We have mentioned in previous sections that there are basically two types of Pension claims. The first of these are claims for veteran households who have low income and few assets. The second type of claim is for veteran households who may have income exceeding the MAPR or who may have substantial assets or both. These households typically only qualify for Pension when a member of the household is paying out-of-pocket for expensive long term care costs.
When the Family Should Not Submit a Claim without Prior Knowledge or Advice
Veterans or family members should seek further advice before attempting to submit a claim that deals with income in excess of MAPR and involves long term care costs. Advice should also be sought for claims that involve assets that may lead to a denial of the benefits.
This second type of claim for higher income households requires medical evidence for substantiating a need for aid and attendance or being housebound. In addition, evidence is needed to prove recurring medical costs. In addition, if assets are going to be a block to a successful award, a qualified consultant must be sought out to help with this issue. And finally, if a fiduciary might be appointed, a consultant could provide advice to reduce the time added to the claims process by this additional step.
According to VA, the average processing time for a claim is 177 days — almost 6 months. Knowing how to submit a well-documented claim could cut this processing time in half. On the other hand, the complexity associated with these high income claims warrants seeking advice or knowledge; otherwise the processing time from VA could be extended to 8 to 12 months or even longer. Not getting things right could mean the maximum award may not be realized or the claim could be denied. Depending on the situation, we recommend you either purchase our book or you seek out the help of a qualified consultant.
When the Family Can Submit a Claim without Help
The claim associated with low income, few assets and no ongoing, long term care costs can usually be attempted by the veteran household or a member of the family without much help. Little additional advice is needed to submit one of these claims. If a member of the family or a trusted friend wants to submit a claim on behalf of a veteran, there must be a proper VA power of attorney. There is a form available online — VA 21–22a — or the veteran can sign a handwritten or typed authorization using the following as authority.
CFR §14.630 Authorization for a particular claim.
(a) Any person may be authorized to prepare, present, and prosecute one claim. A proper power of attorney, and a statement signed by the person and the claimant that no compensation will be charged or paid for the services, shall be filed with the office where the claim is presented. A signed writing, which may be in letter form, identifying the claimant and the type of benefit or relief sought, specifically authorizing a named individual to act as the claimant’s representative, and further authorizing direct access to records pertinent to the claim, will be accepted as a power of attorney.
(b) Representation may be provided by an individual pursuant to this section one time only. An exception to this limitation may be granted by the General Counsel in unusual circumstances. Among the factors which may be considered in determining whether an exception will be granted are:
(1) The number of accredited representatives and claims agents operating in the claimant’s geographic region;
(2) Whether the claimant has unsuccessfully sought representation from other sources;
(3) The nature and status of the claim; and
(4) Whether there exists unique circumstances which would render alternative representation inadequate. (Authority: 38 U.S.C. 501(a), 5903)
[53 FR 52421, Dec. 28, 1988, as amended at 68 FR 8546, Feb. 24, 2003]