Pension Management Center
VARO Philadelphia
October 2015
Burial Automation
◦ Upon the processing of a First Notice of Death (FNOD), if the Veteran was in receipt of Comp/Pension benefits, VA will automate either the $300 basic NSC burial allowance or the $2000 basic SC burial allowance.
◦ Does not mean claimants will no longer file… Does not automate transportation, plot allowance, or additional NSC burial for VAMC deaths.
Recent Pension Rule Changes
Burial Automation
◦ Receipts/itemized funeral bills no longer required.
◦ Funeral Homes are no longer proper claimant for claims received on or after July 7th 2014 (except for unclaimed Veterans)
◦ “First to File” – VA no longer dividing burial payments. Benefit paid to the first person who files and is found entitled.
◦ If automated payment is made to the surviving spouse, and we receive an application from another eligible claimant for additional benefits, if it is determined they paid the expenses, the additional benefits can be paid.
- VA will pay the first living person to file a claim of those listed below:
(1) The veteran's surviving spouse; (2) The survivor of a legal union between
the deceased veteran and the survivor; (3) The veteran's children, regardless of age; (4) The veteran's parents or the surviving
parent (5) The executor or administrator of the
deceased veteran's estate.
WHO SHOULD FILE A BURIAL CLAIM
VII.1.A.4.a. Time Limits for Filing a Burial Claim
Claims for nonservice-connected (NSC) burial allowance must be filed within two years of the date of permanent burial or cremation of the Veteran.
There is no time limit for applying for the
service-connected (SC) death burial allowance VA hospitalization burial allowance plot or interment burial allowance, and transportation reimbursement.
Per this change, there is now no time limit to file a claim for an NSC burial based on VA hospital death, or to file a claim for the plot allowance. Basically the only time limit now is for normal NSC burials.
HUB promulgation Teams
◦ Fiduciary HUBS will now do:
Final findings of incompetency
Release withheld funds.
Recent Pension Rule Changes
PMC Processing Team FunctionAction(s) When a claim is reviewed by a RVSR and there is a Rating Decision that
proposes Incompetency, the Veterans Service Representative (VSR) or designee will perform the following:
VSR or designee prepares Pre-Incompetency letter (date and release) and scans the letter in VVA◦ Adding the necessary paragraph to send correspondence to the Fiduciary Hub have
jurisdiction RVSR or VSR or designee conducts the Brady Bill Phone and documents
the phone call on a report of contact uploaded to Virtual VA
VSR or designee establishes a one-month diary using the, “Local Regional Office – Special use “ with remarks – “Incomp Due Process”
VSR or designee prepares Email notification to the appropriate Fiduciary Hub regarding the proposed incompetency. (Individual Email sent to each Fid Hub)
The VSR or designee will upload a copy of the Email correspondence sent to the Fiduciary Hub to Virtual VA for confirmation purpose that notification of the proposed incompetency was sent to the Fiduciary Hub having jurisdiction over the claim action.
Fiduciary Hubs: Issue a final incompetency rating, unless
the beneficiary requests a hearing or submits additional evidence challenging the proposed incompetency rating.
Prepare the 21-592 and schedule Field Examinations with the proposed fiduciary and the beneficiary.
Authorize payment of monthly benefits and/or withheld retroactive benefits to the fiduciary.
IRS and SSA will provide VA with application income information for pension applicants.
PMC will use this information to verify the income of applicants for original Veterans and survivors pension claims.
In the future upfront verification will be expanded to include additional pension end products.
Upfront Verification of Income
Reduce the potential for fraud and vulnerability to abuse.
Reduce or eliminate improper payments caused by the failure to verify a claimants income at the time the PMC determines entitlement to benefits.
Prevent complex, time-consuming, and untimely income verification matching and due process procedures required to suspend or terminate an award.
Reduce debt management workload.
Benefits of Upfront Verification
Coming In the Near Future
Final Rule at www.regulations.gov AO73
Net Worth Limits and Asset Transfers
Upfront Verification of Net Worth
Nursing Home, Assisted Living Facility(ALF), Independent(Residential)Living Facility(ILF-RLF).
$90.00 Medicaid Nursing Home Rate
When can ILF Room and Board fees be considered Medical Expenses.
Activities of Daily Living(ADLs)
Care Facilities
Must Have A&A or Housebound Rating for Fees to be considered Medical Expenses.
Must have a Statement from Caregiver detailing services and the fees they charge.
If caregiver is a family member, need proof of payment to show they are actually employed in this capacity
In Home Care Givers
Some DIC Payments Now Automated◦ 100% S/C for 10 years or more◦ IU for 10 years or more
and have a dependent spouse on their award
SBP and Non-Concurrent Payments
VAF 21-534EZ VA Obligated to Address the Claimant’s Entitlement to DIC, Survivor’s Pension and Accrued Benefits.
DIC
Criteria for a substantially complete Pension Application for benefits
Claimant’s name and relationship to the Veteran, if applicable Sufficient service information for the Department of Veterans Affairs (VA) to verify
the Veteran’s service, if applicable Benefit claimed Disability(ies) on which the claim for benefits is based (Exposure to certain
agents such as Agent Orange or anthrax, with no corresponding disability or symptomatology, is not a disability for VA purposes.)
Signature of the claimant or other legally authorized individual (M21-1, III.ii.1.A.3b), and
Statement of income for non-service-connected (NSC) disability pension, death pension or Parents’ Dependency and Indemnity Compensation (DIC), if claimed.
If the claimant submits any income or net worth information, but does not complete all blocks, we will obtain the missing information. The application is considered substantially complete. The EP will remain pending while development is undertaken.
For pension claims:VA encourages the use of the VA Form 21-527EZ; however, the VA Form 21-526 and VA Form 21-527 are also acceptable for pension claims.
For DIC and survivor benefits:VA encourages the use of the VA Form 21-534EZ; however, the VA Form 21-534 and VA Form 21-535 are also acceptable for DIC and survivor benefits.
Components of “Standard Claims and Appeals Form” Rule
How to submit an intent to file
An intent to file may be received from the claimant or his/her representative:
Electronically via eBenefits or the Stakeholder Enterprise Portal,
Over the phone with a VA National Call Center or other public contact representative or
On the paper VA Form 21-0966, which may be mailed, faxed or delivered in person.
Components of “Standard Claims and Appeals Form” Rule
Scanning Contractor for Claims and Responses to Development:
Department of Veterans AffairsPension Intake CenterATTN: Philadelphia Pension CenterPO Box 5206Janesville, WI 53547-5206
Not FTI or IVM Responses
Will be scanned into VBMS
Address to SMS Portal
FAX Number to PMC:215-842-4410
Claims uploaded to VVA.
Special Inquiry Phone Queue:215-381-3762
VSO E-mail Addresses:[email protected]
Special PO Box:PO Box 42910
Philadelphia, PA 19101
Special Fax Number:215-842-4410
Special Access to:Philadelphia PMC Advocacy Team
Fiduciary Hub(888) 407-0144