Veterans Aid and Attendance Pension Benefit -- Long Term Care Benefits for Veterans What Is the Aid and Attendance Benefit? The Veterans Benefits Administration offers a disability income available to veterans who served during a period of war or to their surviving spouses. This special benefit is officially called "pension" but is more popularly known as the "veterans aid and attendance pension benefit". For a pension benefit for veterans younger than 65, evidence of total of disability must be provided. Veterans 65 and older do not have to disabled.
The National Care Planning Council estimates that as much as 30% of the US population over the age of 65 would qualify for the aid and attendance pension benefit under the right circumstances. That's how many war veterans or surviving spouses of veterans there are. The benefit is such a well-kept secret that only a small fraction of these eligible veterans are actually receiving it. Death pension -- a benefit available to a surviving spouse-- is a lesser amount based on the same rules for applying for a living pension claim. In other words, the deceased veteran must have met the rules for pension -- with the exception of being totally disabled or over age 65 -- or have been receiving pension in order for his or her spouse to receive the lesser benefit. In addition, in order to be eligible or keep receiving the benefit, the surviving spouse must remain single.
Who can submit a claim? A claim is submitted by the veteran or by the veteran's single surviving spouse in the case of a death claim. A duly appointed service organization, an employee of the local regional VA office, or a VA approved agent may file a claim on behalf of the veteran or the spouse. A claim cannot be filed with a general or durable power of attorney. The application will be sent back requesting proper documentation for a VA power of attorney. The veteran must sign a document specifically authorizing a power of attorney for someone to submit an initial claim for him. Many chagrined children with a durable power of attorney have submitted claims on behalf of a parent only to have the claim rejected by VA.
What happens if the veteran is incompetent? If the veteran cannot submit the original application or sign a power of attorney for a surrogate to file an application, then a duly appointed guardian can complete the application. VA also allows the spouse, a parent or next of kin, or a friend to complete and submit an application on behalf of an incompetent veteran if that person submits the proper power of attorney request and indicates the applicant could be considered incompetent for financial affairs. Even though the veteran or surviving spouse may be incompetent for financial affairs, he or she should always sign the power of attorney request if he or she is competent to do so. VA may appoint a fiduciary to take over the claim and the affairs for the claimant if VA determines he or she is incompetent.
How does VA handle power of attorney? Employees of VA and veterans service organizations already have authorization for power of attorney to file an application on behalf of the veteran. They have forms for the veteran to sign to allow this to happen. An attorney representing the veteran in other affairs can also request a power of attorney in the proper format and on his or her letterhead. Any single individual may also submit a letter requesting power of attorney to submit an application if it is signed by the veteran and if the letter provides certain required information. There is also a VA form in the book support packet that can be submitted for power of attorney. All attorney requests submitted for power of attorney must state that the veteran is not paying a fee to file the application on his or her behalf.
What is an "aid and attendance" or "housebound" rating? A "rating" is granted by a veteran service representative where a condition exists that makes the disability more severe. Medical evidence is required unless someone is a patient in a nursing home, and then the requirement is waived. The rating allows VA to pay an additional monthly amount of pension or compensation to a veteran or a surviving spouse for additional costs associated with this disability.
How does one qualify for aid and attendance or housebound rating? The application form has a block allowing for a request for either rating. Submitting medical evidence in advance instead of waiting for a request from VA can help expedite the process of getting this rating. We have provided in the book support packet, a sample form that might be used for this purpose. This form is also designed around information that VA is looking for and may be a more effective presentation of the facts than typical medical records from the doctor.
What is the effective date? The effective date is generally the day VA receives an original application. If it takes three months for the process of approval or six months, it doesn't matter. The effective date still reverts to receipt of the original application.
When does payment begin? Generally, payments start on the first day of the month following the month of the effective date. This means that if it took six months to get approval, at least five months of benefit will be paid retroactively. VA requires automatic deposit of awards in a checking or savings account.
What happens if the veteran dies during the period of application? If the veteran dies during the period of application and the application was not approved prior to the death, there may be accrued benefits. If the regional office had all of the information in its possession that would have led to an approval, then there is an accrued benefit payable. Otherwise there is none. The full benefit is available for the month of death of the veteran and to a surviving spouse through an application on Form 21-534. This is the same form a surviving spouse uses for a death benefit claim for himself or herself. VA will award either an accrued benefit or death benefit to the surviving spouse whichever is larger. If there is no surviving spouse or dependent child, VA will pay the unreimbursed costs of last illness and burial to the person who paid those costs. A special claim must be submitted for these costs, not Form 21-534.
What is a veteran's federal fiduciary, and does that affect the application? For a veteran who is considered incompetent to handle his own financial affairs, VA will appoint a fiduciary to receive the money and pay the bills. A federal fiduciary is an individual appointed for this purpose, usually a spouse or a family member. In most cases -- except for the spouse living with the veteran -- there is an interview required and mounds of paperwork. This process can take a long time, and it is to the advantage of the person filing an original claim to request the appointment of himself or herself as a fiduciary or for some other appropriate person or organization to help expedite the process. VA always makes the final decision on whom it appoints as a fiduciary. In fact, the agency might well ignore court appointed fiduciaries. In general, the decision favors declaring the veteran competent and avoiding a fiduciary where at all possible.
What is the income test for pension? If the household income adjusted for unreimbursed medical expenses and a deductible is greater than the maximum allowable pension rate -- MAPR -- there is no benefit. In 2007, the maximum allowable rate for a couple with aid and attendance allowance is $21,615 a year. For a single it is $18,234 a year. Without aid and attendance or housebound allowance the maximum couple's rate is $14,313 a year and for a single it is $10,929 a year. Death pension rates are lower. People seeking a benefit with adjusted incomes greater than these levels will be denied.
Can a household with income above the maximum limit qualify for pension? A quirk in the way benefits are calculated can allow individuals and couples earning between $24,000 to $60,000 a year to still qualify for a benefit. It has to do with the treatment by VA of the very large recurring medical costs associated with home care, assisted living, or nursing home care.
What is the pension household asset test, and what can be done if the asset test is not met? As a general rule assets cannot exceed $80,000. A veteran or spouse occupied-house, a reasonable amount of land upon which it sits and a vehicle are exempt from the asset test. In reality there is no specific test in the regulations. Veterans service representatives are required to file paperwork justifying their decision if they allow assets greater than $80,000. Thus this amount has become a traditional ceiling. The service representative is encouraged to analyze the veteran's household needs for maintenance and weigh those needs against assets that can be readily converted to cash. In the end, the decision as to allowable assets is a subjective decision made by a service representative. In certain cases a benefit award could be denied even if assets are below $20,000 or $10,000 or even zero dollars. There are legal ways to get around the asset test if assets are too high. These are described in our book.
What proofs and documents are required with the pension claim? We have already discussed the requirements for power of attorney and fiduciary if they apply. In addition, an original copy of the discharge from service -- typically DD 214 or form WD -- is required and the discharge must have been honorable. If there is a question about the marriage relationship, a marriage certificate or other proof may be necessary. Birth certificates of dependent children are usually not required but may be necessary under certain conditions. A dependent child is a minor, a dependent student under age 23, or a totally dependent adult child. There are certain documents that need to be submitted to prove future recurring medical expenses and to prove need for aid and attendance or housebound allowances. VA does not furnish these documents nor provide any information that they are required. Sample documents that could be used for these purposes are included in our book.
Can someone charge to help fill out the form? Federal code and VA regulations prohibit an agent, advisor or attorney from charging a fee to fill out and file a claim for pension. Most practitioners or providers help their clients for free, sometimes in the context of solving other retirement issues or providing long term care services. Some practitioners offer application advice for a fee (which is legal) but will send their clients to a veterans' service organization to complete the application. Some assisted living facilities or home care providers also offer free advice or help and this seems to be an acceptable practice. An agent or attorney can also be paid by a disinterested third party under certain conditions to complete an application. However, a home care agency, assisted living facility or nursing home that pays an agent or attorney to complete an application on behalf of a resident or client does not meet the definition of a disinterested third party is in violation of the prohibition for charging a fee
How are assets, income and unreimbursed medical expenses determined? The applicant must submit details on the application of all income and all assets including retirement savings accounts such as IRAs. Almost any type of money received or anything received that can be converted into money is income. The only exclusions for assets are a personal residence (occupied by the veteran or spouse) and a reasonable amount of land it sits on as well as vehicles and other personal possessions. Personal possessions used as an investment such as a coin collection are counted as assets. Unreimbursed medical expenses can be almost any expense related to medical needs.
Are there any other reporting requirements? VA requires that any change in income or assets be reported immediately. The award is calculated for 12 months in advance, but at the beginning of each calendar year, a formal report called an EVR (Eligibility Verification Report) must be filed detailing all income, assets and unreimbursed medical expenses for the coming calendar year. For example if the award is granted in April for 12 months in advance, an EVR must be submitted in January of the next year that could affect the award amount for the remaining four months of the initial 12 month period. The EVR will be used for determining benefits for the calendar year on which it is based.
What is a veteran's federal fiduciary, and does that affect the application? VA can appoint a number of different types of fiduciaries to manage the funds on behalf of an incompetent veteran. A federal fiduciary is typically an individual such as the spouse or a child whom the VA is most likely to appoint. If VA is not notified with the application that the veteran may be incompetent and that a fiduciary appointment is requested, this could slow down the application and approval process.
Will the pension benefit pay a nonlicensed homecare provider? VA does not pay providers directly but provides extra income to make up for the cost of licensed medical care. Medical conditions or injuries or diseases that require a need for ongoing licensed homecare will allow the applicant to reduce household income by the cost of homecare making it possible to receive the additional income from a pension award. If the beneficiary has an aid and attendance or housebound allowance, VA will allow deductions for nonlicensed providers as well.
Will the pension benefit pay a member of the family to provide care at home? As explained above, VA will not pay providers directly but only indirectly through extra income. If the beneficiary receiving care in the home has received a rating for aid and attendance or housebound, VA will allow expenses paid to a family member for care to be counted as unreimbursed medical expenses to qualify for the benefit. The care arrangement must be legitimate and appropriate evidence must be provided.
Does the pension benefit pay the costs of a nursing home? The application form has provision for indicating residency in a nursing home and whether or not the applicant is eligible for Medicaid. VA will automatically apply the monthly cost of the nursing home in determining the pension benefit. If the applicant is single with no dependent children at home and is eligible for Medicaid, VA is required to stop any payment of full benefits and only provide the veteran with $90 a month.
Does the pension benefit pay the costs of assisted living? As explained above, VA will not pay providers directly but only indirectly through extra income. If the beneficiary receiving care in assisted living has received a rating for aid and attendance or housebound, VA will allow expenses paid to assisted living for aid and attendance or housebound ratings -- including room and board -- to be counted as unreimbursed medical expenses. The cost of assisted living being used as a retirement residence is not considered a medical expense. It does not warrant a rating and cannot be deducted.
What are the requirements to receive a death pension benefit? The applicant must be a surviving spouse or a dependent child of an eligible veteran. VA form 21-534 is used to apply for death pension, death compensation, accrued benefits, or dependency and indemnity compensation (DIC). The surviving spouse must be single. A surviving spouse of any age is eligible as long as the deceased veteran served at least 90 days during a period of war. They had to be married at least a year prior to death or have a child as a result of the marriage. There is no requirement for total disability for the surviving spouse nor for the deceased veteran to have been totally disabled or older than age 65.
How does one prove that unreimbursed medical expenses will recur every month? VA has specific rules for proving future recurring medical expenses. Information in our book outlines the type of paperwork that must be submitted for each type of long term care service. The book also contains appropriate forms for this purpose. Neither the claims form nor information from the regional office provides any guidance on the rules for proving future recurring medical expenses for home care or assisted living. One simply has to know how to do it. This one crucial step often makes the difference between a successful claim and a denial.
What if the veteran or spouse is currently receiving Medicaid? Our interpretation of the rules leads us to believe that VA will not consider Medicaid payments as income. However, Medicaid will consider the nonallowance portion of the pension to be income. This could affect Medicaid eligibility in income test states. There is evidence that some income test states count the entire pension benefit including the allowance as income. According to federal Medicaid rules this should not happen.
What happens when the veteran or spouse wants to receive pension & Medicaid together? Federal law requires that a single veteran receiving Medicaid with no spouse or dependent children can receive no more than $90 a month from VA. Veterans in state veterans homes are exempt from this requirement. The veteran with a spouse can receive the benefit to help defray the costs of a nursing home. As a general rule, the pension benefit would probably not work if Medicaid were paying the bill. But the benefit does work well for non-Medicaid nursing home beds and while the recipient is going through the Medicaid spend down.
This article is an excerpt from the book -- "VETERANS AID AND ATTENDANCE BENEFIT -- LONG TERM CARE BENEFITS FOR VETERANS" -- published by the National Care Planning Council and written and edited by Thomas Day, Council Director. This first-of-its-kind book is available in two editions -- the Standard Edition (209 pages) for the general public and the Professional Edition (443 pages) to be used as a handbook for advisors and care providers. Both books contain the necessary information and forms to complete an application for the benefit. The Professional Edition also includes citations from rules and regulations, hypothetical planning cases, asset reduction strategies and a software CD with benefit estimate software, all applicable forms and planning sheets. To review and purchase the book go to http://www.longtermcarelink.net/a16veterans_books.htm or type in your browser window www.veteranbook.com.