To File or Not to File once paid out at 100%?
One common question veteran’s ask me when they reach a 100% Permanent and Total (P&T) Schedular or via Extra-Schedular: (Total Disability Individual Unemployabilitym, TDIU) rating is whether they should continue filing additional claims or if new claims are unnecessary, especially since there’s no further increase in monthly compensation.
Below is a breakdown of the benefits and risks every veteran should consider before deciding to file new claims once rated at 100% P&T.
To File…
There are strategic reasons to continue claiming and documenting all service-connected disabilities.
1. Survivor Benefits and Dependency and Indemnity Compensation (DIC)
Probably the most important consideration is surviving spouse and dependents benefits, DIC is a vital benefit provided by the VA if the veteran’s death is related to a service-connected disability. To qualify, the VA needs to confirm that a service-connected condition contributed to or was the primary cause of death. If all relevant service-connected disabilities are documented, it strengthens the case for DIC eligibility, providing financial security for dependents.
Specifically, to qualify for DIC:
• The veteran must have died due to a service-connected disability.
• Alternatively, if the veteran had been rated 100% P&T for at least 10 years prior to death, the surviving spouse automatically qualifies, even if the death was unrelated to service-connected conditions.
Adding all relevant conditions can bolster a DIC claim and ensure continuity of benefits for the veteran’s family, especially within that 10 year period after being rated 100% P&T.
2. Special Monthly Compensation (SMC)
Although the standard VA disability compensation caps at 100%, veterans with multiple severe service-connected disabilities may qualify for Special Monthly Compensation (SMC), which can increase monthly payments beyond the standard 100% rate. SMC is intended to provide additional financial support for specific disabilities, such as:
• Loss of use of limbs, blindness, or deafness.
• Need for regular aid and attendance or being housebound due to service-connected disabilities.
If a veteran’s additional conditions meet these criteria, they could qualify for an increased benefit through SMC.
3. State and Local Benefits
Some states and localities offer benefits that require documented service-connected disabilities, especially at certain combined percentages, and not all of these benefits depend solely on the 100% rating. For example:
• Property Tax Exemptions: Some states provide significant property tax exemptions or reductions based on the specific nature and degree of service-connected disabilities.
• License Plates and Vehicle Benefits: Disabled veterans can sometimes qualify for discounted or free vehicle registration, specific veteran license plates, or fee waivers.
• Employment Preferences and Protections: State-level hiring preferences for veterans often consider specific service-connected conditions.
Each state has unique criteria, and having all service-connected disabilities documented can maximize access to these benefits. Check with your states Veteran Benefits program to be sure.
4. Enhanced Access to VA Healthcare and Priority Groups
Certain conditions may qualify a veteran for higher VA healthcare priority categories, potentially lowering copays and granting quicker access to specialized care. This is beneficial as it assures access to treatment for all documented service-connected conditions, even those not directly related to the veteran’s 100% P&T status.
5. Future Proofing Against Changes in Conditions or VA Policies
While the 100% P&T status offers stability, future medical advancements or policy changes may lead to enhanced benefits for specific conditions. Documenting all service-connected disabilities can serve as a safeguard in case benefits improve, or more conditions qualify for higher ratings or additional forms of compensation.
Not to File? Risk Analysis: Wh in Reopat are the Risksening a claim?
Any client considering adding more service connections to their claim must also understand the risks associated with adding to a claim after reaching 100% Permanent and Total (P&T).
Reopening a claim does come with some risks, particularly the risk of triggering a re-evaluation that could reduce or even sever benefits. Understanding the potential consequences, time frames, and mitigating steps can help a veteran make informed decisions.
1. Risk of Reducing the Current Disability Rating
When a veteran reopens or files a new claim to add conditions, the VA may review the entire disability record, which can potentially lead to a re-evaluation of previously rated conditions. This could result in a reduced rating if the VA determines that certain conditions have improved. While this is generally uncommon, it’s a possibility that veterans should consider, especially if they have conditions that may appear to be in remission or have improved over time.
• Timeline Considerations: The VA typically reviews the current medical evidence, focusing on the last few years of medical records and treatment. For veterans who have not had recent significant improvements or changes in condition, the risk may be lower. However, conditions that seem stable or improved in recent years might be subject to scrutiny. Absence of ongoing medical treatments or records in recent years might be viewed by the VA upon claim review as an “improved condition”. It is vital to always be seeking or maintaining ongoing medical visits and having a consistent treatment history.
2. Risk of Losing Protected Ratings
The VA has specific protections for disability ratings that have been in place for long periods. These protections generally fall under the following time frames:
• 5-Year Rule: If a veteran has maintained a rating for five or more years, the VA must show sustained improvement in the condition, with a clear expectation that this improvement is permanent.
• 10-Year Rule: For disabilities that have been service-connected for at least 10 years, the VA cannot sever the service connection unless there is evidence of fraud.
• 20-Year Rule: For ratings in place for 20 or more years, the VA cannot reduce the rating below the lowest level it has held in that period, barring fraud.
Veterans who have had a stable rating for less than 10 or 20 years, especially if they’re under the five-year mark, face a greater risk of rating reduction.
3. Potential for Triggering a Full Re-Evaluation (Routine Future Exams)
Veterans who reach 100% P&T are generally exempt from routine future exams, meaning they typically no longer face periodic re-evaluations unless they initiate a new claim. However, if the veteran reopens a claim, they might inadvertently trigger a full re-evaluation, especially if:
• The VA requires additional information to substantiate the new claim.
• There is evidence of potential improvement in the existing conditions.
This can lead to a comprehensive re-assessment, which may involve multiple exams, requiring current medical evidence to maintain all ratings.
4. Increased Burden of Proof if Current Evidence Is Limited
For veterans reopening claims many years after initial diagnosis, the VA might scrutinize recent medical records closely. If current documentation is sparse, outdated, or does not support the level of disability claimed, it can increase the chance of rating reductions or denials. To mitigate this, veterans should provide recent medical records and ensure consistent treatment or evaluations for all service-connected conditions.
5. Inadvertent Impact on Special Monthly Compensation (SMC)
Adding claims or reopening existing ones could impact eligibility for Special Monthly Compensation (SMC) if the re-evaluation affects ratings for conditions qualifying for SMC. Veterans should carefully consider how a potential rating reduction might impact SMC, especially since SMC provides additional compensation based on the severity of disabilities.
Mitigating the Risks
To minimize the risks when reopening a claim:
• Ensure Strong Current Medical Evidence: Veterans should maintain updated and comprehensive medical records for each service-connected condition. Regular medical visits and consistent treatment history can be crucial if a claim is reopened.
• Limit Claims to Specific Unrated Conditions: If additional conditions have developed or worsened due to service-connected disabilities, veterans may consider focusing new claims on these issues rather than reopening existing ones.
• Understand the risk to benefit reward ratio: If additional service conditions are potentially life threatening, there is a higher probability of Survivor Benefits and DIC documentation to ensure these dependent benefits. However, if the new condition is likely not life threatening, is the risk of reopening a claim and subjecting yourself to reductions of benefits worth it?
In summary, there is no direct one answer To File or Not To File: while reopening a claim or adding conditions can provide access to additional benefits, veterans should be cautious, especially if their ratings are relatively recent or lack long-term protections. Veterans should weigh the life-threatening nature of new conditions, potential survivor benefits, and the stability of existing ratings before deciding. Being proactive about current medical documentation and consulting with an expert can help mitigate potential risks.