Table of Contents Chapter 3. Information Requests to and From the Social Security Administration (SSA) Table of Contents
Section A: Department of Veterans Affairs (VA) Requests for Information From the SSA Overview 3-A-1 1. General Information on VA Requests to the SSA 3-A-2 2. VA Requests for Disability Records 3-A-3 3. Obtaining Information Through the Federal On-Line Query (FOLQ) 3-A-6 4. VA Requests for Verification of SSA Monthly Payments 3-A-8 5. Evidence Used to Support Joint Claims for Social Security (SS) and Dependency and Indemnity Compensation (DIC) Benefits 3-A-10 6. Addresses of the Program Service Centers (PSCs) 3-A-13 7. Addresses of the SSA District Offices 3-A-16 8. Exhibit 1: VA Request for SSA Disability Records 3-A-18 9. Exhibit 2: VA Request for SSA Records at the National Records Center (NRC) 3-A-19
Section B: SSA Requests for Information From VA Overview 3-B-1 10. General Information on SSA Requests to VA 3-B-3 11. SSA Requests for Medical Information 3-B-4 12. General Information on VA Responses to SSA Requests 3-B-7 13. Releasing Medical Information to the SSA 3-B-10 14. When to Use VA Form 21-4184, Certification of Contents of Document(s) or Record(s) 3-B-13 15. General Information on Determining VA Benefits for SSA Purposes 3-B-16 16. Exclusion of Aid and Attendance (A&A), Housebound or Special Monthly Compensation (SMC) Entitlement for SSA Purposes 3-B-18 17. Exclusion of Deductions When Responding to SSA Inquiries 3-B-22 18. Exclusion of Amounts Payable Due to Medical Expenses 3-B-24 19. General Information on Calculating Award Amounts for Responses to the SSA 3-B-26 20. Calculating Old Law Pension Award Amounts for Responses to the SSA 3-B-27 21. Calculating Section 306 Pension Award Amounts for Responses to the SSA 3-B-30 22. Calculating DIC and Death Compensation Award Amounts for Responses to the SSA Concerning Benefit Payments to Parents 3-B-33 23. Calculating DIC and Death Compensation Award Amounts for Responses to the SSA Concerning Benefit Payments to a Surviving Spouse or Child(ren) 3-B-34 24. Calculating Disability Compensation Award Amounts for Responses to the SSA 3-B-38 25. Calculating Improved Pension Award Amounts for Responses to the SSA 3-B-40 26. Calculating Service Pension Award Amounts for Responses to SSA 3-B-45
Section A. Department of Veterans Affairs (VA) Requests for Information From the SSA Overview
In this Section This section contains the following topics:
Topic Topic Name See Page 1 General Information on VA Requests to the SSA 3-A-2 2 VA Requests for Disability Records 3-A-3 3 Obtaining Information Through the Federal On-Line Query (FOLQ) 3-A-6 4 VA Requests for Verification of SSA Monthly Payments 3-A-8 5 Evidence Used to Support Joint Claims for Social Security (SS) and Dependency and Indemnity Compensation (DIC) Benefits 3-A-10 6 Addresses of the Program Service Centers (PSCs) 3-A-13 7 Addresses of the SSA District Offices 3-A-16 8 Exhibit 1: VA Request for SSA Disability Records 3-A-18 9 Exhibit 2: VA Request for SSA Records at the National Records Center (NRC) 3-A-19
1. General Information on VA Requests to the SSA
Introduction This topic contains general information on Department of Veterans Affairs (VA) requests to the Social Security Administration (SSA), including information on
• the requirements of 38 U.S.C. 5105 • the constraints on VA requests to the SSA • the correct time allowance for follow-up requests to the SSA, and • filing information from SSA records.
Change Date December 13, 2005
a. Requirements of 38 U.S.C. 5105 38 U.S.C. 5105 requires that evidence filed with either the Social Security Administration (SSA) or Department of Veterans Affairs (VA) must be made available to the other agency if needed.
Important: A claimant is not precluded from submitting a duplicate set of proofs.
Reference: For more information on the exchange of evidence between the SSA and VA, see 38 CFR 3.201.
b. Constraints on VA Requests to the SSA Except as provided in M21-1MR, Part III, Subpart iii, 3.A.5 and M21-1MR, Part IX, Subpart ii, 1.C.6, if information is needed from the SSA in connection with adjudication of a claim, request the information in accordance with this chapter.
c. Correct Time Allowance for Follow-Up Requests to SSA Initially follow-up a request or requests to the SSA for medical records after 60 days have elapsed from the date of the original request.
Subsequent follow-up requests must be 60 days apart.
d. Filing Information From SSA Records File all information furnished to VA from SSA records under this section in accordance with the provisions of 38 CFR 1.521.
2. VA Requests for Disability Records
Introduction This topic contains information on VA requests for disability records, including information on
• how to route requests for SSA disability records • what information to include on requests • handling faxed documents, and • follow-up requests.
Change Date December 13, 2005
a. How to Route Requests for SSA Disability Records The correct routing of a request for SSA disability records depends on the individual’s age and mailing address.
Use the table below to determine where to route requests for disability records.
If the person … Then … is younger than age 55 fax the request to the Office of Disability Operations (ODO) in Baltimore, fax number (410) 298-7954.
Reference: For a sample copy of a request for SSA disability records, see M21-1MR, Part III, Subpart iii, 3.A.8. is age 55 or older fax the request to the National Records Center (NRC) in Kansas City, fax number (816) 257-5106.
Reference: For a sample copy of a request for SSA disability records at the NRC, see M21-1MR, Part III, Subpart iii, 3.A.9. resides at a foreign address mail the request to the
Division of International Operations P.O. Box 17769 Baltimore, MD 21235-7769
Continued on next page
2. VA Requests for Disability Records, Continued
b. Information to Include on the Request The request for disability records should be on VA letterhead and should include as much of the following information as possible:
• the name and address of the claimant • the wage earner’s name Social Security number (SSN) date of birth (DOB) place of birth, and age • the name of the wage earner’s parents • the exact nature of the information desired, and • the purpose for which the requested information is to be used.
Important: The requester’s name, telephone number, and fax number are required on the request so that the SSA has a VA point of contact.
c. Handling Faxed Documents When faxing the request
• do not transmit a fax cover sheet with the request • keep the original fax in the claims folder, and • annotate the fax with the date it was transmitted to the SSA.
Note: Date follow-up faxes also.
Continued on next page
2. VA Requests for Disability Records, Continued
d. Follow-up Requests Use the table below to determine how to follow-up on requests for disability records.
If the request was sent to the … Then send the follow-up request … ODO by fax by fax to (410) 298-7954 after 60 days have elapsed from the date of the original request.
Reference: Use the sample copy of the request shown in M21-1MR, Part III, Subpart iii, 3.A.8. If the original request to the ODO was sent by mail, all follow-ups must be sent via mail also. NRC by fax to (816) 257-5106 if no reply has been received within 10 working days. SSA after 60 days have elapsed from the date of the original request.
Note: Send subsequent follow-up requests 60 days apart.
3. Obtaining Information Through the Federal On-Line Query (FOLQ)
Introduction This topic contains information on obtaining information through the Federal On-line Query (FOLQ), including information on
• the definition of FOLQ • when to use the FOLQ • the information provided by FOLQ, and • how to access FOLQ.
Change Date December 13, 2005
a. Definition: FOLQ The Federal On-Line Query (FOLQ) is a read-only-specific, real-time query developed by the SSA for States and other agencies to obtain certain SSA data.
b. When to Use the FOLQ Use FOLQ to verify the amounts of monthly SSA benefits.
Access to FOLQ enables the Veterans Benefits Administration (VBA) to assist veterans and dependents by obtaining instant verification of eligibility information such as that provided on applications and Eligibility Verification Reports (EVRs).
c. Information Provided by FOLQ FOLQ provides the following information:
• verification of SSNs • Title II, Retirement, Survivors, and Disability Insurance data • Title XVI, Supplemental Security Income data, and • a limited payment history file. Continued on next page
3. Obtaining Information Through the Federal On-Line Query (FOLQ), Continued
d. How to Access FOLQ Access FOLQ through SHARE.
FOLQ requires the
• VA file number • claimant’s name SSN, and date of birth (DOB), and • reason for inquiry for each individual for whom information is needed.
Reference: For more information on FOLQ, see the FOLQ User's Guide.
4. VA Requests for Verification of SSA Monthly Payments
Introduction This topic contains information on VA requests for verification of SSA monthly payments, including information on
• where SSA files are maintained, and • verifying a combined SSA payment to a surviving spouse and children, and a veteran and spouse.
Change Date December 13, 2005
a. Where SSA Files Are Maintained All
• tax contribution records are maintained by SSA in its Baltimore office, and • benefit payment records are maintained in the regional Program Service Centers (PSCs).
Access FOLQ through SHARE to verify the amount of monthly benefits.
Reference: For more information on FOLQ, see M21-1MR, Part III, Subpart iii, 3.A.3.
b. Verifying a Combined SSA Payment to a Surviving Spouse and Children Under SSA procedures, a surviving spouse may continue to receive Social Security (SS) benefits in his/her own name but, because of earnings, one or more of these checks must be for the benefit of the child or children in his/her custody.
Access FOLQ through SHARE to verify the amount of monthly benefits. Continued on next page
4. VA Requests for Verification of SSA Monthly Payments, Continued
c. Verifying a Combined SSA Payment to a Veteran and Spouse The SSA may issue a combined payment to a husband and wife, although the benefit is based on the employment of only one spouse if
• both the wage earner and spouse reside at the same address • neither is incompetent, and voices any objection to combining of the payment, and • no other reason exists that would make combining of the payment undesirable, such as entitlement by the dependent spouse to old-age insurance or SS benefits on his/her own account.
Important: Consider only the amount of the combined payment that represents the veteran’s portion as his/her income
Note: Access FOLQ through SHARE to verify the amount of monthly benefits payable to both the wage earner and spouse.
5. Evidence Used to Support Joint Claims for Social Security (SS) and Dependency and Indemnity Compensation (DIC) Benefits
Introduction This topic contains information on the evidence needed to support joint claims for SS and Dependency and Indemnity Compensation (DIC) benefits, including
• the information to provide to the claimant • the VA response if a claimant asks VA to request evidence from the SSA • information provided by the SSA • the action to take when SSA asks the claimant to provide additional evidence • evaluating evidence from the SSA, and • handling evidence accepted by the SSA but rejected by VA.
Change Date December 13, 2005
a. Information to Provide to the Claimant When requesting evidence from the claimant,
• make the usual request for required evidence • advise the claimant that VA will request evidence from the SSA if he/she so desires, and • explain that submission of evidence to VA may expedite claims processing.
b. VA Response if a Claimant Asks VA to Request Evidence From the SSA If the claimant asks VA to obtain the evidence from the SSA
• send a letter to the district office of the SSA as shown on VA Form 21-4182, Application for Dependency and Indemnity Compensation or Death Pension (Including Accrued Benefits and Death Compensation Where Applicable) • maintain a 60-day control, and • follow-up with the SSA at the expiration of the 60-day control.
Reference: For more information on the addresses of the SSA district offices, see M21-1MR, Part III, Subpart iii, 3.A.7. Continued on next page
5. Evidence Used to Support Joint Claims for Social Security (SS) and Dependency and Indemnity Compensation (DIC) Benefits, Continued
c. Information Provided by SSA in Response to a Request In response to a request for information from VA, the SSA will furnish
• either a photocopy of the evidence or a certification on SSA Form 704, Certification of Contents of Document(s) or Record(s) which is acceptable for VA purposes, if other requirements are met, and • a statement signed by an SSA employee on the back of each photocopy, showing whether or not the original document appears to be genuine the purported age, and whether any alterations appear.
d. Action to Take When SSA Asks the Claimant to Provide Additional Evidence SSA informs VA if SSA has asked a claimant to furnish additional evidence.
SSA does not forward such additional evidence to VA without a specific request from VA.
In such cases, request any required evidence from the claimant and make no further request of the SSA, unless the claimant requests that such action be taken.
e. Evaluating Evidence From SSA Evaluate evidence received from the SSA as though the claimant had submitted it. If such evidence is not acceptable, inform the claimant and request that he/she submit the required evidence.
Continued on next page
5. Evidence Used to Support Joint Claims for Social Security (SS) and Dependency and Indemnity Compensation (DIC) Benefits, Continued
f. Action to Take When VA Rejects Evidence Accepted by SSA In the event that a claimant writes VA and alleges that evidence accepted by the SSA to establish entitlement to SS benefits has been rejected by VA, and there is no apparent difference in basic requirements
• acknowledge the letter, and • undertake such additional development action as may be appropriate, including obtaining a copy of any findings made by the SSA.
If, on reconsideration, the regional office (RO) does not determine that a change in the prior decision is warranted, refer the case to Central Office (CO) (211).
6. Addresses of the Program Service Centers (PSCs)
Introduction This topic contains information on the PSCs, It includes information on
• the functions of the PSCs • determining the appropriate PSC for a records request, and • PSC mailing addresses and the range of SSNs assigned to each.
Change Date December 13, 2005
a. Functions of the PSCs The PSCs of the Bureau of Retirement and Survivors Insurance take final action on claims for SS benefits and also handle post-adjudicative actions.
b. Determining the Appropriate PSC for a Records Request Although SSNs are composed of nine digits grouped as “000-00-0000,” determine the appropriate PSC by referring to the first three digits of the SSN.
Each PSC services cases within a specified range of account numbers, regardless of the place of residence or the place of death of the holder of the account number.
c. PSC Mailing Addresses and the Range of SSNs Assigned to Each The table below lists PSC mailing addresses and the range of SSNs assigned to each center.
PSC and Mailing Address Account Number Range(s) Northeastern PSC (PSC 1) Box 314000 Jamaica, NY 11431 001 through 134 Mid-Atlantic PSC (PSC 2) 300 Spring Garden Road Philadelphia, PA 19123 • 135 through 222 • 232 through 236 • 577 through 584 • 596 through 599 • 691 through 699 Continued on next page
6. Addresses of the Program Service Centers (PSCs), Continued
c. PSC Mailing Addresses and the Range of SSNs Assigned to Each (continued)
PSC and Mailing Address Account Number Range(s) Southeastern PSC (PSC 3) 2001 12th Avenue, North Birmingham, AL 35285 • 223 through 231 • 237 through 267 • 400 through 428 • 587 through 595 • 654 through 658 • 666 through 675 • 681 through 690 • 752 through 763 Great Lakes PSC (PSC 4) 600 West Madison Street Chicago, IL 60661 • 268 through 302 • 316 through 399 • 700 through 728 Western PSC (PSC 5) P.O. Box 2000 Richmond, CA 94802 • 501 through 504 • 516 through 524 • 526 through 576 • 586 • 600 through 626 • 646 through 647 • 650 through 653 • 680 • 729 through 751 Continued on next page
6. Addresses of the Program Service Centers (PSCs), Continued
c. PSC Mailing Addresses and the Range of SSNs Assigned to Each (continued)
PSC and Mailing Address Account Number Range(s) Mid-America PSC (PSC 6) 601 East 12th Street Kansas City, MO 64106 • 303 through 315 • 429 through 500 • 505 through 515 • 525 • 585 • 627 through 645 • 648 through 649 • 659 through 665 • 676 through 679
7. Addresses of the SSA District Offices
Introduction This topic contains information on the SSA district offices. It includes information on
• the functions of the SSA district offices • where the SSA district offices are located, and • the office addresses in areas where there is more than one district office or the district offices are not in the same city as the VARO.
Change Date December 13, 2005
a. Functions of the SSA District Offices SSA district offices initiate and develop claims for SS benefits and prepare awards and denials that are submitted to the PSCs for final approval.
b. Where SSA District Offices Are Located These district offices are located throughout the U.S. in major cities.
When reference is made within M21-1MR to the “parallel district office of the SSA,” it refers to the SSA district office nearest the VARO adjudicating the claim.
c. Office Addresses in Areas Where There Is More Than One District Office or the District Offices Is Not in Same City as the VARO The table below lists the addresses to use in areas where there is more than one district office or the district office is not in the same city as the VARO.
VA Office Location SSA District Office Address California, Los Angeles Suite 10203 11000 Wilshire Blvd Los Angeles, CA 90024 California, San Francisco 939 Market Street San Francisco, CA 94103 Continued on next page
7. Addresses of the SSA District Offices, Continued
c. Office Addresses in Areas Where There Is More Than One District Office or the District Offices Is Not in Same City as the VARO (continued)
VA Office Location SSA District Office Address Illinois, Chicago 1233 West Adams Chicago, IL 60607 Maine, Togus 40 Western Avenue Federal Office Building Augusta, ME 04330 Maryland, Baltimore 500 North Calvert Street Baltimore, MD 21202 Michigan, Detroit Room 1550 Patrick V. McNamara Bldg. 477 Michigan Avenue Detroit, MI 48226 Missouri, St. Louis 815 Olive Street Room 50, Old Post Office St. Louis, MO 63101 Montana, Fort Harrison Federal Building Drawer 10075 301 South Park Helena, MT 59626 New York, New York City Downtown District Office Church Street Station, Box 1826 New York, NY 10008 Ohio, Cleveland AJC Federal Building 1240 East 9th Street, Room 793 Cleveland, OH 44199 Pennsylvania, Philadelphia 3rd Floor 5716 Greene Street Philadelphia, PA 19144 Vermont, White River Junction 330 ASA Bloomer State Office Building Rutland, VT 05701 Wisconsin, Milwaukee 6300 W. Fond Du Lac Avenue Milwaukee, WI 53218
8. Exhibit 1: VA Request for SSA Disability Records
Change Date December 13, 2005
a. VA Request for SSA Disability Records A sample copy of a VA request for SSA disability records is below.
Department of Veterans Affairs Veterans Benefits Administration
INITIAL REQUEST FOLLOW-UP REQUEST
TO: SSA ODO DISCLOSURE WORKGROUP FAX: (410) 298-7954 FROM: VA OFFICE: _____________________________________________
SSA DISABILITY RECORDS REQUESTED BY VA
Veteran’s or Dependent’s Name:___________________________ SSN: _________________________
Address:_________________________ VA FILE # ____________________________ __________________________________ Date of Birth: _________________________
VA REQUESTER: (NAME, PHONE AND FAX #’S) ______________________________ PHONE #:_______________________ ______________________________ FAX# _________________________
SSA ODO REPLY DATE ____ The information you requested is provided in this FAX. ____ Original DIB folder is not in ODO SSA JURISDICTION OFFICE. We are sending your request back to you to submit to that office. ____ Your request has been forwarded to the jurisdictional office. Any follow-ups should be directed to ______________________________________________________________ (Include name of contact, phone number and fax of other office) ____ Claimant is over age 55. Your request was forwarded to PSC.
____ The records you requested were mailed on ______________________to the VA office in _______________________________________________________________________ ____ Other: _________________________________________________________________ _______________________________________________________________________
9. Exhibit 2: VA Request for SSA Records at the National Records Center (NRC)
Change Date December 13, 2005
a. VA Request for SSA Records at the NRC A sample copy of a VA request for SSA records at the National Records Center (NRC) is below
Department of Veterans Affairs Veterans Benefits Administration
INITIAL REQUEST FOLLOW-UP REQUEST
TO: SSA NRC, “The CAVES,” VA PROJECT FAX: (816) 257-5106 FROM: VA OFFICE: _____________________________________________
SSA DISABILITY RECORDS REQUESTED BY VA
Veteran’s or Dependent’s Name:___________________________ SSN: _________________________
Address:_________________________ VA FILE # ____________________________ _________________________________ _________________________________ Date of Birth: _________________________
VA REQUESTER: (NAME, PHONE AND FAX #’S) ______________________________ PHONE #:_______________________ ______________________________ FAX# _________________________
SSA NRC REPLY DATE ____ The information you requested is provided in this FAX. ____ Folder is not in SSA NRC. The SSA jurisdictional office is ______________________ We are sending your request back to you to submit to that office. ____ Your request has been forwarded to the jurisdictional office. Any follow-ups should be directed to ______________________________________________________________ (Include name of contact, phone number and fax of other office) ____ Claimant under age 55. Your request was forwarded to OCO in Baltimore. Please make any further contact with that office. ____ The records you requested were mailed on ______________________to the VA office in _______________________________________________________________________ ____ Other: _________________________________________________________________
Section B. SSA Requests for Information From VA Overview
In this Section This section contains the following topics:
Topic Topic Name See Page 10 General Information on SSA Requests to VA 3-B-3 11 SSA Requests for Medical Information 3-B-4 12 General Information on VA Responses to SSA Requests 3-B-7 13 Releasing Medical Information to the SSA 3-B-10 14 When to Use VA Form 21-4184, Certification of Contents of Document(s) or Record(s) 3-B-13 15 General Information on Determining VA Benefits for SSA Purposes 3-B-16 16 Exclusion of Aid and Attendance (A&A), Housebound or Special Monthly Compensation (SMC) Entitlement for SSA Purposes 3-B-18 17 Exclusion of Deductions When Responding to SSA Inquiries 3-B-22 18 Exclusion of Amounts Payable Due to Medical Expenses 3-B-24 19 General Information on Calculating Award Amounts for Responses to the SSA 3-B-26 20 Calculating Old Law Pension Award Amounts for Responses to the SSA 3-B-27 21 Calculating Section 306 Pension Award Amounts for Responses to the SSA 3-B-30 22 Calculating DIC and Death Compensation Award Amounts for Responses to the SSA Concerning Benefit Payments to Parents 3-B-33 23 Calculating DIC and Death Compensation Award Amounts for Responses to the SSA Concerning Benefit Payments to a Surviving Spouse or Child(ren) 3-B-34 Continued on next page
Overview, Continued
In this Section (continued)
Topic Topic Name See Page 24 Calculating Disability Compensation Award Amounts for Responses to the SSA 3-B-38 25 Calculating Improved Pension Award Amounts for Responses to the SSA 3-B-40 26 Calculating Service Pension Award Amounts for Responses to the SSA 3-B-45
10. General Information on SSA Requests to VA
Introduction This topic contains general information on Social Security Administration (SSA) requests to the Department of Veterans Affairs (VA), including information on
• the responsibilities of SSA field offices • the SSA/VA data exchange system • when SSA uses SSA Form L1103, SSI Request for Information to request additional information, and • other VA benefits of interest to the SSA.
Change Date December 13, 2005
a. Responsibilities of SSA Field Offices In administering the Supplemental Security Income (SSI) program, Social Security Administration (SSA) field offices are charged with identifying all of an SSI claimant’s resources, including “income” in the form of monetary benefits from the Department of Veterans Affairs (VA).
b. SSA/VA Data Exchange System The SSA/VA data exchange system is programmed to “break down” VA payments to determine the amount to which each beneficiary is entitled. It cannot, however, calculate the additional amount VA pays for individual dependents.
c. When SSA Uses SSA Form L1103 The SSA uses SSA Form L1103, SSI Request for Information to request pertinent information from VA that is unavailable through the data exchange system.
d. Other VA Benefits of Interest to SSA SSA may request information on other VA benefits, in addition to compensation and pension, such as
• educational benefits • Medal of Honor benefits • Naval pension • Restored Entitlement Program for Survivors (REPS), and • benefits under 38 U.S.C. 1312(a).
11. SSA Requests for Medical Information
Introduction This topic contains information on SSA requests for medical information, including information on
• where SSA sends requests for medical information • the information that should be on SSA Form 828-U4, Request for Medical Information From Records of the Department of Veterans Affairs • what to do with SSA Form 828-U4 • handling misdirected requests for hospital reports • handling requests with insurance numbers only, and • the appropriate action to take when the regional office (RO) that receives the SSA Form 828-U4 does not have the claims folder.
Change Date December 13, 2005
a. Where SSA Sends Requests for Medical Information Requests from the SSA on SSA Form 828-U4, Request for Medical Information From Records of the Department of Veterans Affairs, are sent to regional offices (ROs).
Exception: SSA sends requests for hospital reports on veterans who are currently hospitalized, or who have been discharged within the last 30 days, directly to the VA medical center (VAMC) involved.
b. Information That Should be on SSA Form 828-U4 The SSA Form 828-U4 should contain the
• veteran’s full name file number service number, and Social Security number (SSN) • VARO of jurisdiction • specific information required, and • address of the requesting SSA office. Continued on next page
11. SSA Requests for Medical Information, Continued
c. What to Do With SSA Form 828-U4 When records are provided to the SSA
• annotate both copies of SSA Form 828-U4 to show which records were furnished • return the duplicate of SSA Form 828-U4 with the records furnished • file the original SSA Form 828-U4 in the claims folder.
d. Handling Misdirected Requests for Hospital Reports If the veteran has been discharged from a VA medical center (VAMC) more than 30 days following a recent period of hospitalization, and a hospital summary is not in the folder, acknowledge receipt of the SSA Form 828-U4 and refer the form to the hospital concerned.
e. Handling Requests With Insurance Numbers Only Use the table below to determine the appropriate action to take when the SSA request contains a VA insurance number only.
Step Action 1 Perform a Beneficiary Identification and Records Locator Subsystem (BIRLS) inquiry (BINQ) using the veteran’s name, insurance number, and any other identifying information available. 2 Does the BINQ screen show the existence of a claims folder or an insurance folder only?
• If a claims folder exists, go to Step 3. • If an insurance folder only exists, go to Step 4. 3 Take action to obtain the records as outlined in
• M21-1MR, Part III, Subpart iii, 3.B.11.a through d, and • M21-1MR, Part III, Subpart iii, 3.B.11.f. 4 Acknowledge receipt of the SSA Form 828-U4 and refer the form to the VA Insurance Center in Philadelphia for a reply. Continued on next page
11. SSA Requests for Medical Information, Continued
f. Appropriate Action to Take When the RO Does Not Have the Claims Folder Use the table below to determine the appropriate action to take if the claims folder is not in the RO receiving SSA Form 828-U4.
If BIRLS shows that the folder is … Then … located in another RO • enter the location of the folder under Item IIIA, “Remarks,” of SSA Form 828-U4, and • return both copies of the SSA Form 828-U4 to the SSA office shown on the form. on temporary transfer to Central Office (CO) send the SSA Form 828-U4 to the service within CO that has the folder.
Note: The CO service having possession of the folder will process the SSA-828-U4. on temporary transfer to the Board of Veterans Appeals (BVA) send the SSA Form 828-U4 to CO Compensation and Pension Service (214) for
• review of the folder, and • processing of the form.
12. General Information on VA Responses to SSA Requests
Introduction This topic contains general information on VA responses to SSA requests, including information on
• the requirements of 38 U.S.C. 5105 • the definition of a VA payment • what SSA usually requests • handling requests for information on multiple individuals • responding to follow-up requests, and supplemental requests, and • work credit for responding to SSA.
Change Date December 13, 2005
a. Requirements of 38 U.S.C. 5105 38 U.S.C. 5105 requires that evidence filed with either the SSA or VA must be made available to the other agency if needed.
Important: A claimant is not precluded from submitting a duplicate set of records/evidence to one or the other agency.
Reference: For more information on making evidence available to the SSA and VA, see 38 CFR 3.201.
b. Definition: VA Payment For purposes of this chapter, VA payment means the benefit amount after the round down required by 38 U.S.C. 5123. Continued on next page
12. General Information on VA Responses to SSA Requests, Continued
c. Information SSA Usually Requests An SSA inquiry typically requires only itemization of recurring benefit payments.
Notes: • Use the information in M21-1MR, Part IX, Subpart ii, 1.C.6 to reply to SSA requests for information concerning benefits under 38 U.S.C. 1312(a). • When itemizing recurring benefit payments, show VA payments made from the dates in question by the SSA, which is not necessarily the payment in effect on that date. • SSA is specifically interested in payment receipt dates, not effective dates, and the distinction between retroactive payments and recurring benefits.
d. Handling Requests for Multiple Individuals SSA may simultaneously request payment information on multiple claimants, listing the names of individuals (claimants for SSI purposes) for whom they desire information in Part I of SSA Form L1103.
VA should provide the requested information for each individual.
If the response will not fit in the space provided on SSA Form L1103, attach a continuation sheet and transfer the following identification information from the top of SSA Form L1103 to the top of the continuation sheet:
• the name of the claimant, and • the claimant’s SSN.
e. Responding to Follow-Up Requests Use the table below to determine how to respond to a follow-up request from SSA in the form of a copy of the original request marked “Second Request.”
If … Then … A reply had already been forwarded to the same SSA office • indicate in the “Remarks” section of the SSA Form 828-U4: “VA reply forwarded (date) ,” and • return the SSA Form 828-U4 to the office that sent the follow-up. Continued on next page
12. General Information on VA Responses to SSA Requests, Continued
e. Responding to Follow-Up Requests (continued)
If … Then … The RO is awaiting information to complete the reply • indicate in the “Remarks” section of the SSA Form 828-U4 that further action on the request is suspended pending the collection of additional information • explain briefly the reason for the delay, and • return the SSA Form 828-U4 to the office that sent the follow-up. the request was referred to a VAMC or clinic • acknowledge receipt of the request on a locally-generated letter or transmittal slip • indicate the medical center or clinic to which the request was referred • attach SSA Form 828-U4 to the transmittal, and • return the forms to the requesting SSA office.
f. Responding to Supplemental Requests From SSA If the information VA previously furnished to the SSA is insufficient and more information is required, the SSA will check Item 11E of a supplemental SSA Form 828-U4 and describe the additional information required.
Note: The information VA previously furnished is shown on the supplemental request to avoid duplicate submission.
g. Work Credit for Responding to SSA Take work credit under end product (EP) 400 for responses provided to SSA inquiries.
13. Releasing Medical Information to the SSA
Introduction This topic contains information on releasing medical information to the SSA, including information on
• the action to take when requested medical information is available • who releases the records to the SSA • handling a request involving a helpless child • types of records that are confidential • releasing medical records referring to treatment for human immunodeficiency virus (HIV) or syndrome (AIDS), alcohol abuse, drug abuse or sickle cell anemia, and • the action to take if only VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, is on file, and reports are at both the RO and VA hospital.
Change Date December 13, 2005
a. Action to Take When Requested Information Is Available Furnish photocopies of SF 502, VA Form 10-1000, Hospital Summary, and/or the Compensation and Pension Exam Report, (or its equivalent), covering the period indicated on SSA Form 828-U4.
b. Who Releases the Records to SSA Authorization activity personnel release the records requested by SSA on SSA Form 828-U4, unless the records involved are located at a VA health care facility.
If the records are located at a VA health care facility, refer both copies of the SSA Form 828-U4 to that medical facility for processing.
Note: All records are furnished without charge to SSA.
c. Handling a Request Involving a Helpless Child Provide SSA with evidence of helpless child status if requested. Continued on next page
13. Releasing Medical Information to the SSA, Continued
d. Types of Records That Are Confidential Medical records relating to human immunodeficiency virus (HIV) or syndrome (AIDS), alcohol abuse, drug abuse or sickle cell anemia are confidential, including records containing
• the patient’s identity • diagnosis • prognosis, or • treatment in connection with any program of education training treatment rehabilitation, or research.
e. Releasing Medical Records Referring to Treatment for HIV or AIDS, Alcohol Abuse, Drug Abuse or Sickle Cell Anemia Release these records only
• for purposes and under circumstances expressed in 38 U.S.C. 7332(b), and • with the prior written consent of the patient or subject, or written consent from the next of kin, executor, administrator or other personal representative, if the patient or subject is deceased.
Reference: For more information on the handling of records pertaining to treatment of HIV or AIDS, alcohol abuse, drug abuse or sickle cell anemia, see M21-1MR, Part III, Subpart ii, 4.A.5.
f. Action to Take if Only VA Form 10-7131 Is on File If only a VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, relating to the alleged disability and date of onset, is in the claims folder,
• indicate “VA Form 10-7131 only on file” on SSA Form 828-U4, and • forward the request to the hospital or clinic that executed the VA Form 10-7131 for completion. Continued on next page
13. Releasing Medical Information to the SSA, Continued
g. Action to Take if Requested Reports Are at the RO and VA Hospital If SSA requests both a report of hospitalization and a physical examination report, and the RO has only the physical examination report
• attach a photocopy of the Compensation and Pension Exam Report (or its equivalent) to SSA Form 828-U4, and • forward SSA Form 828-U4 to the VA hospital where treatment is alleged for completion.
Notes: • The VA hospital will attach the report of hospitalization and forward the completed request to the SSA office concerned. • Inform the requesting SSA office of the referral of SSA Form 828-U4 to another RO using a locally-generated letter or transmittal slip.
14. When to Use VA Form 21-4184, Certification of Contents of Document(s) or Record(s)
Introduction This topic contains information on when to use VA Form 21-4184, Certification of Contents of Document(s) or Record(s), including information on
• when to prepare VA Form 21-4184 • preparing the original VA Form 21-4184 • when to use the “Remarks” section of VA Form 21-4184 • action to take when a certification is complete, and not possible.
Change Date December 13, 2005
a. When to Prepare VA Form 21-4184 If SSA requests evidence, certify the requested document or record on VA Form 21-4184, Certification of Contents of Documents(s) or Record(s), unless
• the evidence consists of a court record, or • certification is not feasible.
Reference: For more information on handling a situation when certification is not possible, see M21-1MR, Part III, Subpart iii, 3.B.14.e.
b. Preparing the Original VA Form 21-4184 The original VA Form 21-4184 should
• be prepared by a Veterans Service Representative (VSR) and signed by a Senior VSR in his/her own name, and • contain the essential facts in the identical words appearing on the document or record. Continued on next page
14. When to Use VA Form 21-4184, Certification of Contents of Document(s) or Record(s), Continued
c. When to Use Remarks Section of VA Form 21-4184 Use the “Remarks” section of VA Form 21-4184 as outlined below.
• If the document or record is lengthy or has a number of facts that may be pertinent, put the extra information in the “Remarks” section. • If certification is made from a record other than an original document, make a statement in the “Remarks” section that “the evidence consists of a photocopy or a notarized copy,” for example.
Important: Do not enter explanatory statements anywhere on the VA Form 21-4184 except under the “Remarks” section.
d. Action to Take When Certification Is Complete Complete an authentication for every certification, and then
• forward the certification or copy of the evidence to the requesting office of the SSA, and • annotate the SSA request to show the date VA Form 21-4184 was released, and whether or not additional evidence relating to the particular issue has been requested.
Note: If additional evidence relating to the particular issue has been requested, indicate • the date of the request • to whom the request was addressed, and • the nature of the additional information requested.
Important: Take no further action unless a request for the additional evidence is received from the SSA. Continued on next page
14. When to Use VA Form 21-4184, Certification of Contents of Document(s) or Record(s), Continued
e. Action to Take When Certification Is Not Possible In the event certification is not possible, photocopy the evidence. In the letter transmitting the photocopy to the SSA, include
• a certification that the record from which the photocopy was made is free from erasures, insertions or other alterations, and that the general appearance of the document or record indicates that it is authentic, or • an explanation as to why such a certification cannot be made.
Note: If the record enclosed is a photocopy of a photostat, state this fact.
Exceptions: • Do not photocopy an American passport, a certificate of citizenship or naturalization, or U.S. immigration papers. Furnish a copy of the “memorandum to file” described in M21-1MR, Part III, Subpart ii, 3.C.7.c • If the request relates to an FBI report, see M21-1MR, Part III, Subpart iii, 4.8.
15. General Information on Determining VA Benefits for SSA Purposes
Introduction This topic contains general information on determining VA benefits for SSA purposes, including information on
• determining pay dates and amounts of nonrecurring benefit payments • miscellaneous benefits that may be attributed to the beneficiary, and • handling inquiries involving nursing home patients.
Change Date December 13, 2005
a. Determining Pay Dates and Amounts of Nonrecurring Benefit Payments Perform a Benefits Delivery Network (BDN) Treasury inquiry (TINQ) to determine the pay dates and amounts of nonrecurring payments for any inquiry about
• a period involving an original or reopened award, or • an amended award that increased benefits retroactively.
Note: Nonrecurring, one-time payments are shown as type CP-ONE-T on the BDN T01 PAYMENT HISTORY INQUIRY screen.
b. Miscellaneous Benefits That May Be Attributed to the Beneficiary The Medal of Honor benefit
• may be paid as a sole entitlement or with another entitlement in a combined award, and • is attributed totally to the beneficiary, as are other benefits, such as Naval pension REPS, and benefits under 38 U.S.C. 1312(a).
Note: Only REPS and programs under 38 U.S.C. 1312(a) recognize dependents, and each pays a separate award to each entitled individual. Continued on next page
15. General Information on Determining VA Benefits for SSA Purposes, Continued
c. Handling Inquiries Involving Nursing Home Patients If the SSA Form L1103 indicates that the claimant is a nursing home patient, and the claimant receives Improved Pension in excess of $90.00 per month, determine if reduction is required under 38 U.S.C. 5503(f).
Request that other divisions that process these inquiries refer them to the Veterans Service Center (VSC), when these circumstances exist.
16. Exclusion of Aid and Attendance (A&A), Housebound or Special Monthly Compensation (SMC) Entitlement for SSA Purposes
Introduction This topic contains information on the exclusion of Aid and Attendance (A&A), Housebound or Special Monthly Compensation (SMC) entitlement for SSA purposes, including
• special SSA considerations • exclusions in disability compensation cases • handling Improved Pension cases • what to do when the excludable amount is more than the total award, and • three examples of cases involving the receipt of A&A or Housebound and SMC.
Change Date December 13, 2005
a. Special SSA Considerations SSA
• does not count the additional amount VA pays for Aid and Attendance (A&A) or Housebound entitlement, and • excludes certain “deductions” from VA benefits.
Reference: For more information on deductions to exclude when responding to SSA inquiries, see M21-1MR, Part III, Subpart iii, 3.B.17.
In response to an SSA inquiry about a specific award, always reduce the total VA benefit by these amounts. Make this reduction before performing the calculations shown in M21-1MR, Part III, Subpart iii, 3.B.19 through 26. Continued on next page
16. Exclusion of Aid and Attendance (A&A), Housebound or Special Monthly Compensation (SMC) Entitlement for SSA Purposes, Continued
b. Exclusions in Disability Compensation Cases If A&A or the Housebound benefit is being paid, exclude the “maximum” amount of the benefit from the primary payee’s total award.
For a compensation case that
• involves A&A or housebound entitlement, consider the 100-percent rate, exclusive of any SMC, the adjusted “total” award, and • includes benefits for a spouse in need of A&A, exclude the spouse “add-on” from the total award unless the spouse is being paid an apportionment, and the amount of the add-on from the spouse’s award.
Note: If this exclusion is greater than the spouse’s apportionment, the attributable benefit for the spouse is “none” and nothing is excluded from the primary award.
c. Handling Improved Pension Cases For Improved Pension cases, exclude the amount of the A&A or housebound entitlement from the primary payee’s award to arrive at an adjusted total award.
For pension cases other than Improved Pension, exclude the amount from the payable rate outlined in M21-1, Part I, Appendix B.
d. When the Excludable Amount Is More Than the Total Award If the amount of benefits excludable because of the primary payee’s entitlement to Special Monthly Pension (SMP) is more than the total award, the attributable amounts for all individuals included on the primary award, excluding apportionees, is “none.”
If an apportionment is authorized representing some part of the maximum SMP, it must be attributable to the apportionees as indicated in M21-1MR, Part III, Subpart iii, 3.B.19 through 26, subject to the exclusion of deductions as stated in M21-1MR, Part III, Subpart iii, 3.B.17. Continued on next page
16. Exclusion of Aid and Attendance (A&A), Housebound or Special Monthly Compensation (SMC) Entitlement for SSA Purposes, Continued
e. Example 1: Case Involving A&A for a Spouse and SMC for a Veteran Situation: • A veteran is receiving compensation under SMC code 03 (L), based on the need for A&A. • The veteran receives additional compensation for a spouse who is rated as in need of A&A. The spouse receives an apportionment of $50.00 monthly.
Result: Because the veteran is entitled to A&A, consider the 100-percent rate for veteran and spouse, $2,336.00 (including the spouse A&A add on), the adjusted total rate.
As outlined in M21-1MR, Part III, Subpart iii, 3.B.19 through 26, the $50.00 apportionment will later be excluded from the veteran’s award. The spouse’s A&A add-on, $108.00, will be excluded from her apportionment of $50.00, developing a negative value or “none” attributable to the spouse.
Action: Attribute $2,286.00 to the veteran in this case.
Note: This example is based on rates in effect on December 1, 2000.
f. Example 2: Case Involving A&A and Section 306 Pension Situation: • A veteran with a spouse is receiving Section 306 Pension. • The veteran is entitled to A&A and, in 1978, was paid based on income over the limit but less than the special limit for A&A cases
Result: The special A&A allowance is $110.22. The amount attributable is “none.”
Note: If any part of the allowance was apportioned, consider the amount of the apportionment as outlined in M21-1MR, Part III, Subpart iii, 3.B.19 through 26. Continued on next page
16. Exclusion of Aid and Attendance (A&A), Housebound or Special Monthly Compensation (SMC) Entitlement for SSA Purposes, Continued
g. Example 3: Case Involving A&A and Improved Pension Situation: • A veteran is receiving Improved Pension with only a spouse as a dependent. • The veteran is entitled to the A&A allowance.
Result: The maximum pension rate • without consideration of A&A is $12,186.00, and • with A&A is $18,405.00.
Based on countable income of $14,000.00, the amount attributable is “none,” since pension would not be payable but for entitlement to the A&A allowance.
Note: This example is based on rates in effect on December 1, 2000.
17. Exclusion of Deductions When Responding to SSA Inquiries
Introduction This topic contains information on the deductions VA allows but must exclude when responding to an SSA inquiry, including information on
• SSA’s consideration of deductions allowed by VA • deductions, by type and codes, that must be included • obtaining deduction information • the action to take when an excludable deduction is a factor, and A&A, Housebound has been considered, and • when to complete Part III, Block G of SSA Form L1103.
Change Date December 13, 2005
a. SSA’s Consideration of Deductions Allowed by VA SSA excludes certain deductions that VA allows in determining entitlement to VA benefits.
In responding to an SSA inquiry, exclude the amount of deductions for deduction types other than the codes listed below in M21-1MR, Part III, Subpart iii, 3.B.17.b.
b. Deductions, by Type and Code, That Must Be Included For SSA purposes, include the amount of the deduction if the BDN M01 DEDUCTION/RECEIVABLE/BALANCE DATA screen shows one of the following deduction type codes:
• 31 for attorney fees • 66 for debt from REPS benefits • 67 for debt from Chapter 1606 education benefits, or • 68 for debt from an education loan. Continued on next page
17. Exclusion of Deductions When Responding to SSA Inquiries, Continued
c. Obtaining Deduction Information Use the table below to determine when to request deduction information from the finance activity.
If … Then … there is no indication that excludable deductions apply do not request deduction information from the finance activity. the BDN M01 DEDUCTION/ RECEIVABLE/BALANCE DATA screen shows current excludable deductions, or the folder contains evidence of prior pertinent excludable deductions, request a complete summary of pertinent deductions from the finance activity only for the period(s) identified in the SSA inquiry.
d. Action to Take When an Excludable Deduction Is a Factor When an excludable deduction is a factor, subtract the total amount of the excludable deduction from the primary or apportioned award that contains the excludable deduction.
e. Action to Take When A&A or Housebound Entitlement is Involved Exclude the deductions after A&A or Housebound entitlement has been considered, since the deductions may be irrelevant after the exclusion of SMP (but not SMC), as described in M21-1MR Part III, Subpart iii, 3.B.16.
f. When to Complete Part III, Block G of SSA Form L1103 Complete Part III, block G of SSA Form L1103 only if the code for the deduction type is 30.
18. Exclusion of Amounts Payable Due to Medical Expenses
Introduction This topic contains information on SSA’s exclusion of additional benefits that VA pays based on a beneficiary’s unreimbursed medical expenses, including information on
• SSA regulations concerning unreimbursed medical expenses • how SSA categorizes the additional benefits VA pays for unreimbursed medical expenses • the effect of unreimbursed medical expenses on a pension award, and • when to provide information on payment amounts attributable to unreimbursed medical expenses.
Change Date December 13, 2005
a. SSA Regulations Concerning Unreimbursed Medical Expenses Under SSA regulations, the SSA cannot count as income the increased amount of VA pension or parent’s Dependency and Indemnity Compensation (DIC) payable because of unreimbursed medical expenses.
b. How SSA Categorizes the Additional Benefits VA Pays for Unreimbursed Medical Expenses Reimbursement by VA for medical expenses incurred by pensioners qualifies as a third-party payment for medical care or services.
As such, it is not available for meeting basic needs and is not “income” for the purpose of determining SSI eligibility and payment amount.
c. Example of the Effect of Reimbursement by VA for Medical Expenses on a Pension Award Situation: • A veteran with no dependents is receiving a monthly pension of $200.00, effective December 1, 2000, based on countable annual income of $6,904.00. • The veteran submits a claim for deductions for unreimbursed medical expenses of $1,000.00.
Result: This entitles the veteran to an adjustment payment of $535.00. The entire $535.00 does not count as “income” for determining SSI eligibility and payment amount. Continued on next page
18. Exclusion of Amounts Payable Due to Medical Expenses, Continued
d. When to Provide Information on Payment Amounts Attributable to Medical Expenses Provide information on the payment amounts attributable to medical expenses only if the information is requested in Part II, Block F of the SSA Form L1103.
The amount attributable to reported unreimbursed medical expenses is the difference between the rate payable with the allowed medical expenses and the rate that would be payable without the medical expenses.
Notes: • Do not attempt to show “shares” of medical expenses for the primary beneficiary and dependents. • Report the amount of the gross benefit attributable to medical expenses.
19. General Information on Calculating Award Amounts for Responses to the SSA
Introduction This topic contains general information on calculating award amounts for responses to the SSA, including information on
• responding to Part I of SSA Form L1103 • considering apportionees, and • handling apportionment awards involving multiple apportionees.
Change Date December 13, 2005
a. Responding to Part I of SSA Form L1103 In responding to Part I of SSA Form L1103, determine the SSI claimant’s share of benefits as discussed in M21-1MR, Part III, Subpart iii, 3.B.19 through 26.
Indicate whether the SSI claimant is a VA beneficiary or a dependent of a VA beneficiary.
b. Considering Apportionees Always consider an apportionee as a beneficiary and not a dependent.
c. Handling Apportionment Awards Involving Multiple Aportionees If an apportionment award includes benefits for multiple individuals, divide the award total by the number of apportionees on the award and attribute the result to each apportionee on the award.
If the apportionment does not divide evenly, attribute the extra pennies to the spouse or to the oldest child apportionee.
20. Calculating Old Law Pension Award Amounts for Responses to the SSA
Introduction This topic contains information on calculating Old Law Pension award amounts for responses to the SSA, including information on
• Old Law Pension disability rates • allowances for dependents, and • attributing Old Law Pension disability benefits, and death benefits.
Change Date December 13, 2005
a. Old Law Pension Disability Rates The Old Law Disability Pension rates are as follows:
• the statutory rate is $78.75, and • the rate with Housebound is $100.00, and the A&A allowance is $135.35.
b. Allowances for Dependents The Old Law Pension program includes no allowance for dependents but does recognize dependency without an increase in payment rates.
The existence of a dependent may be the entitling basis for payment. For example, a veteran may be over the income limit applicable for a veteran without a dependent. Continued on next page
20. Calculating Old Law Pension Award Amounts for Responses to the SSA, Continued
c. Attributing Old Law Disability Pension Benefits Use the table below to determine how to attribute Old Law Disability Pension benefits.
If … Then … the veteran’s protected 1960 income for VA purposes is $1,400.00 or less attribute the entire amount to the veteran after any allowable exclusions as outlined in M21-1MR. Part III, Subpart iii, 3.B.16 through 18. the veteran’s protected 1960 income for VA purposes exceeds $1,400.00 attribute the entire benefit, less any allowable exclusions, to the dependents. there are multiple dependents divide the benefit equally among the dependents. the shares do not divide evenly attribute the extra pennies to the spouse or the oldest child.
d. Attributing Old Law Death Pension Benefits Use the table below to determine how to attribute Old Law Death Pension benefits.
If … Then … the surviving spouse’s protected 1960 income for VA purposes is $1,400.00 or less • attribute $50.40 to the surviving spouse, and • divide the difference between the rate payable and $50.40 among the children. the surviving spouse’s protected 1960 income for VA purposes exceeds $1,400.00 attribute the entire benefit, less any exclusions, to the children in equal shares. Continued on next page
20. Calculating Old Law Pension Award Amounts for Responses to the SSA, Continued
d. Attributing Old Law Death Pension Benefits (continued)
If … Then … there is an excludable deduction under M21-1MR, Part III, Subpart iii, 3.B.17 reduce the amount attributed to the
• surviving spouse by half of the amount of the deduction, and • child or children by half of the deduction. the shares do not divide evenly attribute the extra pennies to the surviving spouse or the oldest child.
21. Calculating Section 306 Pension Award Amounts for Responses to the SSA
Introduction This topic contains information on calculating Section 306 Pension award amounts for responses to the SSA, including information on
• the basis for Section 306 Pension rates • computing the 1978 income for VA purposes, and augmented rate (rate increased because of dependent(s)) for Section 306 Pension.
Change Date December 13, 2005
a. Basis for Section 306 Pension Rates For Section 306 Pension, rates are based on income levels. A veteran may be paid for a maximum of three dependents. A surviving spouse may be paid for unlimited dependent children.
b. Computing 1978 Income for VA Purposes To compute the veteran’s or surviving spouse’s 1978 income for VA purposes, first determine whether the dependents’ income or expenses were a factor in arriving at the beneficiary’s protected 1978 income for VA purposes.
Note: A child’s income was not countable in determining Section 306 Pension rates in 1978.
Use the table below to compute the veteran’s or surviving spouse’s 1978 income for VA purposes.
If … Then … dependents’ income or expenses were not a factor use the protected income for VA purposes. dependents’ income or expenses were a factor in arriving at the beneficiary’s protected 1978 income for VA purposes recompute the 1978 income for VA purposes based on the beneficiary’s income and expenses. Continued on next page
21. Calculating Section 306 Pension Award Amounts for Responses to the SSA, Continued
b. Computing 1978 Income for VA Purposes (continued)
If … Then … the income can be attributed to a dependent exclude the income. the actual attribution of benefits cannot be determined (it cannot be determined whether certain income or expenses belong to the beneficiary or to the dependents) assume the income or expenses belong to the beneficiary.
c. Computing the Augmented Rate for Section 306 Pension Use the table below to compute the veteran or surviving spouse beneficiary’s augmented rate for Section 306 Pension.
If … Then … the beneficiary’s 1978 income for VA purposes, as computed in M21-1MR, Part III, Subpart iii, 3.B.21.b, is $3,770.00 or less • compute the beneficiary’s rate using the 1978 rate chart in M21-1, Part I, Appendix B, page VI(1978) for a veteran alone, or M21-1, Part I, Appendix B, page I(1978)-1 for a surviving spouse alone • round down to the next even dollar, and • attribute the rounded amount, after any allowable exclusions under M21-1MR. Part III, Subpart iii, 3.B.16 through 19, to the veteran or surviving spouse. Continued on next page
21. Calculating Section 306 Pension Award Amounts for Responses to the SSA, Continued
c. Computing the Augmented Rate for Section 306 Pension (continued)
If … Then … the veteran’s or surviving spouse’s 1978 income for VA purposes, as computed in M21-1MR, Part III, Subpart iii, 3.B.21.b, is greater than $3,770.00 • attribute $0.00 to the veteran or surviving spouse • subtract the amount attributed to the veteran or surviving spouse from the current benefit, after deduction of any allowable exclusions, and • attribute to the dependents the difference between the current benefit and the amount attributed to the veteran or surviving spouse, in equal shares. the shares do not divide evenly attribute the extra pennies to the
• surviving spouse, or • oldest child.
22. Calculating DIC and Death Compensation Award Amounts for Responses to the SSA Concerning Benefit Payments to Parents
Introduction This topic contains information on calculating DIC and death compensation award amounts for responses to the SSA concerning parents’ payments, including information on
• attributing DIC and death compensation payments to parents, and • an example of how DIC payments are attributed to a parent.
Change Date December 13, 2005
a. Attributing DIC and Death Compensation Payments to Parents Attribute the full award amount to the payee.
b. Example of How DIC Payments Are Attributed to a Parent Situation: A remarried father of a veteran is receiving $186.12 in monthly benefits.
Explanation: In every case, attribute the total award amount to the father, the beneficiary.
Response: If SSA inquires about benefits payable to the father and a spouse, respond as follows: • father, “name given”-$186.12, and • spouse, “name given”-$0.00.
23. Calculating DIC and Death Compensation Award Amounts for Responses to the SSA Concerning Benefit Payments to a Surviving Spouse or Child(ren)
Introduction This topic contains information on calculating DIC and death compensation award amounts for responses to the SSA concerning payments made to a surviving spouse or child(ren), including
• information on attributing DIC benefits for a surviving spouse and children, and children with no surviving spouse • examples of attributing DIC benefits for a surviving spouse and children, and children with no surviving spouse • information on attributing a surviving spouse’s death compensation, when an apportionment is involved. • an example of attributing a surviving spouse’s death compensation, and • information on attributing children’s payments when the surviving spouse is not entitled.
Change Date December 13, 2005
a. Attributing DIC Benefits for a Surviving Spouse and Children If the benefits are apportioned, attribute the apportioned amount(s) to the apportionee(s). Attribute the
• amount of DIC added to the payment because of a child to each child in the custody of the surviving spouse, and • balance of the award to the spouse.
Note: The amount of DIC added to the payment because of a child is specified in the DIC rate tables in M21-1, Part I, Appendix B. Continued on next page
23. Calculating DIC and Death Compensation Award Amounts for Responses to the SSA Concerning Benefit Payments to a Surviving Spouse or Child(ren), Continued
b. Example 1: Attributing DIC Benefits for a Surviving Spouse and Children Situation: • A surviving spouse receives DIC benefits for herself and three children based on the death of the veteran in March 1998. • In addition, two children receive apportionments. The apportionment for one child is the additional amount received for the child, but the other child is receiving a special apportionment of $300.00. • The total monthly benefit is based on five children and is $2,056.00. • The amount of DIC added for each child is $229.00.
Response: If SSA inquires about benefits payable to the six individuals, indicate a breakdown as follows: • surviving spouse “name given”-$840.00 • child 1, “name given”-$229.00 • child 2, “name given”-$229.00 • child 3, “name given”-$229.00 • child 4, apportionee “name given”-$229.00, and • child 5, apportionee “name given”-$300.00.
Note: This example is based on rates in effect on December 1, 2000.
c. Example 2: Attributing DIC Benefits for a Surviving Spouse and Children Situation: • A surviving spouse was awarded benefits based on pay grade 0-5, effective December 1, 1989. • In addition, two children over age 18 are being paid by separate awards and one child is helpless.
Response: If SSA inquires about benefits payable to the three individuals, indicate a breakdown as follows: • surviving spouse “name given”-$1,239.00 • child 1, schoolchild “name given”-$194.00, and • child 2, helpless child “name given”-$386.00.
Note: This example is based on rates in effect on December 1, 2000. Continued on next page
23. Calculating DIC and Death Compensation Award Amounts for Responses to the SSA Concerning Benefit Payments to a Surviving Spouse or Child(ren), Continued
d. Attributing DIC Benefits for Children With No Surviving Spouse For DIC benefits for children, including direct payment to children when there is no surviving spouse, and payments for children over 18, attribute the full amount payable to the children.
For consolidated awards to multiple children, attribute the share for each child to each child plus the additional allowance payable to each helpless child.
e. Example: Attributing DIC Benefits for Children With No Surviving Spouse Situation: • Two children under 18 and a helpless child are receiving benefits based on the veteran’s death on June 8, 1999. • There is no surviving spouse. • The two minor children are paid on a consolidated award.
Response: If SSA inquires about benefits payable to the three individuals, indicate a breakdown as follows: • child 1, “name given”-$241.00 • child 2, “name given”-$241.00, and • child 3, (name given)-$470.00.
Note: This example is based on rates in effect on December 1, 2000.
f. Attributing a Surviving Spouse’s Death Compensation, When an Apportionment is Involved For a surviving spouse in receipt of death compensation whose benefits are apportioned, attribute the
• apportioned amount to the apportionee • balance to the spouse and any children in custody, and • the amount from the rate chart specified in M21-1, Part I, Appendix B as the “child’s share,” based on the total number of children shown to be in custody. Continued on next page
23. Calculating DIC and Death Compensation Award Amounts for Responses to the SSA Concerning Benefit Payments to a Surviving Spouse or Child(ren), Continued
g. Example: Attributing a Surviving Spouse’s Death Compensation Situation: • A surviving spouse is receiving death compensation for herself and a helpless child. • A second helpless child is receiving an apportionment of $42.50.
Response: If SSA inquires about benefits payable to the three individuals, indicate a breakdown as follows: • surviving spouse, “name given”-$65.00 • child in custody, “name given”-$42.50, and child not in custody, “name given”-$42.50.
h. Attributing Children’s Payments When the Surviving Spouse Is Not Entitled to Death Compensation For children’s payments, when the surviving spouse is not entitled, attribute to each child the amount specified in the rate chart in M21-1, Part I, Appendix B, Section V as each child’s share.
24. Calculating Disability Compensation Award Amounts for Responses to the SSA
Introduction This topic contains information on calculating disability compensation award amounts for responses to the SSA, including
• information on attributing disability compensation, and • an example of attributing disability compensation.
Change Date December 13, 2005
a. Attributing Disability Compensation Use the table below to determine how to attribute disability compensation.
If … Then … benefits are apportioned attribute the
• apportioned amounts to the apportionees, and • benefits payable for non-apportioned dependents to the dependents in an amount equal to the amount paid for the dependent, as determined from the applicable rate table. minor children are a factor • the amount for each child varies based on the actual amounts shown in the rate table, and • attribute the amounts to such children, in sequence, oldest to youngest, and balance to the veteran, including any amount payable because of an apportionee dependent but not paid to the apportionee. Continued on next page
24. Calculating Disability Compensation Award Amounts for Responses to the SSA, Continued
b. Example: Attributing Disability Compensation Situation: • A veteran is rated 90 percent disabled and receives compensation for a spouse, a mother, two minor children and three schoolchildren. • The mother and one schoolchild receive separate apportionments of less than the additional amount of compensation payable to the veteran for them as dependents ($88.00 and $172.00, respectively). • The mother receives $75.00 per month and the schoolchild receives $120.00.
Explanation: Attribute the “difference” of $65.00 to the veteran.
Response: If SSA inquires about benefits attributable to the veteran and each of his dependents, respond as follows: • veteran, “name given”-$1,331.00 • spouse, “name given”-$108.00 • mother, apportionee “name given”-$75.00 • child 1, apportionee, schoolchild “name given”-$120.00 • child 2, schoolchild “name given”-$172.00 • child 3, schoolchild “name given”-$172.00 • child 4, “name given”-$79.00, and • child 5, “name given”-$56.00.
Note: The amounts shown in this example are based on rates in effect on December 1, 2000.
25. Calculating Improved Pension Award Amounts for Responses to the SSA
Introduction This topic contains information on calculating Improved Pension award amounts for responses to the SSA, including
• determining the amount of attributable benefits • computing apportionee amounts • an example of computing apportionee amounts • attributing a primary disability or death pension award • computing the percentage for each dependent on a primary disability or death pension award • examples of computing the factors and share • computing the veteran’s amount when two veterans are married to each other • considering separate awards when two veterans are married to each other, and • considering SMP when two veterans are married to each other.
Change Date December 13, 2005
a. Determining the Amount of Attributable Benefits Because of the nature of Public Law (PL) 95-588, benefits that are intended to supplement family income based on the number of dependents, a different procedure is required to determine the amount of benefits attributable to the respective family members. The benefits paid by VA are distributed “proportionately.”
b. Computing Apportionee Amounts To compute apportionee amounts, attribute the amount apportioned, if any, to the apportionees.
If the apportionment is for multiple individuals, divide the total amount of the apportionment by the number of apportionees to determine the individual shares.
Reference: For more information on calculating award amounts for responses to SSA, see M21-1MR, Part III, Subpart iii, 3.B.19 through 26. Continued on next page
25. Calculating Improved Pension Award Amounts for Responses to the SSA, Continued
c. Example: Computing Apportionee Amounts Situation: • $100.00 is apportioned for a spouse and five children. • The $100.00 divided by six results in $16.6666 dollars for each individual.
Explanation: Attribute • $16.66 for each child, a total of $83.30, and • $16.70 (the difference between the total apportionment ($100.00) and the children’s shares ($83.30)) to the spouse.
d. Attributing a Primary Disability or Death Pension Award Attribute the balance or available amount of a primary disability or death award to all individuals included on the award (the primary beneficiary and all dependents), on a proportionate basis, after
• exclusion of the A&A allowance, if applicable, and any pertinent deductions in M21-1MR. Part III, Subpart iii, 3.B.17, and • subtraction of the total apportioned amount, if applicable.
e. Computing the Percentage for Each Dependent on a Primary Disability or Death Pension Award Compute the portion for each dependent included on a primary award based on his or her percentage of the maximum pension payable.
To determine the percentage or “factor” for each dependent,
• determine the maximum pension payable, excluding any SMP allowance • determine the amount of additional pension payable because of dependents • identify the first dependent for a disability award by considering the spouse (or oldest child if there is no spouse) the first dependent, or death award by considering the oldest child the first dependent, and • divide the amount of additional pension payable by the maximum pension payable.
Notes: • More pension is always payable for the “first” dependent than any additional dependents. • If a child is the first dependent, and is a twin or triplet, for example, randomly designate one of the multiple siblings as the oldest child. Continued on next page
25. Calculating Improved Pension Award Amounts for Responses to the SSA, Continued
f. Example 1: Computing the Factors and Shares Situation: A veteran with five dependents (a spouse and four children) is receiving the maximum pension rate of $18,530.00, effective December 1, 2000. This is the maximum rate payable not including SMP entitlement.
Computing the Dependents’ Factors: Compute • the first dependent’s factor by taking the difference between the maximum pension payable for a veteran without dependents ($9,304), and for a veteran with a dependent ($12,186.00), and dividing the difference ($2,882.00) by the maximum pension payable ($18,530.00), for a factor of 0.1555, and • the factor for each additional dependent by dividing the pension payable for each additional dependent ($1,586.00) by the maximum pension rate ($18,530.00), for a factor of 0.0855.
Computing the Dependents’ Shares: • Compute each dependent’s factor to four decimal positions, and share by multiplying the available primary award amount by the factor • subtract the total of the shares of all dependents from the “available” primary award amount, and • attribute the remaining amount to the payee.
Note: Drop fractions of a cent. For example, $44.1269 rounds down to $44.12. Continued on next page
25. Calculating Improved Pension Award Amounts for Responses to the SSA, Continued
g. Example 2: Computing the Factors and Shares Situation: • A veteran with $2,400.00 countable annual income is receiving pension, including the A&A allowance. • A spouse and three children have been recognized as dependents. • The spouse is receiving an apportionment of $100.00 monthly, and all the children are in the veteran’s custody. • The total monthly pension payment is $1,212.00, excluding the A&A allowance.
Computing the Available Primary Award Amount: Subtract the $100.00 apportionment from $1,212.00 to obtain the difference ($1,112.00), which is the available primary award amount.
Computing the Dependents’ Shares: Compute the dependent’s shares as explained in M21-1MR, Part III, Subpart iii, 3.B.25.f.
Computing the Spouse’s Share: Because the spouse is an apportionee, it is not necessary to compute the spouse’s share.
Computing the Veteran’s Share: • The factors for the children’s shares are the same, since the spouse is considered the “first” dependent. • Each child’s factor is 1586/16994 or .0936. • Attribute to each child $104.48 of the available amount (.0936 x 1,112.00 = 104.0832 rounded down). • Subtract the total of the children’s shares ($312.24) from the available amount ($1,112.00) to determine the veteran’s share of $799.76.
Response: If SSA inquires about benefits for all family members, respond as follows: • veteran, “name given”-$799.76 • spouse, “name given”-$100.00 • child 1, “name given”-$104.08 • child 2, “name given”-$104.08, and • child 3, “name given”-$104.08.
Note: The amounts shown in this example are based on rates in effect on December 1, 2000. Continued on next page
25. Calculating Improved Pension Award Amounts for Responses to the SSA, Continued
h. Computing the Attributable Amount When Two Veterans Are Married to Each Other If a disability award is based on two veterans married to each other, a special procedure is required to compute the amount attributable to each payee-veteran.
The amount attributable to ach veteran will be half of the amount available after subtraction of the amounts for dependent children.
Example: In the example in M21-1MR. Part III, Subpart iii, 3.B.25.g, this would result in each veteran being attributed half of $899.76, or $449.88.
i. Considering Separate Awards When Two Veterans Are Married to Each Other If separate awards are authorized, divide benefits equally between the veterans, according to M21-1MR, Part V, Subpart iii, 4.3 (TBD) or M21-1, Part IV, 25.20. For purposes of responding to a SSA inquiry, consider the awards a “combined” award, subject to a single breakdown.
Note: SSA may not be aware that the case involves married veterans paid separately. Regardless of whether the SSA request is under one or both file numbers, process the case as if it were a combined award.
j. Considering SMP When Two Veterans Are Married to Each Other If both veterans are entitled to SMP, exclude the appropriate total SMP allowance.
If the “early war bonus” under 38 U.S.C. 1521(g) is a factor, do not exclude the amount of the bonus. Rather, divide the amount of the bonus equally between the spouses, even if only one spouse has such entitlement.
Important: Only one such “bonus” may be paid.
26. Calculating Service Pension Award Amounts for Responses to the SSA
Introduction This topic contains information on calculating service pension award amounts for responses to the SSA, including information on
• disability benefits • available death benefits for surviving spouses • attributing death benefits • available death benefits for children, and • attributing death benefits for children.
Change Date December 13, 2005
a. Disability Benefits At this time, no known claimants are paid under the various provisions authorizing service pensions for veterans.
b. Available Death Benefits for a Surviving Spouse A surviving spouse may be entitled to the following death benefits:
• for the Indian Wars and Civil War, the statutory rate is $40.64 if the claimant is less than 70 years of age $70.00 if the claimant is 70 or older, or $75.00 if the claimant was married to the veteran during service in the war, and • for the Spanish-American War the statutory rate is $70.00, regardless of age, or $75.00 if the claimant was married to the veteran during service in the war, and an A&A allowance of $79.00 may be added.
Note: An additional $8.13 is payable for each eligible child of a veteran of any of these three wars.
c. Attributing Death Benefits Attribute rates for a case involving a spouse, to the spouse, after any allowable exclusions, such as A&A, apportionments, and certain deductions, minus $8.13 per child in the spouse’s custody. Continued on next page
26. Calculating Service Pension Award Amounts for Responses to the SSA, Continued
d. Available Death Benefits for Children For children only, the statutory rate is $73.13 for the first child, and an additional $8.13 for each additional child.
e. Attributing Death Benefits for Children Attribute rates for a case involving only children, to the children, on an equal-share basis.
-------------------- HONOR OUR VETERANS WITH BETTER CARE AND BENEFITS Posts: 3482 | Registered: Jul 2005
| IP: Logged |
(c) 1999-2005. INDIVIDUAL MEMBERS RESERVE ALL RIGHTS TO THEIR POSTINGS ON THIS BULLETIN BOARD WHERE COPYRIGHT IS NOT EXPLICITLY DISCLAIMED. (KANSAS CITY, MO.) *** Junior members, members, moderators, and administrators reserve common-law copyright privileges and rights to their own individual postings, unless expressly disclaimed. By using this bulletin board and in consideration for the privileges of such use, all guests, junior members, members, moderators, and administrators irrevocably agree to grant AGWVA permission and consent to use, store, retrieve, copy, distribute, and edit such message postings without limitation or exception, and irrevocably appoints AGWVA as agent for the purpose of execting any document or instrument necessary to effectuate this agreement. Furthermore, by using this bulletin board and in consideration therefor, all authorized or unauthorized guests, junior members, members, moderators, and administrators agree that the controlling jurisdiction over any dispute or controversy arising from the use or access of this bulletin board shall be governed under the laws of the State of Missouri and jurisdiction of the Circuit Court of Clay County, Missouri. *** While we encourage private messages to be posted in private forums requiring special authorization to enter, some messages on this bulletin board are protected by attorney-client privilege, doctor-patient privilege, and/or priest-penitent privilege, and such messages are intended solely for the use of those posting those messages, the intended recipient of that message, and AGWVA Bulletin Board's management - any disclosure beyond these parties is unintentional. The voluntary provision of medical, regulatory services/VA-representation, or religious services to members of the AGWVA Bulletin Board shall be limited by the case-by-case circumstances of each situation and shall be provided or not provided at the sole discretion of the person providing such services with the understanding that such services may stop or be limited at any time. Voluntary provision of any such service does not guarantee or assure any person a future or further right to such services. *** For posting messages to or from this bulletin board, AGWVA's management (moderators and administrators) are not compensated, directly or indirectly. *** Unauthorized use, copying, or distribution of material posted to this bulletin board is prohibited. Unauthorized access to this bulletin board is illegal and AGWVA reserves the right to prosecute anyone attempting to illegally access this bulletin board. AGWVA has stated explicit rules of conduct for its members posting on this bulletin board and all such rules are incorporated herein by reference as if fully set out hereinbelow. ***
UBBFriend: Email this page to someone!
Printer-friendly view of this topic
