Sleep Disorder Update 06: What to Do When You Can’t Sleep
Compared with other insomnia symptoms, having difficulty falling asleep in 2002 was the main insomnia symptom that was predictive of cognitive impairment (dementia) 14 years later, in 2016. More frequent trouble falling asleep was predictive of poorer episodic memory, executive function, language, processing speed, and visuospatial performance. The associations between sleep initiation and later cognitive impairment were partially explained by depressive symptoms and vascular disease burden for all domains except episodic memory, which was only partially explained by depressive symptoms. Trouble falling asleep a modifiable risk factor for dementia.
If you’re one of the millions of Americans who struggle with insomnia, you may find your mind racing and your body tossing and turning when you just want to be asleep. With the right approach, you can reliably fall asleep within a matter of minutes. One of the keys to smoothly 71 falling asleep is relaxation. Research shows that the relaxation response is a physiological process that positively affects both the mind and body. By reducing stress and anxiety, the relaxation response can enable you to peacefully drift off to sleep. Some of the below step-by-step guides offer proven relaxation methods that may help with insomnia and other sleep problems. Experts emphasize that it can take time to master these techniques, but the practice pays off. Even better, these methods are customizable, so you can adjust them over time to make them work for you.
The Four Key Elements to Cultivating Relaxation
For thousands of years, relaxation has been a central focus of spiritual and cultural practices, enabling a sense of calm and connection with oneself and the surrounding world. Only in recent decades, though, have meditative practices for relaxation become a focus of scientific research, which has come to identify four key elements for fostering the relaxation response.
- A quiet environment. Quiet does not have to mean completely silent. Calming sounds or music can be beneficial. Loud, abrasive sounds or noises should be avoided.
- A focus of attention. A word, phrase, mantra, breathing pattern, or mental image can all be used to draw your attention and reduce thinking about external concerns.
- A passive attitude. Accepting that it’s normal for your mind to wander allows you to remain at-ease and draw your focus back to the object of your attention.
- A comfortable position. Finding a cozy place to relax is critical. Naturally, when relaxing to fall asleep, the recommended position is lying in bed.
All of the following methods are ways of achieving these core elements so that you can calmly fall asleep. Keeping these basics in mind empowers you to adjust these methods to suit your preferences. Once you’re lying comfortably in bed, try one of these techniques to put yourself at ease and settle gently into sleep.
Controlled Breathing — This is excellent for people just getting started with relaxation techniques or who have difficulty using other objects of focus like imagery or mantras. A series of slow, deep breaths can enable a sense of calm. This method, also known as pranayamic breathing, is believed to help reduce stress in the nervous system4 and may prepare the brain for sleep5 by reducing excitatory stimulus. How to Do It:
- Option 1: Counting Breaths
o Inhale slowly and gently through your nose.
o Exhale slowly and gently through your mouth.
o Count up. You can count each breath or each cycle of inhalation and exhalation, whichever comes more naturally to you.
- Option 2: Dr. Andrew Weil’s 4-7-8 Method
o Place the tip of your tongue near the ridge behind your front two teeth and hold it in this location throughout the breathing exercise.
o With your mouth closed, slowly inhale through your nose while counting to four.
o Hold your breath while counting to seven. Open your mouth and exhale while counting to eight. Because of the location of your tongue, exhalation should cause a whooshing sound.
o Repeat this 4-7-8 cycle three more times.
Meditation and Mindfulness
This is centered around slow, steady breathing and a nonjudgmental focus on the present moment. By reducing anxiety and rumination, it has been found to have sweeping health benefits, including an ability to help reduce insomnia. Anyone can meditate, including with mindfulness meditation, but it can take more practice to get used to. As a result, it usually works best for people who can devote at least five minutes per day to increase their comfort with it. There are many variations of mindfulness meditation for different situations. One easy to use style is the body scan meditation.
- Focus on slowly inhaling and exhaling at a comfortable pace.
- Notice the position of your body on the bed.
- Notice any sensations, good or bad, in your legs and feet. Let your legs be soft.
- Continue the “body scan,” observing, from your legs up to your head, each region of your body and its sensations. The goal is to stay present and observe your body without judging or reacting and then letting each part of your body relax.
- After scanning each part of your body, reflect on your body as a whole and allow it to relax. Progressive Muscle Relaxation — Progressive muscle relaxation1 (PMR) creates a calming effect by gradually tightening and releasing muscles throughout the body in conjunction with controlled breathing. Studies have found that PMR can help people with insomnia, and when done carefully, may be beneficial for people who are bothered by arthritis or other forms of physical pain. PMR is not recommended for people with uncontrolled cardiovascular problems.
How to do it:
- With your eyes closed, slowly breathe in and out.
- Starting with your face, tense your muscles (lips, eyes, jaw) for 10 seconds, then release your muscles and breathe deeply in and out for several seconds.
- Tense your shoulders for 10 seconds and then relax and breathe.
- Continue tensing and relaxing the following body parts, skipping any area where tensing the muscles causes pain: Shoulders, Upper arms, Lower arms and hands, Back, Stomach, Buttocks, Hamstrings, Calves, and then Feet. Imagery — Visualizing a peaceful image from your past and all of its details engages your attention in order to promote relaxation. Visual thinkers who easily recall past scenes replete with details are ideally suited to using imagery as part of their bedtime relaxation.
How to do it:
- With your eyes closed and in a comfortable position, think about a place or experience in your past that feels relaxing, such as a quiet natural setting.
- While slowly breathing in and out, reflect on the details of this setting and how it looks.
- Continue focusing on this image by adding details relating to your other senses (smell, sound, taste, touch) and experiencing the calmness of this mental imagery. What If I Still Can’t Fall Asleep? 73 If you get into bed and cannot fall asleep after 20 minutes, get up, go to another part of your house, and do something soothing, such as reading or listening to quiet music. Lying awake in bed for too long can create an unhealthy mental connection between your sleeping environment and wakefulness. Instead, you want your bed to conjure thoughts and feelings conducive to sleep. Before you actually get into bed, a few simple tips can help make sure your mind and body are prepared to fall asleep easily:
- Wind down for at least half an hour before bedtime. Reading, light stretching, and other relaxing activities are ideal during this time.
- Disconnect from close-range electronic devices like laptops, phones, and tablets because they can stimulate the brain and make it harder to fall asleep.
- Dim the lights to help your eyes relax, and make sure you’re in comfortable clothing.
- Make sure your bedroom is set to a pleasant temperature. The cooler the better.
- Consider a calming scent, like lavender essential oils, that can generate a calming effect.
- Avoid big meals, spicy foods, caffeine, and alcohol in the lead-up to bedtime. Big-Picture Tips to Fall Asleep Easily Beyond the immediate run-up to bedtime, incorporating fundamental sleep tips can aid in falling asleep and prevent serious sleeping problems.
- Follow a consistent sleep schedule with the same wake-up time every day, including on weekends. This helps fine-tune and entrain your internal clock for more regular sleep.
- Make time for physical activity. Regular exercise benefits the body in many ways, and facilitating better sleep is one of them.
- If you have a hard time sleeping, start keeping a sleep diary to identify trends that could be throwing off your nightly rest.
- See a doctor. If your sleeping problems are severe, long-term, or worsening, it’s important to see a doctor who can work with you to try to identify a cause and recommend optimal treatment
Geriatrics & Extended Care Update 03: Advance Care Planning | Making Health Care Decisions
There is no one way to get started with Advance Care Planning, which is a process of making decisions about:
- What treatments you would or would not want if you were ill or injured and were not able to make those decisions for yourself
- Who you want to make those decisions for you. In any case, the information you need to get started can be found at www.va.gov/Geriatrics:
- What are Advance Directives?
- How do I go about Choosing a Person to Make Decisions?
- How do I begin Talking with Loved Ones?
- Where can I get Help Setting Health Care Goals?
- Can I do this with other Veterans and caregivers through Group Visits?
- Are there Other Types of Advance Care Planning I should think about?
- Where can I find More Resources?
Veterans and their caregivers must think about many factors when making care and treatment decisions – choices that meet needs and honor Veteran preferences. These resources can help you identify your priorities. They can also help you prepare to talk with your providers or loved ones about your preferences and make decisions about health care or planning for long term care.
- Conversation Guide for Patients and Caregivers for Identifying their Health Priorities
- Tips for Patients to Communicate with Clinicians
- Veteran Decision Aid for Care at Home or in the Community– Helps Veterans think about what matters most when considering long term care choices
- Caregiver Self-Assessment– Helps caregivers review their roles and responsibilities and evaluate their stress Visit www.va.gov/Geriatrics to learn more about services and resources for Veterans and their caregivers.
Visit www.va.gov/Geriatrics to learn more about services and resources for Veterans and their caregivers.
[Source: Military Times | Leo Shane III | March 23, 2021 ++]
VA Secretary Q & A Update 01 ► Community Town Hall Event | SEP 2018 In late September 2018, Secretary Wilkie hosted a State of VA community town hall event which allowed Veterans to ask questions. VA reviewed those questions and found several consistent themes which are listed and answered below.
A video of Wilke’s State of the VA Community Town Hall can be viewed at https://youtu.be/TewZj4gYWZY: -o-o-O-o-o
Q: Why can’t I get Dental?
A: All Veterans are not eligible for dental services per Title 38 United States Code (U.S.C.) §§1710(c), 1712 and Title 38 Code of Federal Regulation (C.F.R.) 17.160 – 17.166. Eligibility includes, Prisoners of War, Veterans rated 100% service-connected disability, or Veterans who received dental injuries due combat or service trauma. To see the full list of eligibility factors, take a look at Dental Benefits for Veterans. The good news is if you are not eligible, Veterans enrolled in VA health care can purchase dental insurance at a reduced cost through the VA Dental Insurance Program (VADIP).
Q: What is the status of granting benefits to Blue Water Navy Veterans?
A: With the HR 299 passing the House of Representatives and the Senate hearings on the same bill there have been a lot of questions regarding the VA’s position about securing benefits for Blue Water Navy Veterans. Dr. Paul Lawrence, Undersecretary of Benefits for the Department of Veterans Affairs, testified that “no credible scientific evidence supports extending Agent Orange-related benefits to shipboard personnel who never went ashore in Vietnam or patrolled its rivers.” Without such evidence, he said, “it would be wrong, and would create a disastrous precedent, to award VA benefits.” Currently, Blue Water Veterans are not presumed to have been exposed to Agent Orange or other herbicides. The Department of Veterans Affairs can only provide benefits as approved by law. However, certain Veterans who stepped foot in Vietnam or served on its inland waterways anytime between January 9, 1962, and May 7, 1975, are presumed to have been exposed to herbicides when claiming service- 22 connection for diseases related to Agent Orange exposure. Veterans in these circumstances can find the ship(s) on which they served in the list as well.
Q: Will the VA expand its list of Agent Orange presumptive conditions?
A: Currently, VA recognizes 14 presumptive conditions associated with exposure to Agent Orange or other herbicides. VA has recognized certain cancers and other health problems as presumptive diseases associated with exposure to Agent Orange or other herbicides during military service. The Department of Veterans Affairs can only provide benefits as approved by federal law or regulatory guidance and presumes that certain diseases are a result of exposure to these herbicides. This “presumptive policy” simplifies the process for receiving compensation for these diseases since VA foregoes the normal requirements of proving that an illness began during or was worsened by your military service. However, in November 2017 the Department of Veterans Affairs started to review the National Academy of Medicine (NAM)’s latest report regarding Veterans and Agent Orange and is conducting a legal and regulatory review of these potential presumptive conditions for awarding disability compensation to eligible veterans. A Veteran who believes he or she has a disease caused by Agent Orange exposure that is not one of the conditions listed below must show an actual connection between the disease and herbicide exposure during military service.
Q: When will the VA allow promote the use of Marijuana for pain and PTSD. How can I get into a Marijuana study?
A: Several states in the U.S. have approved the use of marijuana for medical and/or recreational use. Veterans should know that federal law classifies marijuana – including all derivative products – as a Schedule One controlled substance. This makes it illegal in the eyes of the federal government. The Department of Veterans Affairs is required to follow all federal laws including those regarding marijuana. As long as the Food and Drug Administration classifies marijuana as Schedule One, VA health care providers may not recommend it or assist Veterans to obtain it. To comply with laws, such as the Controlled Substances Act (Title 21 United States Code (U.S.C.) 801 et. al.), VA health care providers are prohibited from completing forms or registering Veterans for participation in a State approved marijuana program. However, Veterans that are in state medical marijuana studies should consult their VA provider to discuss how marijuana may impact other aspects of their overall care, such as how marijuana may interact with other medications. View the full directive: Access to VHA Clinical Programs for Veterans Participating in State Approved Marijuana Programs.
Q: How can I find out which (outside) providers can provide me healthcare though VA Community Care programs (Choice)?
A: If you are requesting Care in the Community (formerly known as the Choice Program), please contact your local VA medical facility to coordinate your care. They will be able to provide you help with your healthcare needs and offer community care options. If you are unaware of whom you should contact, visit the VA Facility Locator to find your closest VA site of care at: https://www.va.gov/directory/guide/home.asp.
Q: How do I know if I am eligible for Community Care Programs through the VA?
A: Veterans may be eligible to receive care through the VA Community Care Program (formally known as the Choice Program), if a Veteran faces an excessive burden in traveling to the nearest VA medical facility (such as geographic challenges, environmental factors, or a health problem that makes it hard for you to travel), lives more than 40 miles (driving distance) from the nearest VA medical facility, or can’t make an appointment for the Veteran at the nearest VA medical facility within 30 days of the clinically indicated date.
f you are having issues please visit https://www.va.gov/COMMUNITYCARE/programs/veterans/VCP/index.asp#new
Or call the Choice Program Support Line: 866-606-8198. 23
Q: My provider has not been paid by the VA for Community (Choice) Care and it is impacting my credit score; who can I reach out to?
A: VA Adverse Credit Helpline: 877-881-7618 VA will help you resolve adverse credit reporting and debt collection issues as a result of using the Veterans Choice Program.
[Source: Vantage Point | Beth Lamb| November 30, 2018 ++]
Vet Weight ► Study Shows Only One in Seven are Not Overweight or Obese
The number of disabled veterans is rising. And so, too, is their weight.
A new study, based on a survey of more than 33,000 post-9/11 service members and veterans, found that 51.7 percent of wounded warriors have a body mass index that qualifies them as obese — up from 48.6 percent two years ago. Of those, 6.2 percent are morbidly obese. Even more grim? The percentage of vets who are overweight in 2018 is nearly seven times greater than the percentage of those who are not, according to the study released 4 DEC by Wounded Warrior Project and the nonprofit’s research partner, Westat. 35
Fewer than half of survey participants, 42 percent, said they exercised at least three times a week, and those who maintained healthy eating habits were also in the minority. Many listed lack of time, fear of injury and discomfort in social situations as reasons for not working out more. But the report’s authors also link struggles with depression, sleep, stress and the military-to-civilian transition as factors that could be impacting weight gain in the wounded warrior population. “I think with any type of uncertainty and/or change, there is a heightened sense of stress,” said Melanie Mousseau, metrics director for Wounded Warrior Project. “With stress comes a myriad of other challenges.”
In the study, veterans said the most challenging parts of transitioning out included missing the camaraderie of the military, problems adapting to the civilian workforce and difficulty navigating the red tape at the Defense and Veterans Affairs Departments during the transition process. “I only feel comfortable in combat,” one veteran wrote. “I do not feel comfortable in civilian life or trust it.” And another put it this way: “After leaving a structured environment like the military, it’s difficult to be around people without a standard.” More than 90 percent of the veterans and service members who responded to the Wounded Warrior Project survey between March and May 2018 were enlisted, and 45 percent deployed three or more times during their career. Sixty-two percent had received a disability rating of 80 percent or higher, and the vast majority of respondents reported that they suffer from posttraumatic stress disorder, trouble sleeping, and back, neck or shoulder pain.
While the rate of obesity reported in the study is notably higher than that of the general adult population in the U.S., according to the National Center for Health Statistics, obesity among this group is “compounded by a unique set of issues and circumstances,” Mousseau said. Diana Thomas, a professor at West Point, said contributing factors to obesity are complex. She pointed to research that has shown a relationship between stress and weight gain, as well as a study which found higher weight gain in people who were once fit. “Transition to civilian life will no longer have weigh-ins or structured PT. So it is possible that a change in lifestyle leads to a change in structured habits,” she said in an email. “One thing we know is that during physical activity, there is a phenomena called compensation. Basically, we eat more. If this is not reversed when PT stops, then it will lead to weight gain.”
When asked about strategies for combating obesity, especially for a population of veterans dealing with physical and mental limitations, Thomas suggested walking and swimming, which are “low impact exercises.” And for veterans who struggle to work out because of uneasiness in social situations, she recommends finding a structured workout time with a personal trainer. [Source: MilitaryTimes | Natalie Gross | December 4, 2018 ++]
Vet Eating Habits ► Study Shows Vets Not Eating Veggies
An apple a day may keep the doctor away, but veterans don’t seem to be buying the advice. A comprehensive Wounded Warrior Project survey of more than 33,000 veterans and service members, released 4 DEC, shows a vast majority of vets aren’t eating the recommended amount of fruits and vegetables each day — and could be missing out on key health benefits as a result. “It’s widely recognized that a healthy eating plan is critical for good health and 36 for mitigating the effects of chronic disease,” said Melanie Mousseau, metrics director for the Wounded Warrior Project.
The Department of Agriculture puts the recommended daily fruit intake at 2 cups for men over age 19 and women between 19 and 30. Women who are 31 or older only need 1.5 cups per day to maintain a healthy diet. Men between 19 and 50 should also be eating 3 cups of vegetables each day. Older men and women between 19 and 50 should eat 2.5 cups, and the recommended amount for women over 50 is 2 cups daily.
Among veterans who responded to the Wounded Warrior Project survey between March and May 2018 — 90 percent of whom reported having more than three service-connected injuries or health problems — more than 28 percent said they ate no fruit in a typical day. Around 44 percent said they had only one serving, which is still under the recommended amount for all adult age groups. Vegetable counts were slightly better; only about 61 percent of survey respondents were under the USDA’s suggested daily intake, compared to nearly 73 percent of delinquent fruit eaters. According to the USDA, its recommended portions are appropriate for individuals who get less than 30 minutes per day of moderate physical activity, which includes many of the veterans surveyed who expressed difficulty exercising because of physical or other limitations.
The study also showed that when given the choice between a carrot stick or a bag of chips, veterans are more likely to go for the chips. For example, 8.3 percent reported eating four or more snacks per day, compared to 2.5 and 3.9 percent who said they ate the same amount of servings in fruits and vegetables, respectively. Though the survey did not ask participants to specify what types of snacks they are eating, Mousseau said it’s safe to assume many are processed foods or higher in calories than broccoli or a banana.
In fairness to veterans, many American adults aren’t eating enough fruits and veggies either. The Centers for Disease Control and Prevention reported last year that just 1 in 10 adults are eating the recommended amount. But healthy eating is an “important,” yet “overlooked,” component of maintaining good physical and mental health, and should be even more of a priority for veterans who struggle with pain and chronic conditions, Mousseau said. “(It’s) more important than (for) the average person to make sure they are filling their body with the proper nutrition,” she said.
The 2018 Wounded Warrior Project report is based on the organization’s ninth annual survey — the first to include questions about respondents’ eating habits. About six percent of respondents were still serving on active duty at the time of the survey, though the overwhelming majority had transitioned out of the military. [Source: MilitaryTimes | Natalie Gross | December 4, 2018 ++]
VA Community Care Update ► This is the old “Veterans Choice” program
Nationwide Ops Shift to TriWest Health Care Alliance Veterans Affairs officials announced 2 OCT that TriWest Health Care Alliance will take over nationwide operations for the department’s main community care programs despite concerns raised last month about overpayments to the company. For the last five years, operations for the department’s primary two outside care programs — PatientCentered Community Care and Veterans Choice Program — had been operated by TriWest and Health Net Federal Services. The new contract extends TriWest’s partnership and names them the sole provider until the two programs are replaced next year with a new overarching community care program mandated in the VA Mission Act, which President Donald Trump signed into law this summer. VA officials praised the contract as ensuring that veterans will not see disruptions in their health care in the coming year. “Extending the time and reach of our partnership with TriWest will ensure veterans get the care they need while the department transitions to delivering care under the Mission Act next year,” VA Secretary Robert Wilkie said in a statement. Last month, the VA inspector general found that over a one-year period, TriWest officials filed more than 111,000 duplicate claims for outside care services and made mistakes in nearly 300,000 others, resulting in department overpayments of more than $45 million dollars. Similar errors by Health Net officials resulted in $56 million in overpayments, investigators said. In response, VA officials implemented new payment controls and recovered about $40 million of that money. Additional reimbursements are being reviewed. Veterans’ cases currently being handled by Health Net will be transitioned to the new program in a way department officials promise will not disrupt care. Details of how other cases will be transferred from existing community care programs to future ones have yet to be finalized. On 28 SEP, congressional staffers received a briefing from VA officials on the Mission Act implementation, laying out future timelines for new community care rules and parameters for that work. Last week, in an appearance before the Senate Veterans Affairs Committee, VA Secretary Robert Wilkie predicted the new community care rules will “revolutionize veterans’ care” once implemented. “My view of Congress’ trust and mission is to … give that veteran choice and allow that veteran to continue with the choice that he or she is most comfortable with,” he said. [Source: Military Times | Leo Shane III | October 2, 2018 ++]
VA Major Problems ►
In the span of less than a month, news reports have emerged detailing some major problems at the VA. Some of these problems are new, and some of them have been lingering for years: Claim Delays. One investigative team looked into the persistent delays of disability claim appeals across the country. They say that almost a half-million veterans have been waiting for years to get a hearing on their appeals. When disability claims get denied by the VA, the VA sends a rejection letter and promises that the veteran is entitled to an appeal hearing, but then the process seems to get stuck there. One veteran, who is simply seeking to get a hearing aid for the damage he says he sustained while training with grenades and jumping out of jets, has been waiting for more than three years. Meanwhile, veterans who are waiting to get their appeals evaluated only experience worsening health without proper medical treatment. Some hopeful news has recently come in regarding appeals delays, though. Last year, Trump signed the Veterans Appeals Improvement and Modernization Act, which promises to revamp the appeals process. Implementing this new program has been delayed by technical issues involving the VA’s computer system, but in the meantime, the VA has implemented the Rapid Appeals Modernization Program (RAMP). Under RAMP, the VA has hired about 1,500 employees to handle appeals, and veterans are already seeing some promising results. Higher Backlog Than Claimed. In other recent VA news, one headline reads, VA Inspector General finds VA disability claims backlog larger than officials reported. The VA Office of Inspector General (OIG) has been investigating the sizeable backlog of disability claims since September of 2015, and they’ve found that the VA hasn’t been counting the claims that were waiting for rating approvals for over 125 days from the date of review. That means the backlog has been underestimated by about 21%, which comes to about 63,000 additional claims to the previously reported 239,000. The OIG also found a couple more problems that probably led to the misreported backlog figures they reported that the VA was improperly processing some rating claims and that claims assistants were lacking proper training and oversight. Cancelled Radiology Tests. In another news story, mass cancellations of orders for radiology tests have raised some suspicions. It started when a radiology technologist at a VA hospital in Iowa City, IA, noticed a wrong cancellation for a particular patient’s CT scan. He then looked into the issue and found lots of possibly erroneous cancellations. The OIG is currently auditing these cancellations at eight different medical centers to see what could be going on. Those VA medical centers are in Denver; Las Vegas; Salisbury, NC; Tampa and Bay Pines, FL; Cleveland; Dallas; and Los Angeles. Staffers in the Iowa City facility have given sworn testimony that they were instructed to clean up thousands of pending orders that they thought were outdated, an action that could have caused this issue. The way they canceled these orders did not follow national VA guidelines for order processing, and similar cancellation procedures are being scrutinized at a Tampa hospital. [Source: Axcess News | Melissa Thompson | October 9, 2018 ++]
VA Aid & Attendance Update 22 ►
Determining Eligibility | Means & Evidence Although VA pension benefits are “means-tested” (i.e. the applicant’s income and assets are considered in determining eligibility), there was previously no specific asset limitation, and applicants were assessed on a case-by-case basis. The new rules provide a countable asset “cap” which matches the Community Spouse Resource Allowance for Medicaid ($123,600 for 2018).
An applicant’s annual income is included in calculating their countable assets, as are the assets and income of the applicant’s spouse. To apply for Aid and Attendance applicants must complete VA form https://www.veteransaidbenefit.org/forms/VBA-21-527EZ.pdf Assets
The VA suggests that its adjudicators use a certain amount of personal judgment on this issue. But the bottom line is: does it realistically appear that the veteran or surviving spouse may outlive their assets? If so, they are likely eligible for aid and attendance. In determining assets:
- Do NOT count their residence or vehicle when estimating net worth.
- Do NOT count a life insurance policy (because the policy holder must be deceased in order to benefit from it).
- DO count CDs, annuities, stocks, bonds, savings, checking, IRAs, Keogh, etc.
- DO count any assets owned by the spouse as well.
- As a rule of thumb, assets should not exceed $123,600.
That amount drops depending on the age of claimant Countable Income
- Estimate total annual income for the veteran and his spouse (if any). All income must be included. This includes social security, pensions including VA’s, interest income, dividends, income from rental property, etc.
- Deduct from income all annual unreimbursed, recurring health care expenses. This includes: o Assisted living cost of Nursing home cost of Home care service o Health insurance premium on Medicare premium o Regular unreimbursed prescriptions verifiable through a pharmacy printout
- The difference of the preceding is your countable income. Claim Evidence Required To support a claim for non-service-connected pension, the evidence must show:
- You met certain minimum requirements regarding active service during a period of war.
Generally, those requirements involve:
- 90 days of consecutive service at least one day of which was during a period of war; OR
- 90 days of combined service during at least one period of war:
- If your service began after September 7, 1980, additional length of service requirements may apply, typically requiring two years of continuous service or completion of active-duty obligation) OR
- Any length of active service during a period of war with a discharge due to a service-connected disability
- You are age 65 or older or are permanently and totally disabled. You are considered permanently and totally disabled if medical evidence shows you are:
- A patient in a nursing home for long-term care; OR
- Receiving Social Security disability benefits; OR
- Unemployable due to a disability reasonably certain to continue throughout your lifetime; OR
- Suffering from a disability that is reasonably certain to continue throughout your lifetime that would make it impossible for an average person to follow a substantially gainful occupation; OR
- Suffering from a disease or disorder that VA determines causes persons who have that disease or disorder to be permanently and totally disabled 3. Your net worth and income do not exceed certain requirements (see above on Assets & Countable Income) Applicant’s Need for Benefit Evidence
- To support a claim for non-increased disability pension benefits based on the need for aid and attendance, the evidence must show:
- You have corrected vision of 5/200 or less in both eyes; OR
- You have contraction of the concentric visual field to 5 degrees or less; OR
- You are a patient in a nursing home due to mental or physical incapacity; OR
- You require the aid of another person in order to perform personal functions required in everyday living, such as bathing, feeding, dressing yourself, attending to the wants of nature, adjusting prosthetic devices, or protecting yourself from the hazards of your daily environment; OR
- You are bedridden, in that your disability requires that you remain in bed apart from any prescribed course of convalescence or treatment
- To support your claim for increased disability pension benefits based on being housebound, the evidence must show:
- You have a single permanent disability evaluated as 100 percent disabling; AND due to such disability, you are permanently and substantially confined to your immediate premises; OR
- You have significant additional disability (rated 60% or higher) in addition to any disability necessary to
- You have significant additional disability (rated 60% or higher) in addition to any disability necessary to establish pension eligibility.
[Source: https://www.veteranaid.org/docs/income.pdf | October 2018 ++]
VA Most Common Disabilities ►
FY 2017 Stats Tinnitus remained the most prevalent service-connected disability among new Veterans Benefits Administration beneficiaries in FY 2017, as VA saw a 6 percent increase in auditory disabilities compared with the previous year. Nearly a quarter-million (247,944) auditory disability claims were made by new compensation recipients in FY 2017, according to the administration’s recently released Annual Benefits Report. Of those, 159,800 involved tinnitus, bringing the total number of VA tinnitus cases to 1,786,980 – most among all service-connected disabilities. Another 83,329 new beneficiaries suffered from some form of hearing loss, bringing that overall total to more than 1.1 million, second on the overall list. New compensation recipients accounted for more than 1.5 million disabilities in FY 2017, up from the previous year (1,516,948 to 1,495,373). Each veteran new to the VA system averaged 5.11 disabilities, down from 5.26 in FY 2016. The most prevalent disabilities among new compensation recipients in FY 2017:
- Tinnitus: 159,800 cases.
- Limitation of flexion, knee: 83,329.
- Hearing loss: 81,529.
- Lumbosacral or cervical strain: 73,073.
- Limitation of motion of the arm: 67,563.
- Scars, general: 61,580.
- Post-traumatic stress disorder 51,273.
- Limitation of motion of the ankle 50,384.
- Migraine 41,912.
- Paralysis of the sciatic nerve, 36,584.
The average individual disability payout, excluding service-connected death payouts, was $11,822 in FY 2017, per the report, for a total of $3.51 billion. That’s up slightly from the year before, with an average of $11,661 resulting in $3.32 billion in payouts to new beneficiaries. Total VA disability compensation for FY 2017, including service connected death payouts, was $76.52 billion, up more than $5 billion from the previous year. [Source: MOAA Newsletter | Kevin Lilly | September 24, 2018 ++]
VA Burial Benefits Update 46 ►
Burial & Plot Interment Allowance
WHAT ARE VA BURIAL ALLOWANCES? VA burial allowances are flat rate monetary benefits that are generally paid at the maximum amount authorized by law for an eligible Veteran’s burial and funeral costs. A VA regulation change in 2014 simplified the program to pay eligible survivors quickly and efficiently. Eligible surviving spouses of record are paid automatically upon notification of the Veteran’s death, without the need to submit a claim. VA may grant additional benefits, including the plot or interment allowance and transportation allowance, if it receives a claim for these benefits. “Plot” means the final disposition site of the remains, whether it is a grave, mausoleum vault, columbarium niche, or similar place. “Interment” means the burial of casketed remains in the ground or the placement of cremated remains into a columbarium niche
WHO IS ELIGIBLE? If the burial benefit has not been automatically paid to the surviving spouse, VA will pay the first living person to file a claim of those listed below:
- Veteran’s surviving spouse; OR
- The survivor of a legal union* between the deceased veteran and the survivor; OR
- The Veteran’s children, regardless of age; OR
- The Veteran’s parents or surviving parent; OR
· The executor or administrator of the estate of the deceased Veteran. * Legal union means a formal relationship between the decedent and the survivor that existed on the date of the Veteran’s death, which was recognized under the law of the State in which the couple formalized the relationship and evidenced by the State’s issuance of documentation memorializing the relationship. The Veteran must also have been discharged under conditions other than dishonorable. In addition, at least one of the following conditions must be met.
- Died as a result of a service-connected disability, OR
- Was receiving VA pension or compensation at the time of death, OR
- Was entitled to receive VA pension or compensation, but decided instead to receive his or her full military retirement or disability pay, OR
- Died while hospitalized by VA, or while receiving care under VA contract at a non-VA facility, OR · Died while traveling under proper authorization and at VA expense to or from a specified place for the purpose of examination, treatment or care, OR
- Had an original or reopened claim for VA compensation or pension pending at the time of death and would have been entitled to benefits from a date prior to the date of death, OR 29
- Died on or after October 9, 1996, while a patient at a VA–approved state nursing home. Note: Disabilities determined by VA to be related to your military service can lead to monthly non-taxable compensation, enrollment in the VA health care system, a 10-point hiring preference for federal employment and other important benefits. Ask your VA representative or Veterans Service Organization representative about Disability Compensation, Pension, Health Care, Caregiver Program, Career Services, Educational Assistance, Home Loan Guaranty, Insurance and/or Dependents and Survivors’ Benefits.
HOW MUCH DOES VA PAY? Death Service-Connected
- If the Veteran died on or after September 11, 2001, the maximum service-connected burial allowance is $2,000.
- If the Veteran died before September 11, 2001, the maximum service-connected burial allowance is $1,500.
- If the Veteran is buried in a VA national cemetery, VA may reimburse some or all of the cost of transporting the deceased Veteran’s remains. Non-Service-Connected Death
- If the Veteran died on or after October 1, 2017, VA will pay a $300 burial allowance and $762 for a plot.
- If the Veteran died on or after October 1, 2016, but before October 1, 2017, VA will pay a $300 burial allowance and $749 for a plot.
- If the Veteran died on or after October 1, 2015, but before October 1, 2016, VA will pay a $300 burial allowance and $747 for a plot. Effective October 1, 2011, there are higher non-service-connected death rates payable if the Veteran was hospitalized by VA when he or she died.
- If the Veteran died on or after October 1, 2017, VA will pay a $762 burial allowance and $762 for a plot.
- If the Veteran died on or after October 1, 2016, VA will pay a $749 burial allowance and $749 for a plot.
- If the Veteran died on or after October 1, 2015, but before October 1, 2016, VA will pay a $747 burial allowance and $747 for a plot.
- If the death occurred while the Veteran was properly hospitalized by VA, or under VA contracted nursing home care, some or all of the costs for transporting the Veteran’s remains may be reimbursed.
Note: If the Veteran dies while traveling at VA expense for the purpose of examination, treatment or care, VA will pay burial, funeral, plot or interment allowances, and transportation expenses. Unclaimed Remains
- If a Veteran dies and their remains are unclaimed, the entity responsible for the burial of the Veteran would be entitled to a $300 burial allowance.
- If the Veteran is buried in a VA national cemetery, VA may reimburse the cost of transporting the deceased Veteran’s remains. VA may also reimburse for the cost of a plot.
TIME LIMIT FOR FILING A CLAIM – A claim for non-service-connected burial allowance must be filed with VA within 2 years after the date of the veteran’s permanent burial or cremation. If a veteran’s discharge was corrected after death to “Under Conditions Other Than Dishonorable,” the claim must be filed within 2 years after the date of correction. There is no time limit for the service-connected burial allowance, plot or interment allowance, VA hospitalization death burial allowance, or reimbursement of transportation expenses
HOW CAN YOU APPLY? You can apply by filling out VA Form 21P-530, Application for Burial Benefits which can be downloaded at VA’s website http://www.vba.va.gov/pubs/forms/VBA-21P-530-ARE.pdf. 30
- You should attach a original or certified copy if the Veteran’s military discharge document (DD 214 or equivalent) which contains information as to the length, time, and character of service will permit prompt processing and death certificate Death in a government institution does not need to be proven. In other cases, the claimant must forward a copy of the public record of death. If proof has previously been furnished VA, it need not be submitted again
- If you are claiming transportation expenses, please attach a receipt for the expenses paid. If transported by common carrier, a receipt must accompany the claim. All receipts for transportation charges should show the name of the veteran, the name of the person who paid, and the amount of the charges. The itemized statement of account should show the charges made for transportation. Failure to itemize charges may result in delay or payment of a lesser amount
- You can call us toll-free within the U.S. by dialing 1-800-827-1000. · If you are located in the local dialing area of a VA regional office, you can also call us by checking your local telephone directory. For the hearing impaired, our TDD number is 711.
- You should mail your application to the VA regional office located in your state. You can obtain the mailing address for VA regional offices by accessing our locations site www.va.gov/directory. The address is also located in the government pages of your telephone book under “United States Government, Veterans.”
RELATED BENEFITS VA National Cemetery Burials/ Headstones, Markers and Medallions/Presidential Memorial Certificates/ Burial Flags [Source: VA Benefits Bulletin | October 2018 ++]
MY HEALTH VET UPDATE FEBRUARY 14TH, 2018
Click here to add your own text