Overview
In This Section |
This section contains the following topics:
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1. General Information on Reducing Pension Under 38 CFR 3.551 and 38 CFR 3.556
Introduction |
This topic contains general information on reducing pension awards under 38 CFR 3.551 and 38 CFR 3.556, including
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Change Date |
December 14, 2018
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III.v.6.B.1.a. Criteria for Reducing Pension of a Hospitalized Veteran |
Generally, the provisions of 38 CFR 3.551 require a reduction of pension payments for a Veteran who
Note: A therapeutic residence is considered domiciliary care for the purposes of reduction of benefits under 38 CFR 3.551(e).
The following table summarizes the criteria for reduction of current-law, Section 306, and Old-Law Pension.
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III.v.6.B.1.b. Benefits Not Subject to Reduction Under 38 CFR 3.551 |
The provisions of 38 CFR 3.551 prohibit VA from reducing the following pension benefits due to hospitalization at VA expense:
Reference: For information on Medal of Honor Special Pension, see M21-1, Part IX, Subpart ii, 3.1.b.
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III.v.6.B.1.c. Electing the Greater Benefit of Pension or Compensation |
If a Veteran in receipt of pension subject to reduction under 38 CFR 3.551 is also entitled to compensation, he/she may
Note: If Old-Law or 306 Pension is reduced under 38 CFR 3.551, review the evidence of record to determine if it might be advantageous for the payee to elect current-law pension. If so, inform the payee accordingly.
Reference: For more information about elections between compensation and pension, see M21-1, Part III, Subpart v, 4.A.2.a.
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III.v.6.B.1.d. Screening CAPRI Reports to Determine if Adjustment Is Required |
Use Options 7 (Discharge Report) and 11 (Special Report for A&A/Pension) on the Compensation and Pension Records Interchange (CAPRI) system to generate reports for Veteran pension beneficiaries who
Screen each report across the corporate record to determine if an adjustment under 38 CFR 3.551 is required.
Reference: For more information on using the CAPRI system, see the CAPRI Desk Reference Guide.
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III.v.6.B.1.e. Due Process and Controls for Hospital Adjustments |
Notice of proposed adverse action is required prior to any award adjustment. In order to provide proper notification and establish proper controls,
References: For information on notice of proposed adverse action requirements, see
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III.v.6.B.1.f. VETSNET Adjustments of Pension Awards for Hospitalization |
Take the following actions in the (Veterans Service Network) VETSNET to adjust pension awards due to hospitalization:
Reference: For more detailed information on adjusting awards using VETSNET, see the VETSNET Awards User Guide.
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III.v.6.B.1.g. Provisions of PL 102-568 for Current-Law Pension |
Under Public Law (PL) 102-568, any current-law pension in excess of the $90 per month and withheld due to nursing home care must be deposited in a revolving fund at the VA medical facility furnishing nursing home care.
These funds are made available to help defray the operating expenses of the medical facility.
Reference: For more information on the authority to apply the withheld funds, see38 U.S.C. 5503(a)(1)(B).
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III.v.6.B.1.h. Adjusting Awards Involving Additional Allowance for A&A |
For information on adjustments to compensation or pension involving an aid and attendance (A&A) allowance, see M21-1, Part III, Subpart v, 6.C.1.a.
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III.v.6.B.1.j. Cases Involving Entitlement to MRP |
For adjustment of pension awards for Veterans who are receiving, or eligible to receive, MRP, see M21-1, Part III, Subpart v, 5.B.7.
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2. Reducing Pension Upon the Initial Admission of a Veteran
Introduction |
This topic contains information on reducing an award upon the initial admission of a Veteran for treatment or care, including
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Change Date |
July 29, 2011
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III.v.6.B.2.a. Establishing a Date of Reduction for an Initial Grant of Pension |
When a claim for pension is filed after admission for treatment or care, the date controlling the date of reduction is the date of admission, not the inception date of entitlement to monetary benefits. The effective date of reduction due to hospitalization is determined independently of the effective date for award of benefits.
References: For more information about the effective date of
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III.v.6.B.2.b. Reducing Current-Law Pension: Admission After January 31, 1990 |
Use the following table to reduce a Veteran’s current-law pension when he/she is receiving inpatient treatment or care at VA expense after January 31, 1990.
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III.v.6.B.2.c. How to Consider Care When a Veteran Is Transferred |
For current-law pension reductions because of domiciliary or nursing home care, use the table below to determine how to consider treatment or care for reduction purposes when a Veteran is transferred between VA institutions.
Reference: For more information on current-law pension reductions, see 38 CFR 3.551(e)(4).
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III.v.6.B.2.d. Reducing Section 306 Pension Cases for Hospitalization |
When a Veteran in receipt of Section 306 Pension, having neither dependent spouse nor child, has received two full months of VA treatment or care, reduce the award to $50 effective the first day of the third calendar month following admission (see 38 CFR 3.551(c)).
Note: Consider treatment of
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III.v.6.B.2.e. Applying PL 101-237 to Section 306 Pension Cases |
Prior to the enactment of PL 101-237, the procedures used for reducing Section 306 Pension cases were the same as the procedures used for reducing current-law pension cases before February 1, 1990.
VAOPGCPREC 19-1990, dated June 15, 1990, held that the
Apply the regulations in effect before January 1, 1979, to all retroactive, current, and future reductions of Section 306 Pension. However, if Section 306 Pension was previously adjusted using current-law pension regulations, do not create an overpayment if applying the regulations in effect before January 1, 1979, would result in a lower rate.
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III.v.6.B.2.f. Requesting Certification When a Veteran Is Admitted to a Nursing Home for Rehabilitation |
Upon receipt of a report of nursing home admission for a current-law pension case subject to reduction under 38 CFR 3.551(e), follow the procedures in M21-1, Part III, Subpart v, 6.A.2.b. In addition to those procedures
The VAMC should furnish the appropriate certification of discontinuance of participation in such a rehabilitation program, if discontinuance occurs prior to discharge.
Consider status under the rehabilitation program as continuing until the VAMC reports that the Veteran’s participation in the rehabilitation program has ended.
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III.v.6.B.2.g. Establishing Controls for Future Adjustment in Rehabilitation Cases |
Upon receipt of certification of participation in a 38 U.S.C. 1718, program, establish a control for 90 days from the date of admission to review for a later reduction of current-law pension.
References: For more information on
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III.v.6.B.2.h. Allowing for an Extension of the Rehabilitation Period |
If a VAMC certifies that a current-law pension recipient is participating in a prescribed rehabilitation program under 38 U.S.C. 1718, do not reduce pension due to VA-furnished nursing home care for a period of up to three additional calendar months after
After 90 days from admission, send a follow-up inquiry through CAPRI to verify the status of the Veteran’s rehabilitation program.
Note: Generally, rehabilitation services should not take more than the additional three months. Under 38 CFR 3.551(h)(2), if the Veteran remains hospitalized or in a nursing home for rehabilitation beyond this time period, the Chief Medical Director or designee must certify that the need for furnishing continued care is to provide the Veteran with a program of rehabilitation designed to restore the Veteran’s ability to function within the Veteran’s family and community.
Reference: For more information about hospitalization for rehabilitation, see 38 CFR 3.551(h).
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III.v.6.B.2.i. Application of 38 CFR 3.551(h) When Initial Admission Is for Other Than Rehabilitation |
When a current-law pension recipient is admitted to VA-furnished nursing home care for purposes other than rehabilitation, the provisions of 38 CFR 3.551(h) apply if, at a later time during the continuous period of care, the primary purpose of care becomes that of rehabilitation.
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III.v.6.B.2.k. Reducing Old-Law Pension Cases |
Under 38 CFR 3.551(b), when a Veteran in receipt of Old-Law Pension, having neither spouse, child, nor dependent parent, has received six full months of treatment or care
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3. Reducing Pension Upon the Readmission of a Veteran
Introduction |
This topic contains information on reducing an award when a Veteran is readmitted for treatment or care, including
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Change Date |
December 14, 2018
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III.v.6.B.3.a. Reducing Current-Law Pension: Readmission After January 31, 1990 |
Use the table below to take appropriate action when
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III.v.6.B.3.b. Reducing Section 306 Pension Cases |
Use the table below to determine the appropriate action in a Section 306 Pension case when a
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III.v.6.B.3.c. Handling an Old-Law Pension Case: Regular Discharge or Discharge to Outpatient Care |
Under 38 CFR 3.551(b)(2), in an Old-Law Pension case, when the prior period of treatment or care was terminated by a regular discharge or a discharge to outpatient care, a readmission the next day to the same or any other VA institution begins a new period of hospitalization, unless the Veteran was released for purposes of admission to another VA institution.
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III.v.6.B.3.d. Handling an Old-Law Pension Case: Irregular Discharge |
Use the following table to take appropriate action on an award in an Old-Law Pension case when there has been an irregular discharge
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4. Adjusting Pension for Authorized Absences and Non-Bed Care Status
Introduction |
This topic contains information on adjusting an award for authorized absences and non-bed care status, including
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Change Date |
December 14, 2018
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III.v.6.B.4.a. Adjusting for Authorized Absences in Section 306 Pension Cases |
For the purpose of computing periods of hospitalization for Section 306 Pension cases, under the provisions of 38 CFR 3.551(f), authorized absences
Note: Absences of 96 hours or less are not reported to regional offices.
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III.v.6.B.4.b. Restoring the Full Rate for Absences of 30 Days or More |
Upon receipt of notice showing that an authorized absence of 30 days or more has been granted to a competent Veteran, take action without awaiting expiration of the 30 days, per 38 CFR 3.556(a).
Use the table below to determine the appropriate action to take.
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III.v.6.B.4.c. Reducing Section 306 or Old-Law Pension Upon a Veteran’s Return From an Authorized Absence |
Upon receipt of notice that a Veteran has returned to the hospital, reduce either a Section 306 Pension award (if still in order) or an Old-Law Pension award effective the date of return.
Reference: For information on adjustment of awards for incompetent Veterans, see M21-1, Part III, Subpart v, 6.E.7.
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III.v.6.B.4.d. Adjusting an Award for Absences of Less Than 30 Days |
Except as provided in M21-1, Part III, Subpart v, 6.B.4.e, do not restore the Veteran’s full pension rate if the Veteran has not been discharged from VA-furnished hospitalization and has been absent less than 30 days, counting the day of departure, per 38 CFR 3.556(b).
Note: Current-law pension is not adjusted for inpatient hospital care at VA expense after January 31, 1990. It is subject to reduction, however, for nursing home or domiciliary care.
References: For information on
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III.v.6.B.4.e. Restoring Full Pension Rates Because of Hardship |
As an exception to the requirement outlined in M21-1, Part III, Subpart v, 6.B.4.d, restore the Veteran’s full pension rate prior to discharge to authorize the full rate covering the cumulative number of days of absences of less than 30 days if the following conditions are met:
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5. Adjusting Pension When a Veteran Has Dependents
Introduction |
This topic contains information on adjusting an award when the Veteran has dependents, including
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Change Date |
December 14, 2018
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III.v.6.B.5.a. Establishing the Relationship of an Alleged Dependent |
If records indicate a Veteran has a dependent that has not been established as a dependent for VA purposes, ask the Veteran to complete and return to VA
References: For more information about
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III.v.6.B.5.b. Action to Take Based on Whether Evidence Is Received |
Use the table below to determine the appropriate action to take based on whether evidence that constitutes proof of relationship is received.
Notes:
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III.v.6.B.5.c. Apportionment to an Estranged Spouse |
Per 38 CFR 3.454(b), apportion all or part of the money retained under a withholding to an estranged spouse when
When adjusting the Veteran’s award,
When the Veteran is discharged, review the apportionment based on all the facts and equities to determine if it should be continued, modified or discontinued. If the apportionment is continued or modified on the basis of establishing dependency of the apportionee, a readmission may not necessitate a reduction under 38 CFR 3.551(c), 38 CFR 3.551(d), or 38 CFR 3.551(e).
Reference: For information about selecting a withholding reason and amount if using VETSNET, see the VETSNET Awards User Guide.
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III.v.6.B.5.d. Loss of a Dependent When the Only Dependent Is a Child |
Reduce a Veteran’s award under 38 CFR 3.551 after expiration of the required period of time if the Veteran was receiving additional benefits for a dependent child who
Use the table below to determine the appropriate expiration of the required period of time.
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III.v.6.B.5.e. Unexpected Loss of a Dependent in Section 306 and Old-Law Pension Cases |
Follow the steps in this table when a Veteran has an unexpected loss of a dependent in a Section 306 or Old-Law Pension case.
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III.v.6.B.5.f. Acquisition of Dependents During Hospitalization |
When a Veteran without dependents is hospitalized and, following admission to the institution, gains a dependent(s), authorize the appropriate payment rate of current-law pension or restore the full December 31, 1978, amount of Section 306 or Old-Law Pension, as appropriate, effective the date that he/she acquired the dependent(s), but not prior to the date of acquisition of such a dependent.
Example: The effective date would not be prior to the date of marriage or the birth of a child.
Note: The reduction under 38 CFR 3.551 would be removed effective the date the dependent was acquired. However, the effective date of payment of additional benefits for the dependent would be controlled by 38 CFR 3.31.
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III.v.6.B.5.g. Awards to Dependents of Incompetent Veterans |
For information on awards to dependents of incompetent Veterans, See M21-1, Part III, Subpart v, 6.E.5.
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6. Restoring Previous Pension Rate Upon the Discharge of a Veteran
Introduction |
This topic contains information on restoring an award when a Veteran is discharged from treatment or care, including restoring awards
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Change Date |
July 29, 2011
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III.v.6.B.6.b. Restoring Awards in Old-Law Pension Cases |
Use the table below to determine the appropriate action to take to restore an award in an Old-Law Pension case when the Veteran has received
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III.v.6.B.6.c. Restoring Awards to Incompetent Veterans |
Do not restore amounts withheld prior to the expiration of six months following a rating of competency, per 38 CFR 3.556(e).
Reference: For more information on restoring awards after a rating of competency when there is a court-appointed fiduciary, see M21-1, Part III, Subpart v, 9.B.6.a.
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Historical_M21-1III_v_6_SecB_5-11-15.doc | May 16, 2019 | 225 KB |
12-14-18_Key-Changes_M21-1III_v_6_SecB.docx | May 16, 2019 | 70 KB |
2-25-19_Key-Changes_M21-1III_v_6_SecB.docx | May 16, 2019 | 62 KB |
Change-May-11-2015-Transmittal-Sheet-M21-1III_v_6_SecB_TS.docx | May 16, 2019 | 42 KB |
in Chapter 6 Hospitalization at Department of Veterans Affairs (VA) Expense, Part III General Claims Process, Subpart v General Authorization Issues and Claimant Notification
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