to a VA regional office and have a VA employee assist you
Dentistry
Certain Veterans may receive dental treatment from VA. VA dental care eligibility and Veteran dental care benefits are based on a number of factors. Both the Veterans Benefits Administration (VBA) and the Veterans Health Administration (VHA) may make decisions regarding dental benefits and treatment. The Dental Benefits for Veterans fact sheet describes dental eligibility criteria and contains information to assist Veterans in understanding their eligibility for VA dental care.
How to Apply
Go to a VA Medical Center and have a VA employee assist you with determining eligibility and application procedures
Hospital Treatment
Temporary Ratings (Hospitalization)
Veterans who are hospitalized for more than 21 days for a service-connected disability may receive a temporary 100% disability compensation rating.
Eligibility Requirements:
You must be a Veteran
You must be hospitalized for more than 21 days in a Department of Veterans Affairs or an approved hospital for a service-connected disability, OR
Be under hospital observation at Department of Veterans Affairs expense for a service-connected disability for a period in excess of 21 days.
Evidence Requirements:
Evidence such as a discharge summary that shows the length of hospitalization to be more than 21 days, AND
That the hospitalization is or was due to a service connected disability, AND
That the hospitalization is or was in an approved VA hospital.
If the hospitalization is at a VA facility, simply tell us when you apply and we will obtain the records for you.
Example
A Veteran is considered 40% disabled for his service-connected diabetes mellitus is taken by ambulance to a VA hospital after lapsing into a diabetic coma. He recovered, but required over 21 days of hospitalization due to the coma and infection. His rating was raised to 100% due to hospitalization and then returned to 40%.
How to Apply
Apply online using eBenefits, OR
Work with an accredited representative or agent, OR
Go to a VA regional office and have a VA employee assist you.
. Individual Unemployability
Individual Unemployability is a part of VA's disability compensation program that allows VA to pay certain Veterans disability compensation at the 100% rate, even though VA has not rated their service-connected disabilities at the total level.
Eligibility Requirements:
You must be a Veteran
You must have at least one service connected disability rated at least at 60%, 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.
You must be unable to maintain substantially gainful employment as a result of service-connected disabilities (marginal employment, such as odd jobs, is not considered substantial gainful employment for VA purposes).
Evidence Requirements:
Evidence of at least one service connected disability AND
That the service-connected disability or disabilities are sufficient, without regard to other factors, to prevent performing the mental and/or physical tasks required to get or keep substantially gainful employment AND
That one disability is ratable at 60 percent or more, OR
If more than one disability exists, one disability is ratable at 40 percent or more with a combined rating of 70 percent or more.
Under exceptional circumstances this benefit may be granted with a lower disability rating than noted above provided the evidence shows the service-connected disability or disabilities present such an exceptional or unusual disability picture, due to such factors as marked interference with employment or frequent periods of hospitalization, that applying the normal disability requirements is impractical.
Example 1
A Veteran has a service-connected heart condition evaluated as 60% disabling. She has been able to work without difficulty until last year, when she began to experience chest pain with any exertion.
Her physician recommended that she retire as soon as possible. She subsequently filed a claim for increased disability compensation. Evidence regarding the Veteran's work history and education were reviewed by the Rating Team. As it confirmed the Veteran was "individually unemployable" due to her service-connected disability, entitlement to compensation at the rate payable to a 100% disabled Veteran was granted.
Example 2
A Veteran served as a medic in Vietnam and stepped on a land mine severing his right leg below the knee. He wears a prosthesis that allows him good mobility.
He had a great deal of difficulty readjusting to civilian life and was recently diagnosed with post-traumatic stress disorder. Service connection was established for both disabilities. The ratings for these disabilities are 40% and 50%, respectively. The combined disability rating is 70%.
He applied for individual unemployability because he has not been able to maintain gainful employment for many years. His only income during the last two years has come from a neighbor who pays the Veteran to watch his dogs while he's out of town. The evidence established that his service-connected disabilities render him unemployable.
Based on this finding, the Rating Team granted entitlement to compensation at the rate payable to a Veteran rated 100% disable.
How to Apply
Apply online using eBenefits, OR
Work with an accredited representative or agent, OR
Go to a VA regional office and have a VA employee assist you.
Prestabilization Ratings
A prestabilization rating is a temporary initial rating normally given to Veterans who were recently separated from service and have an unstable disability and are most likely in need and least likely to be self-sufficient. Pre-stabilization ratings may be granted at the 50% or 100% rate, depending on the severity of the disability. They continue for a 12-month period following discharge from service.
Eligibility Requirements
You must be a Veteran
You must have been separated from military service with an unstable, significantly disabling service-connected disability at the time of separation that will continue for an indefinite period.
Evidence
The evidence must show:
You separated from active military service, AND
You have an existing unstabilized condition stemming from any disease or injury that is service-connected (This will normally be part of a Service Treatment Record.), AND
Your disability has been significantly disabling at the time of separation and will continue for an indefinite period.
Example
A Veteran was diagnosed with Hodgkin's disease and received a medical discharge from service. The service treatment records (STRs) demonstrate that the disease is active because as of discharge the Veteran continued receiving treatment (e.g. chemotherapy) for her Hodgkin's disease. She was told to contact her local VA medical center for follow-up and any further treatment of her condition, if needed. The claim for compensation resulted in a pre-stabilization rating of 100% for one year from the date of discharge.
How to Apply
Apply online using eBenefits, OR
Work with an accredited representative or agent, OR
Go to a VA regional office and have a VA employee assist you.
SOURCE: U.S DEPARTMENTOF VETERANS AFFAIRS
No comments:
Post a Comment