I.  Introduction  

 “America’s veterans deserve the best health care and compensation system we can provide.” (Anthony Principi, Secretary of Veterans Affairs, News Release, February 3, 2003).  While there are several different commonly known types of VA benefits available to veterans or widow(er)s of veterans, most people are unaware of the benefits available to our senior citizens who need health care assistance.  Incorporating VA benefits planning into a traditional elder law or estate planning practice is essential, especially in light of the Medicaid financial eligibility laws pursuant to the Deficit Reduction Act of 2005.   

II.  Veterans Administrations’ Two Branches           

A.  Veteran’s Health Administration.  Its primary purpose is to provide health care for prior service members. 

Programs include:

• VA Hospitals
• VA Nursing Homes
• prescription benefits
• outpatient dental services
• services for Blind and Vision impaired Veterans
• prosthetic services
• Alcohol and Drug-Dependence Treatment 

All veterans who served in the military and received a discharge other than dishonorable can take advantage of the veterans health care services.  Certain time requirements with regard to length of service may apply.  However, the veteran must be enrolled in the health care system and submit to a physical.  Due to the large numbers of veterans, there is typically a long waiting list to receive the physical.  Moreover, the veterans health care system ranks veterans with an hierarchy of preference based on whether the veteran has service connected disabilities, is a POW, is in need of aid and attendance, etc.             

Generally, only veterans with a service connected disability rating of at least 70% or whose service connected illness caused the need for skilled nursing care will be able to reside in a VA nursing home.  If a veteran meets this criteria, then they will be able to stay in the nursing facility at no cost.  If the VA has space in the nursing home, it may permit veterans who do not meet the service connected disability standards to live in the nursing home as well.  When this is the case, the veteran must either pay privately for the care, or be receiving Medicaid services.

In addition to VA Federal nursing homes, the VA has a contract with many private nursing homes.  A veteran who meets the criteria for a VA Federal nursing home would be eligible for a slot in a private nursing home with a VA contract.  The contracts are renewable every six months. 

Lastly, some states have State owned and operated nursing homes specifically for veterans.  Each state may have different eligibility criteria.  Generally, the veteran does not have to have a service connected disability.  Rather, the home may require that the veteran have served during a war time period and be a resident of that state for a particular number of years immediately preceding the nursing home admission. 

To receive health care services through a health care clinic, the veteran may need to meet certain income eligibility criteria.  Thus, the VA will require the veteran to complete an income verification form each year proving the exact amount of income the veteran made for the previous year.  Some veterans may have to pay a co-pay for certain services if income is found to be excessive.

Once the veteran has “entered” the system, he will be assigned to a priority group based on his military service, condition, and financial need.

B.  Veteran’s Benefits Administration  This branch administers monetary benefits programs for eligible veterans. 

Programs include:

• Compensation for Service-Connected Disabilities
• vocational rehabilitation and employment
• education and training
• home loan guaranties
• Disability and Indemnity Compensation for Surviving Spouses and dependents
• Special Monthly Pension: House Bound & A&A
• specially adapted housing
• life insurance benefits
• burial benefits

III.        Service Connected vs. Non-Service Connected Disabilities

Eligibility for the different types of benefits largely depends on whether the veteran has a service connected disability or non-service connected disabilities.  Other factors also include the veteran’s service record, length of time in the service, whether the veteran was disabled in the service or after discharge, and whether the veteran served during a war time period.

A.  Service Connected Disabilities

A veteran who obtained an injury or disease while on active duty, and the injury was the result of his service or was exacerbated by service, may be entitled to a monthly income called “compensation.”  The veteran must have a service connected disability rating in order to receive income compensation.  The level of the rating will determine the amount of monthly income received.  A veteran can request an increase in the disability rating if the condition worsens.  

If a veteran is rated 100% disabled and is in need of the aid and attendance of another person to assist with the activities of daily living, the veteran can receive, in addition to regular compensation, a special monthly compensation (SMC).  In these cases, the injuries must be very severe.

B.  Non-Service Connected Disabilities

There is one type of financial benefit that most veterans know nothing about.  Yet, it is the primary source of income that elder care attorneys can help them receive. 

Veterans or widow(er)s of veterans are entitled to an Improved Pension which will provide a Special Monthly Pension (SMP) to offset the cost of necessary health care.  The three types of SMP available are called “Low Income Pension”, “Housebound” benefits and “Aid and Attendance” benefits.  The VA offered two previous versions of this program, called “Old-Law Pension” (veterans receiving pension benefits prior to July 1, 1960) and “Section 306 Pension” (veterans receiving pension benefits between July 1, 1960 and December 31, 1978). A person must meet certain criteria to be eligible for the different pension benefit options.

IV. Basic Eligibility Criteria for Improved Pension, Housebound and Aid and Attendance

All of the following criteria must be met before a veteran or widow(er) of a veteran can receive Improved Pension benefits:

1. The veteran must have served at least 90 days of consecutive active duty service, one day of which must have been during a war-time period;

In general, wartime is:

World War I

World War II - Dec. 7, 1941 - Dec. 31, 1946

Korean War - June 27, 1950 - Jan. 31, 1955

Vietnam War - Aug. 5, 1964 - May 7, 1975

Gulf War - August 2, 1990 through date to be set by law by Presidential Proclamation

1. The veteran must have received a discharge other than dishonorable;

2. The claimant must have limited income and assets available;

3. The claimant must have a permanent and total disability at the time of application;

4. The disability was caused without willful misconduct of the claimant, and

5. The veteran or widow signs an application and provides the application to the Veteran’s Administration         

A.     Low Income Pension

Low income pension is the VA’s equivalent of SSI.  The claimant must meet all the criteria above.   

Permissible family income limits for 2008 to receive Low Income Pension:

Veteran with no dependents         $   985/month            $11,820/year

Veteran with one dependent         $1,291/month           $15,492/year

Widow(er) with no dependents     $   661/month            $  7,392/year     

B.  Housebound Benefits

Housebound benefits are available to a veteran or widow(er) of a veteran who is determined to be disabled and is essentially confined to the home.  The two ways to prove entitlement include:

(1) a single permanent disability rated as 100% disabling under the VA schedule and confined to the dwelling, or  

(2) a 100% disability with another 60% disability, regardless of whether or not the person is confined to the dwelling. 

A disability rating is not required for people aged 65 or older.  People aged 65 or older are presumed to be disabled; however, the VA will require a physician’s affidavit regarding the claimant’s condition.

Permissible family income limits for 2009 to receive housebound benefits are:

Housebound veteran with no dependents         $1,204/month;       $14,448/year

Housebound veteran with one dependent         $1,510/month;       $18,120/year

Household widow(er) with no dependents         $   808/month        $  9,164/year                

C.        Aid & Attendance

Aid and Attendance benefits are available to a veteran or widow(er) of a veteran who meets one of the following conditions:

(1) Claimant is blind;

(2) Claimant is living in a nursing home; OR

(3) Claimant is unable to:

(a) dress/undress or keep self clean and presentable;

(b) unable to attend the wants of nature; OR

(c) has a physical or mental incapacity that requires assistance on a regular basis to protect Claimant from daily environmental hazards.