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 3.556
Introduction |
This topic contains general information on reducing pension awards under 38 CFR 3.551 and 3.556, including
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Change Date |
November 30, 2020 |
X.iii.1.D.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). |
X.iii.1.D.1.b. Reducing Current-Law and Section 306 Pension for Inpatient Care at VA Expense |
The following table summarizes the criteria for reduction of current-law and Section 306 Pension.
Notes:
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X.iii.1.D.1.c. 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 more information on Medal of Honor Special Pension, see M21-1, Part XIII, Subpart i, 6.1. |
X.iii.1.D.1.d. 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 Section 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 VI, Subpart ii, 1.A.2.a. |
X.iii.1.D.1.e. Screening CAPRI Reports to Determine if Adjustment Is Required |
Use the reports discussed in M21-1, Part X, Subpart iii, 1.A.1.e, to identify 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 Compensation and Pension Record Interchange (CAPRI), see the CAPRI Desk Reference Guide. |
X.iii.1.D.1.f. 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,
Note: If proposed adverse action is pending for an aid and attendance (A&A) reduction due to hospitalization and an EP 330 is received for admission to a domiciliary, nursing home, or contract nursing home (CNH) that requires another reduction, reissue due process to include both before taking final action.
References: For more information on notice of proposed adverse action requirements, see
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X.iii.1.D.1.g. Adjusting Pension Awards for Hospitalization in the Award Processing System |
When completing a hospitalization adjustment, utilize the following screens in the award-processing system:
References: For more information on adjusting awards using
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X.iii.1.D.1.h. 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, see 38 U.S.C. 5503(a)(1)(B). |
X.iii.1.D.1.i. Adjusting Awards Involving Additional Allowance for A&A |
For information on adjustments to compensation or pension involving an A&A allowance, see M21-1, Part X, Subpart iii, 1.C.1.a. |
X.iii.1.D.1.j. Adjusting Pension of Incompetent Veterans |
The procedures in this section apply equally to cases of competent and incompetent Veterans. However, for additional actions required for hospitalized incompetent Veterans, see M21-1, Part X, Subpart ii, 6.F. |
X.iii.1.D.1.k. Cases Involving Entitlement to MRP |
For adjustment of pension awards for Veterans who are receiving, or eligible to receive, military retired pay (MRP), see M21-1, Part VI, Subpart ii, 4.B. |
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 |
November 30, 2020 |
X.iii.1.D.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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X.iii.1.D.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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X.iii.1.D.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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X.iii.1.D.2.d. Reducing Section 306 Pension Cases for Hospitalization |
When a Veteran in receipt of Section 306 Pension, having neither 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, per 38 CFR 3.551(c).
Note: Per 38 CFR 3.551(f), consider treatment of
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X.iii.1.D.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. |
X.iii.1.D.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 X, Subpart iii, 1.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. |
X.iii.1.D.2.g. 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 the last day of the
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). |
X.iii.1.D.2.h. 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. |
X.iii.1.D.2.j. Adjusting Pension Awards Based on CNH/VA NHCU Admission |
Upon admission to a CNH or VA nursing home care unit (NHCU), review the claim and admission details to determine if a reduction to the $90 rate is needed in accordance with 38 CFR 3.551, and consider authorizing A&A based on qualified nursing home patient status.
Note: If a claimant is receiving less than the $90 rate per month for pension, a reduction due to admission to a CNH or VA NHCU does not apply. Continue the present rate.
Follow the table below for action to take upon admission to a CNH or VA NHCU.
References: For more information on
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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 reducing
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Change Date |
August 3, 2020 |
X.iii.1.D.3.a. Reducing Current-Law Pension: Readmission After January 31, 1990 |
Use the table below to take appropriate action when
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X.iii.1.D.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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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 |
August 3, 2020 |
X.iii.1.D.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. |
X.iii.1.D.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).
If the award involves Section 306 Pension authorize the full monthly rate, including, if payable, the HB rate or allowance for A&A, effective the date of departure.
Note: This applies unless it is determined that an apportionment for an estranged spouse should be continued.
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X.iii.1.D.4.c. Reducing Section 306 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) effective the date of return.
Reference: For information on adjustment of awards for incompetent Veterans, see M21-1, Part X, Subpart ii, 6.F.5. |
X.iii.1.D.4.d. Adjusting an Award for Absences of Less Than 30 Days |
Except as provided in M21-1, Part X, Subpart iii, 1.D.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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X.iii.1.D.4.e. Restoring Full Pension Rates Because of Hardship |
As an exception to the requirement outlined in M21-1, Part X, Subpart iii, 1.D.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 |
August 3, 2020 |
X.iii.1.D.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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X.iii.1.D.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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X.iii.1.D.5.c. Apportionment to an Estranged Spouse |
Per 38 CFR 3.454(b), it is generally appropriate to apportion to an estranged spouse all withheld benefits when
When determining an estranged spouse’s entitlement to an apportionment under the provisions of this block, follow the instructions in M21-1, Part VII, Subpart iii, 1.A.2.a.
When adjusting the Veteran’s award to reflect the apportionment,
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)-(e).
Reference: For information about selecting a withholding reason and amount if using VETSNET, see the VETSNET Awards User Guide. |
X.iii.1.D.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 child who
Use the table below to determine the appropriate expiration of the required period of time.
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X.iii.1.D.5.e. Unexpected Loss of a Dependent in Section 306 Pension Cases |
Follow the steps in this table when a Veteran has an unexpected loss of a dependent in a Section 306 Pension case.
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X.iii.1.D.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 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. |
X.iii.1.D.5.g. Awards to Dependents of Incompetent Veterans |
For information on awards to dependents of incompetent Veterans, See M21-1, Part X, Subpart ii, 6.F.3. |
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 |
November 30, 2020 |
X.iii.1.D.6.a. Restoring Awards in Section 306 or Current-Law Pension Cases |
Upon receipt of a discharge report showing termination of hospitalization, domiciliary, or nursing home care in a Section 306 or current-law pension case,
Reference: For more information on proper disposition of EP 330 when restoring pension awards, see M21-1, Part I, Subpart ii, 1.C.1.i. |
X.iii.1.D.6.b. Restoring Awards After CNH/VA NHCU Discharge |
Upon discharge from a CNH or VA NHCU, restore full pension effective the date of discharge.
If A&A was granted administratively, continued entitlement to A&A requires a rating decision. Review the electronic claims folder to see if there is medical evidence of record that would support continued entitlement to A&A. Such evidence can include VA Form 21-2680, in addition to any VA examination or medical reports and findings by private physicians of record.
Follow the table below for action to take for reconsideration of A&A status.
Reference: For more information on how the CNH reports of admission/discharges will be generated, see M21-1, Part I, Subpart ii, 1.C.1.g.
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X.iii.1.D.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 X, Subpart ii, 6.D.6.a. |