How do I appeal denied VA benefits?
Veterans and caregivers who receive a denied application to the Program of Comprehensive Assistance for Family Caregivers (PCAFC) may now appeal or request the Veterans Health Administration (VHA) to review the decision.
Depending on the date when a decision was issued, there are different processes for filing an appeal. Those who received a decision before Feb. 19, 2019, can file an appeal with the Board of Veterans’ Appeals for a Veterans law judge to review it. To start the process, fill out this form: Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182).
If appealing a decision made on or after Feb. 19, 2019, there are three options:
- Supplemental claim:
VA will consider new, relevant evidence that was not on record when the agency made the first PCAFC decision. To file, complete Decision Review Request: Supplemental Claim (VA Form 20-0995).
- Higher-level review:
An official from the Caregiver Support Program who was not involved in the initial decision will review the original application; no other information will be considered. This process can be started with the form Decision Review Request: Higher-Level Review (VA Form 20-0996).
- Appeal to the Board:
A Veterans law judge on the Board of Veterans’ Appeals will review the original decision made by the VHA. Form Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182).
Who is eligible for the PCAFC?
Caregivers of veterans who served during the Vietnam War and earlier and those who were severely injured on or after Sept. 11, 2001, are eligible for a monthly payment provided by the U.S. Department of Veterans Affairs (VA).
In October 2022 the program is expected to extend to veterans injured between May 7, 1975, and Sept. 10, 2001.
Legislation called Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act, signed into law in June 2018, prompted the benefit’s expansion to Vietnam-era vets. When the law took effect in June 2019, caregivers were not able to access it because of problems with VA’s information technology (IT) system. However, veterans were given additional private health care options, another piece of the legislation.
This new version of the program broadened eligibility by expanding what is considered a “serious injury” to include illness and disease. Veterans are required to have a single or combined service-connected disability rating of 70 percent and require personal care for a minimum of six continuous months to qualify. Here are the detailed eligibility requirements.
Disability ratings are assigned by the VA based on the severity of an illness and how much it decreases a veteran’s overall health and ability to function.
Monthly payments are set by a federal rate assigned to where a veteran lives. For example, a primary family caregiver of a veteran in Dallas who is unable to perform daily living activities or requires continuous supervision would receive approximately $2,800 a month. If the veteran is able to perform daily living activities, the caregiver would receive about $1,750 a month.
How to apply to the PCAFC
The caregiver and service member need to fill out a joint application, which asks for contact information and the VA Medical Center where the veteran receives or will receive care. Applications may be completed online, or forms and supporting documents may be provided in person to any VA Medical Center’s caregiver support coordinator or be mailed to:
Program of Comprehensive Assistance for Family Caregivers
Health Eligibility Center
2957 Clairmont Road NE, Suite 200
Atlanta, GA 30329-1647
Additional Services Offered to Caregivers
Other new benefits offered through the Program of Comprehensive Assistance for Family Caregivers (PCAFC) will include financial planning and legal services for the primary caregiver.
Caregivers also are eligible for the program’s previous offerings, including:
- Access to health care benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
- Caregiver education and training
- Financial assistance, lodging and travel expenses for a caregiver when traveling with the veteran to receive care
- Mental health services and counseling
- A monthly stipend
- Up to 30 days of respite care a year
If a veteran is ineligible for the PCAFC, the VA’s Program of General Caregiver Support Services provides resources, education and support to veterans’ caregivers. It is available for veterans of any era, regardless of illness or injury, who are enrolled for care in the Veterans Health Administration.
To learn more, contact the nearest caregiver support coordinator (CSC) or the department’s Caregiver Support Line at 855-260-3274 (8 a.m. to 8 p.m. ET).
Source: AARP; Department of Veteran’s Affairs.
We hope this information is helpful to you in the important work you do as a family caregiver.
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