How to Properly Use an Informal Claim to Establish an Effective Date with the Department of Veterans Affairs
This article was written to educate individuals accredited with the Department of Veterans Affairs (VA) and to help senior veterans and their surviving spouses applying for Pension or Death Pension understand the process of establishing an Effective Date with VA. This article explains how an Informal Claim works and how VA may grant retroactive payment if certain criteria are met. Furthermore, this article highlights serious issues involving the filing of an informal claim before a claimant has met the medical, asset, and income standards set by VA.
An Effective Date is typically the date an application (or original claim) for VA Pension or Death Pension was received by the Department of Veterans Affairs (VA). In some cases (which may be beneficial to the claimant) there are exceptions to this rule which can allow for an earlier date. (see 38 U.S.C.S. §5110 and 38 C.F.R. §3.400).
Generally, payments for a VA Claim are effective from the first of the month following the month in of the Effective Date (so long as an award is given). For instance,
A qualifying 88 year old single veteran filed a claim for VA Pension with the Aid and Attendance Allowance in March and an award was granted 5 months later. The VA will begin paying the veteran in October and will grant a lump sum retroactive payment for the months of April through September.
In the situation above, notice that the lump sum retroactive payment did not include the month of March when the veteran made application. Although the effective date was established in March, the VA will not make any kind of payment in the month in which the original claim was received.
Before applying for benefits a veteran or the surviving spouse of a veteran (in either case, the claimant) may wish to establish an Effective Date by means of an Informal Claim even though they are not yet prepared to apply. This is done to 'lock-in a date' while the claimants are gathering supporting evidence to include in their application. Supporting evidence can take some time to gather and may include any number of the following:
- Military Records
- Doctor's Examinations and other Medical Evidence
- Marriage and Death Certificates
- Banks Statements
- Statements from Care Providers
Using an Informal Claim to establish an Effective Date before the claimant has sufficiently prepared his or her application will allow the claimant to receive a larger lump sum retroactive payment than he or she otherwise would have. For instance:
In February, a qualifying 79 year old surviving spouse of a veteran wishes to apply for VA Death Pension but cannot find her husband's DD 214 and she has not yet scheduled an appointment with her physician to complete the VA Form 21-2680. Locating the DD 214 and visiting her doctor will likely take her 5 weeks to accomplish. February is about to end and she does not want to lose the opportunity to establish an effective date, therefore, she sends an informal claim to the VA. Finally, in April, after obtaining the DD 214, visiting her physician, and completing the rest of her application, she files a claim for Death Pension, which is subsequently awarded in November. The VA will begin paying her in December and will grant a lump sum retroactive payment for the months of March through November.
In the situation above, had the surviving spouse not submitted an Informal Claim, her Effective Date would have been in April rather than February. Therefore, she would have missed the retroactive payments for the months of March and April. Remember, VA will not make any kind of payment in the month in which the claim, or in this case the Informal Claim, was received.
SPECIFICS OF AN INFORMAL CLAIM
An Informal Claim is a written declaration of intent to apply for benefits from the VA. Below is a portion of the Informal Claim definition taken from the Code of Federal Regulations (38 CFR 3.155 Informal Claims):
Any communication or action, indicating an intent to apply for one or more benefits under the laws administered by the Department of Veterans Affairs, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within 1 year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim.
The Informal Claim is best stated on the blank VA Form 21-4138. The Informal Claim should include the following statement in the form of a letter:
Please accept this correspondence as my informal claim for non service-connected pension (or death pension) for a veteran (or the surviving spouse of a veteran) as provided by the following statute:
38 CFR 3.155 Informal Claims
This statement is to preserve my effective date for entitlement to benefits. I am in the process of assembling my claim for submission.
The Informal Claim must also list:
- The claimant's name (if other than the Veteran)
- The Veteran's name
- The Veteran's social security #
- The Veteran’s service dates
Once VA receives the Informal Claim, they will respond to the claimant by sending a formal application. This form must be completed within one year from the date when the VA Form was mailed. If the claimant does not submit the application by the one-year deadline, the effective date established by the informal claim will not be honored.
REMEMBER: Always keep of copy of anything you send to VA and all proof of any transmition or mailing (e.g. fax report or certified mail).
SERIOUS ITEMS TO BE AWARE OF
Occasionally (to the chagrin of the claimant), VA may change the Effective Date to a month different than the month the claimant was expecting. Below are a few examples of instances where a claimant was expecting a specific Effective Date but was granted a later one.
EXAMPLE 1 (No Ongoing unreimbursed medical expenses (UMEs) present at the time the Informal Claim was submitted):
An 83 year old single veteran’s gross monthly income is $2000. He lives at home and, due to his poor health, requires help with bathing, dressing, walking around his home, and feeding himself. He sends an Informal Claim to VA in January then applies in March. On the same day he completes his application, he hires a home care company to cook and feed him healthy meals, help him bathe, dress himself, and move around the house. For this service he pays $1,500.00/month. He includes this cost on his application. In June, VA awards him the benefit and grants a retroactive payment for the months of April and May only. VA does not grant a payment for the months of February and March because, at that time, the veteran did not have any an ongoing care cost (or UME’s) thus rendering his income too high.
EXAMPLE 2: (Bad / Incomplete Information):
An 85 year old single veteran is moving into an assisted living facility and learns that he is eligible for $1703/month through VA Pension and Aid and Attendance. His savings have vanished and his income will not adequately cover the care costs. Unfortunately, the veteran needs extra money immediately to pay for his care as realizes that VA may take months to award him the benefit. He is told that VA will ‘back pay’ and subsequently takes out a loan to cover his costs for the months he is waiting for VA to make a decision.
All within the same month, the veteran moves into the facility, takes out a loan, files an Informal Claim, and sends his formal claim to the VA. Four months later, VA awards him the benefit but only grants a retroactive lump sum payment for three months. The three month lump sum payment is not large enough to pay back the loan and now, due to the misinformation given to the veteran regarding the ‘back pay’, he is now unable to meet his loan obligation. Had the veteran known that payments for a VA Claim are effective from the first of the month following the month in which the claim (or Informal Claim) was received he could have made a better choice regarding the loan.
On rare occasions, establishing an Effective Date can be detrimental to the success of the application. Below is an example where a claimant filed an Informal Claim and was denied because of it.
EXAMPLE 3 (Too Many Assets):
An 84 year old surviving spouse of a veteran lives in an assisted living facility and wants to apply for Death Pension with the Aid and Attendance Allowance. She has $90,000 in assets. Her attorney tells her to file an Informal Claim which she does to lock in a date. The following month the attorney does some estate planning to help her meet the asset limits set forth by VA. After the completion on the estate planning, she files her application. While processing her application, VA learns that the $90,000 was transferred out of her name after the Informal Claim was submitted. Using this information, VA denies her claim based on the fact that she had enough assets in her name to pay for her own care at the time she had established an effective date.
This 2014 Edition provides detailed instructions on how to submit claims for benefits from the Department of Veterans Affairs and uses the successful "Fully Developed Claim Process" for faster and better decisions. View the Book...
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