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M21-1, Part VI, Chapter 1 – General Chapter 18 Benefits Information

Overview


In This Section

This section contains the following topics:
Topic Topic Name

1

Handling of Chapter 18 Benefits by the Denver Regional Office

2

Impact of Chapter 18 Benefits on Other VA Benefit Entitlements

3

Monthly Monetary Allowance

4

Health Care and Vocational Training

1.  Handling of Chapter 18 Benefits by the Denver Regional Office


Change Date

December 21, 2015

VI.1.1.a. Information on Controlling Chapter 18 Benefit Claims

The Denver Regional Office (RO) processes all claims for Chapter 18 benefits.

Use the table below to determine the action ROs must take upon receipt of a VA Form 21-0304, Application for Certain Children with Disabilities Born of Vietnam and Certain Korean Service Veterans, or other supporting documents or evidence related to Chapter 18 benefits.

If … Then the RO will …
a Veterans Benefits Management System (VBMS) electronic claims folder (eFolder) exists for the child
  • upload the documents, (i.e., application and/or supporting documents or evidence) into the child’s eFolder, and
  • send the Denver RO  an encrypted e-mail with the Veteran’s claim number and child’s Social Security number (SSN) toVAVBADEN/RO/TRIAGE.
no VBMS eFolder exists for the child scan the documents and send them via an encrypted e-mail toVAVBADEN/RO/TRIAGE.

Note:  Do not establish an end product (EP) or an eFolder.  The Denver RO will create a corporate record for the child and establish the EP and eFolder.

there is no way to identify the child’s information
  • transfer documents to the Denver RO centralized mail portal, and
Notes:
  • ROs other than the Denver RO should not establish EPs for Chapter 18 benefit claims.  All Chapter 18 claims will be tracked under the jurisdiction of RO 339.
  • Concurrent EPs should not be sent to the Denver RO.  The Denver RO only works the Chapter 18 issue.
  • Do not transfer the Veteran’s claims folder in Control of Veterans Records System (COVERS) or broker in VBMS.
  • Claims for Chapter 18 benefits are worked under the child’s SSN and there is no claims folder or COVERS location for these claims.

2.  Impact of Chapter 18 Benefits on Other VA Benefit Entitlements


Introduction

This topic contains information on the


Change Date

March 11, 2010

VI.1.2.a.  Impact of Chapter 18 Benefits on Entitlement to Other VA Benefits

Payment of Chapter 18 benefits has no effect on the right of the
  • Chapter 18 beneficiary to receive any other VA benefit to which he/she may be entitled under VA law, with one exception, or
  • Veteran on whose service the Chapter 18 benefits are based to receive additional compensation benefits for the Chapter 18 beneficiary.
Exception:  VA regulations prohibit an individual pursuing a program of vocational training based on Chapter 18 eligibility to receive concurrent assistance under a Chapter 35 program.
Examples:
  • An individual who is entitled to Dependency and Indemnity Compensation (DIC) may also be eligible for Chapter 18 benefits.
  • A child in receipt of Chapter 18 benefits is also a dependent on the Veteran’s compensation award.

VI.1.2.b.  Prohibition on Multiple Chapter 18 Allowances

An individual is eligible to receive only one Chapter 18 monthly allowance.
Note:  An individual currently receiving spina bifida benefits under 38 CFR 3.814who has another qualifying birth defect under 38 CFR 3.815 will be paid the greater Chapter 18 monthly benefit.

3.  Monthly Monetary Allowance


Introduction

This topic contains information on the monthly monetary allowance, including


Change Date

November 1, 2004

VI.1.3.a.  Levels of Monthly Allowance Payable for Spina Bifida and Other Covered Birth Defects

A monthly monetary allowance is payable at one of
  • three levels to, or on behalf of, an individual with spina bifida, and
  • four levels to, or on behalf of, an individual with other covered birth defects, which may or may not include spina bifida.
Note:  Individuals with covered birth defects other than spina bifida may be evaluated at a non-compensable level (level zero). Although these individuals are not compensated, they may be entitled to VA health care and vocational training.
References:  For more information on the
  • disability levels for individuals with spina bifida,  see M21-1, Part VI, 2.C.2.a.
  • disability levels for individuals with other covered birth defects, see M21-1, Part VI,2.C.3.a, and
  • rate of the monthly allowance designated for each disability level, see the Veterans Benefits Administration web site Birth Defect Rates page.

VI.1.3.b.  Chapter 18 Beneficiaries Under Age 18

Beneficiaries of a monthly monetary allowance who are under the age of 18 will be paid as minor children in the custody of a parent or guardian.

VI.1.3.c.  Chapter 18 Incompetent Beneficiaries

Beneficiaries over the age of 18 may be determined to be incompetent under the provisions of 38 CFR 3.353.

4.  Health Care and Vocational Training


Introduction

This topic contains information on health care and vocational training, including


Change Date

December 21, 2015

VI.1.4.a.  Extent of Health Care Coverage Provided by VA

VA health care and vocational training are available to individuals who qualify for Chapter 18 benefits at any level of disability described under 38 CFR 3.814(d)(1)or 38 CFR 3.815(e)(1).
VA shall provide health care necessary for an eligible individual’s spina bifida and other covered birth defects and for any associated disability.  (See 38 CFR 17.900-17.905.)
Important:  Note the following VA policies regarding the extent of health care coverage under Chapter 18 benefits:
  • coverage does not extend to unrelated conditions or disabilities
  • health care is provided directly by VA or by an arrangement with an approved health care provider, and
  • pre-authorization for service is required in many cases.

VI.1.4.b.  Where to Find More Information on Health Care Coverage

More information about health care coverage is available from the
  • VA spina bifida hotline at 1-888-820-1756, or
  • Spina Bifida Health Care Benefits Program
PO Box 469065
Denver, CO 80246-9065
Phone: 888-820-1756
Preauthorization requests may be made to:
Chief Business Office Purchased Care
PO Box 469065
Denver, CO 80246-9065
Fax: (303) 331-7807

VI.1.4.c. Availability of Vocational Training

If achievement of a vocational goal is feasible, an individual found entitled at any level of disability described under 38 CFR 3.814(d)(1) or 38 CFR 3.815(e)(1) may be eligible for a program of vocational training provided by Vocational Rehabilitation and Employment (VR&E).
The local VR&E office will schedule the individual for an evaluation appointment once
  • the individual files an application for vocational training, and
  • VA verifies the individual’s monthly monetary allowance.
Note:  Pursuant to VA regulation for vocational rehabilitation and employment, an individual may not receive benefits concurrently under
Important:  If the individual is eligible for both benefits, he/she must elect in writing which benefit to receive.
Reference:  For more information on vocational rehabilitation and employment based on Chapter 18, see 38 CFR  21.8010 – 21.8410.

VI.1.4.d.  Where to Find More Information on Vocational Training

Eligible individuals should contact the VR&E Division at the nearest RO.
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