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Agent Orange, Herbicides, and TCDD Explained

TCDD is 2,3,7,8-Tetrachlorodibenzodioxin, a chemical in a group of compounds named dioxins. It is what makes Agent Orange as notorious as it is, and is arguably the most toxic of all the dioxins, which is saying a lot, as dioxins are notoriously toxic.

TCDD wasn’t purposely part of Agent Orange, it’s a by-product of the process by which creates organochloride herbicides. Agent orange was intended to be a mixture of 2,4,5-Trichlorophenoxyacetic acid (2,4,5, T) and 2,4-Dichlorophenoxyacetic acid, (2,4-D) which were commonly used herbicides. There was already some controversy related to the health effects of these herbicides (particularly 2,4,5-T,) but it was the contamination of Agent Orange somewhere during the manufacturing process with TCDD that really made it so deadly.

Often, I hear people talk about illnesses related to Agent Orange as cause by “herbicide.” TCDD isn’t an herbicide, and wasn’t placed in there to kill plants, it was simply an accident, likely caused by Monsanto overheating the mixture during manufacture. (It’s interesting to note that other manufacturers, and even published, peer-reviewed studies had already warned that TCDD could be a contaminant when high temperature processes were used, but Monsanto used this method anyway, perhaps because it was cheaper or quicker.)

Even if the batch hadn’t become contaminated with TCDD, it would likely be the case that vets and civilians would have become ill, just due to the health problems associated with the herbicides, and the crazy amount they were spraying overhead. But TCDD is nasty, nasty stuff, even in small amounts.

Basically, TCDD activates proteins in our bodies called aryl hydrocarbon receptors, which help us protect ourselves from naturally-occurring toxic chemicals like benzene. These receptors trigger the production of enzymes called Cytochrome P450 to break down these hydrocarbons to protect our cells from the damage they cause. This is actually a GOOD thing, and we actually see with miniscule doses, LESS cancer and LESS diabetes in TCDD-exposed rats. However, as soon as you’re exposed to a decent dose for a period of time, everything goes haywire. The body can’t produce more P450 enzymes, so we are unable to break down toxins, and you see huge increases of cancer and the whole mess of health problems that we associate with Agent Orange.

It’s actually a very similar to the way heroin/morphine work and cause withdrawal. Heroin is an opiate receptor agonist, and TCDD is an aryl hydrocarbon agonist. When you take away the morphine, you get withdrawal symptoms because your brain stops making dopamine, since the heroin has been clogging up all the opiate receptors. With TCDD, instead of dopamine, you stop producing P450, whose job it is to break down all these cancer-causing hydrocarbons. It’s like letting loose a cancer free-for-all.

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by Chris Amidon, Veterans Advocate
September 16, 2014

Is my adult child eligible for something more than SSI? What are DAC benefits?

A Disabled Adult Child (DAC) claim provides Social Security Disability Insurance benefits to a disabled adult who can prove a medical disability resulting in an inability to work, prior to age 22. An adult disability claim for Social Security disability benefits entails a 5-step sequential evaluation:

First, a person must demonstrate that s/he is not performing Substantial Gainful Activity (SGA). For 2014, the threshold level for SGA is $1070/month for non-blind individuals. For blind individuals, SGA is $1800/month. Second, the Administration asks whether an individual has a Medically Determinable Impairment of at least 12-month duration, or likely to result in death. That is, has the claimant been diagnosed by an acceptable medical source (i.e, a doctor)? Third, a claimant’s impairment (or combination or impairments) are compared to the SSA medical Listings. If a claimant’s condition manifests itself in a way identical to or medically equal to the definitions and descriptions of the SSA medical Listings, the individual can be found disabled. If, however, the claimant’s impairments do not meet or equal the medical Listings, the analysis proceeds to the 4th and 5th steps of the sequence.

At step 4, a claimant must prove that the impairment preclude the ability to return to his/her Past Relevant Work (PRW). PRW is any work a claimant has substantially performed over the preceding 15 years such that it can be assumed s/he acquired the skills and/or familiarity to perform that job. If it is determined that the individual could not return to the PRW, then step 5 analyzes whether there are any other jobs exist in the economy in “substantial numbers” that the claimant could perform despite any limitations caused by his/her medical conditions.

At the time of a claimant’s Initial Application, it does not matter whether s/he is already receiving Supplemental Security Income (SSI) benefits. The claimant need only prove that the disability began prior to his/her 22nd birthday. Additionally, an individual is only technically eligible if s/he has a parent who is retired, deceased or disabled upon application for DAC benefits.

DAC benefits may increase a disabled person’s monthly income as compared to SSI benefits. The 2014 Federal Payment Amount for SSI is $721. However, DAC benefits are based upon the Disability Insurance benefits (DIB) of the parent’s account. Presently, the maximum DIB benefits is $2642 for 2014. As discussed in the first Blog about DAC benefits, a claimant is eligible for 50% of a parent’s monthly DIB if the parent is living, and up to 75% of the monthly DIB if the parent is deceased.

Additionally, a person is eligible only for Medicaid as a recipient of SSI; whereas, Medicare will kick in 29 months after the disabled individual is found disabled as a DAC recipient.

However, the DAC benefit is mainly for unmarried disabled adult children. Generally speaking, upon marriage, the eligibility for DAC ceases. There is an exception for disabled individuals who marry another Social Security disability benefit recipient.

The burden to prove Steps 1-4 of the sequential analysis is upon the person seeking DAC benefits.   Overcoming that burden and rebutting the Agency’s findings at Step 5 requires objective medical evidence, sound medical opinion evidence, and a strong knowledge of the Social Security Act and agency policies.

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by Attorney Randi Johnson
September 15, 2014

Traumatic Brain Injury – A New Rating System (Part 2: How VA Rates TBI – 38 CFR 4.124a)

When the VA rates residuals of traumatic brain injury, three main areas of dysfunction are considered: cognitive, emotional/behavioral, and physical. It is important to note that when the VA uses terms such as “mild”, “moderate” and “severe” when rating TBI, these terms refer to the classification of TBI made at, or close to, the time of the injury, rather than the severity of the current symptoms.

Cognitive Impairment

Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Not all of these brain functions may have been affected by TBI, and some functions may be more affected than others. Symptoms may even fluctuate from day to day. Cognitive impairment is rated by a table included in this regulation. Cognitive functional categories include:

  1. Memory, attention, concentration, and executive functions
  2. Misplacing
  3. Judgment
  4. Social interaction
  5. Orientation
  6. Motor activity (with intact motor and sensory system)
  7. Visual spatial orientation (maps, unfamiliar, following)

Cognitive impairment can also have subjective symptoms that may be only residuals of TBI or be associated with cognitive impairment or other areas of dysfunction. While 38 CFR 4.12a gives a rating chart for subjective symptoms, some residuals have a distinct diagnosis (such as migraines or Meniere’s disease), and will be rated under that specific category.

Subjective symptoms are rated under the following categories:

  1. Neurobehavioral effects
  2. Communication (language, gestures, spoken)
  3. Consciousness

Emotional/Behavioral Dysfunction

Emotional/behavioral dysfunction is rated under 38 CFR 4.130 (mental disorders) when there is a diagnosis of a mental disorder. If there is no diagnosis of a mental disorder, the VA will rate those symptoms according to the cognitive functional/subjective symptoms as described above.

Physical/Neurological Dysfunction

Physical/neurological dysfunctions are rated according the diagnostic code of the specific condition or symptom. These include:

  • Motor and sensory dysfunction
  • Visual impairment
  • Hearing loss & tinnitus
  • Loss of sense of smell and taste
  • Gait, coordination & balance problems
  • Speech and other communication disorders
  • Neurogenic bladder
  • Neurogenic bowel
  • Cranial nerve dysfunctions
  • Autonomic nerve dysfunctions
  • Endocrine dysfunctions

Special monthly compensation can be awarded for TBI for problems such as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance, being housebound, etc.

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by Mary Klements, Veterans Advocate
September 12, 2014

Traumatic Brain Injury – A New Rating System (Part 1)

Traumatic Brain Injury (TBI) has escalated in prevalence since the beginning of the Gulf Wars, and even more so as veterans of Afghanistan and Iraq start coming home. TBI is such a frequent occurrence that it has become known as the “signature injury” of Afghanistan and Iraq veterans. Insurgents would use roadside bombs (IEDs), fire bombs, and other explosives to fend off American soldiers. TBI is characterized by physical and psychological effects, and veterans often feel residual effects of TBI long after the initial injury.

A 2013 audit on the processing of TBI cases by the VA Regional Offices revealed that the VA makes significant errors on TBI cases. In fact, of the 77 inspections made on VA Regional Offices, VA staff had made errors in 31 % of the TBI cases reviewed. More than half of those errors were due to the staff using “inadequate medical examination reports to evaluate residual disabilities associated with traumatic brain injury” (Sondra McCauley, Deputy Assistant Inspector General for Audits & Evaluations, December 4, 2013). Furthermore, inspections and audits performed by the Office of the Inspector General have consistently shown that the VA Regional Offices do not always comply with the Veterans Benefits Administration’s national policy to accomplish their benefits delivery mission.

In response to a previous May 2011 report, the VA agreed to implement a second-signature policy on all TBI claims in order to ensure accuracy of TBI claims decisions. This second-signature policy would continue until the Rating Veterans Service Representatives (RVSR) demonstrate a 90 percent accuracy in TBI claims processing. In spite of the second-signature policy, however, errors continued to be made.

Because these alarming findings, the VA revised regulation 38 CFR 3.310 in order to help more veterans with TBI to qualify for benefits.

38 CFR 3.310

Before the proposed revisions were published, 38 CFR 3.310 already included a section on traumatic brain injury. This regulation defines how the VA determines disabilities that are proximately due to, or aggravated by, service-connected disease or injury. The revised regulation presumes service-connection to TBI for the 5 following conditions:

  1. Parkinsonism, including Parkinson’s disease, following moderate or severe TBI
  2. Unprovoked seizures, following moderate or severe TBI
  3. Dementia of the following types if manifest within 15 months of the injury:
    1. Presenile dementia of the Alzheimer type
    2. Frontotemporal dementia
    3. Dementia with Lewy bodies
  4. Depression, if manifest within 3 years of moderate to severe TBI, or within 12 months of mild TBI
  5. Diseases of hormone deficiency that result from hypothalamo-pituitary changes, if manifest within 12 months of moderate or severe TBI

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by Mary Klements, Veterans Advocate
September 11, 2014

Do my dependents qualify for healthcare through VA?

The first pension benefits for dependents of disabled Veterans came following the War of 1812. However, the expansion of these deserved benefits to include education and healthcare benefits took decades to arrive. On June 29, 1956 dependents of disabled Veterans began to receive education benefits, which I discussed in my last post. On August 2, 1973 dependents finally began receiving healthcare assistance with the creation of the Civilian Health and Medical Program of VA or CHAMPVA. CHAMPVA is entirely different from TRICARE, the Department of Defense program for active duty military and retirees including their dependents. This post will overview CHAMPVA, provide eligibility information and explain how to apply for these benefits.

CHAMPVA is a cost sharing healthcare program administered by VA and covers most medically necessary care and equipment. There is an annual deductible and “catastrophic cap” required from beneficiaries each calendar year. The mandatory deductible is $50 per person but only $100 per entire family. CHAMPVA will then pay 75% of allowable charges up to an aggregate $3,000 including beneficiary expenses, after which CHAMPVA will pay 100% of allowable charges. CHAMPVA, like Veterans healthcare coverage, satisfies Affordable Care Act or ACA requirements.

CHAMPVA is available to dependents of Veterans that meet any of the following criteria:

  • Rated permanently and totally disabled due to a service-connected disability
  • Rated permanently and totally disabled due to a service-connected condition at the time of death
  • Died of a service-connected disability
  • Died on active duty and the dependents are not otherwise eligible for TRICARE benefits

Important, spouses lose eligibility if divorce or annulment occurs and widow(er)s lose eligibility if remarriage occurs before age 55. Children lose eligibility at age 18, or 23 if enrolled in college, and stepchildren lose eligibility when no longer living with the Veteran. Dependents eligible for both CHAMPVA and TRICARE may not receive both at the same time. Further, TRICARE is required for spouses of military retirees and service members killed in action. While CHAMPVA does not include dental coverage, VA recently began offering this option and beneficiaries must contact the following providers directly:

  • Met Life          1-888-310-1681
  • Delta Dental   1-855-370-3303

CHAMPVA is an excellent resource for eligible beneficiaries and does not require healthcare treatment at VA facilities, although some VA hospitals are willing to provide care to CHAMPVA beneficiaries. While there is no CHAMPVA provider directory, most TRICARE providers accept CHAMPVA. Before applying, ensure the local VA Regional Office has verified your dependent status. In order to apply, simply mail VA Form 10-10d and VA Form 10-7959c or call 1-800-733-8387.

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by Eric Cook, Veterans Claims Advocate
September 9, 2014

Is your adult child getting the full social security benefits he is entitled to?

If you are disabled and at least 18 years of age, you may be eligible for more than “just” Supplemental Security Income, even if you have never worked or did not earn enough work credits to claim Disability Insurance benefits on your own account. A disabled individual may claim on the Social Security account of his/her parent (sometimes grandparent or step-parent) if the parent is deceased, retired or disabled at the time of the claim and the disabled individual can show that the disability began before the age of 22. This is called a Disabled Adult Child claim (DAC). It is considered a Child’s Benefit because the disabled individual is (usually) collecting on the account of an insured parent.

The eligibility remains in place so long as the disabled individual remains disabled, unmarried and does not work at the Substantial Gainful Activity level. However, if you marry another Social Security beneficiary, you may still be eligible for these benefits. You must show a continuing disability that is likely to last 12 months or result in your death. The typical DAC beneficiary received SSI as a child under the age of 18. Yet, this is not always the case. Sometimes, if a child’s family was over-resourced, that rendered the child ineligible for SSI Child benefits. When s/he turns 18 years of age, Social Security considers him/her an adult and may now become eligible for DAC and/or SSI benefits.

It is important to consult with an attorney for these complicated questions regarding a potential DAC claim because these claims come with more than a monthly check – The DAC beneficiary will become eligible for Medicare 29 months from the date s/he has been found disabled. Benefits will not be paid more than one year prior to the date of application, so it is especially important to apply as soon as the disabled adult child meets the criteria.

A DAC claim is potentially worth more than an SSI application alone. A DAC beneficiary stands to receive ½ of the parent’s full benefit, if the parent is living and ¾ of the parent’s full benefit, if the parent is deceased. If both parents are disabled, retired or deceased, the DAC beneficiary is entitled to the higher of the 2 parent accounts.

Understanding the subtle nuances of the DAC claim requires a fluent knowledge base of Social Security law. If you are an adult and are currently receiving SSI benefits, it still may not be too late to apply for a DAC benefit claim. Contact an experienced attorney who can help answer your eligibility questions.

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by Attorney Randi Johnson
September 8, 2014

I was granted dependent education benefits, what should I know about them?

On March 4, 1865, President Abraham Lincoln delivered his second inaugural address during which he created VA’s motto – “…to care for him who shall have borne the battle and for his widow and his orphan…” President Lincoln clearly understood sacrifices made by family members of disabled Veterans and our moral obligation to provide support for these unsung heroes. There are many different types of dependent benefits including Dependency and Indemnity Compensation, Survivors pension, Aid and Attendance and in some cases health care and education benefits. This post focuses on information regarding grantedChapter 35 education benefits and overviews the actual benefit, related time limits and explains how to apply.

Chapter 35 benefits vary depending on the education program intensity; full time students currently receive $1,018 per month and rates decrease in intervals to $254.50 per month for ¼ time students. There are different rates for Apprentice or On-the-job training, Farm Cooperative and Special Restorative training programs. Eligible dependents may receive benefits for 45 months and an aggregate $1,018 benefits paid equates to one month. However, after October 1, 2013 some dependents may receive benefits for 81 months when utilizing Chapter 35 benefits conjointly with other education benefits. Institutions must be VA approved, and recipients are encouraged to decide carefully where to attend.

There are time limits to utilize these benefits, although circumstances beyond reasonable control may extend the limits. Spouses are eligible for ten years from one of the following dates:

  • Effective date of the Veteran’s permanent and total disability evaluation
  • Date VA notifies the Veteran of the permanent and total disability evaluation
  • Beginning date you choose, between the date you become eligible and the date VA notifies the Veteran of the permanent and total disability evaluation

Surviving spouses may be eligible for either ten or twenty years, depending on when the Veteran died. Surviving spouses are eligible for ten years if the Veteran died as the result of a service connected disability. In this case, surviving spouses may choose when the ten-year period begins although this date must be between the date of death and date the death is determined due to a service-connected condition. Surviving spouses are eligible for twenty years from the date of death, if the Veteran died on active duty. On October 10, 2008, Federal law increased surviving spouse eligibility to twenty years provided the Veteran’s effective date of permanent and total disability falls within three years of discharge from service. Children, including adopted and step, are eligible for benefits between ages 18 and 26, although exceptions to this rule exist. Important, Veterans may not receive increased compensation for dependency while eligible children receive education benefits.

Eligible dependents may call 1-888-442-4551 to receive free counseling on specifics. In order to apply, submit VA Form 22-5490, Application for Survivors and Dependents’ Educational Assistance by mail or simply go to the GI Bill website. In my next post, I’ll discuss health care benefits for dependents.

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by Eric Cook, Veterans Claims Advocate
September 5, 2014

I heard about “the fire of 1973 that destroyed records for VA claims”, what should I know?

The Digital Revolution began in 1947 with the invention of the transistor, and evolved into the Information Age of today. This immense technology boom has finally initiated the transition from our completely paper based society into someday becoming totally digital. However, the advent of paperless records management systems was too late to prevent the disaster known among many Veterans as “the fire of 1973”. This post will briefly explain the fire’s history, outline exactly whom the event concerns and provide information to affected Veterans.

The two main facilities responsible for housing millions of Veteran records, the Records Management Center (RMC) and National Personnel Records Center (NPRC), are both located in Saint Louis, Missouri. In the early morning hours of July 12, 1973, authorities responded to fire alarms on the sixth floor within NPRC. The ensuing blaze lasted almost five whole days, and was so devastating investigators were unable to determine the exact cause. The fire destroyed approximately 18 million records, and the aftermath continues to wreak havoc within the lives of Veterans applying for disability benefits.

The most compelling evidence of the “in service injury/event” element necessary for service connection is oftentimes contained within service personnel and medical records. When such evidence is unavailable for any reason, the process becomes more challenging and may result in the unjust denial of benefits. While NPRC houses records from every service branch, the fire only affected Army and Air Force Veterans. The following identifies those affected:

  • Army personnel discharged between November 1, 1912 and January 1, 1960
  • Air Force personnel discharged between September 25, 1947 and January 1, 1964 (specifically names alphabetically after Hubbard, James E.)

Thankfully, this travesty has some good news; first, no one was injured or killed and second, many records identified above actually survived. In fact, authorities immediately began recovery efforts and salvaged approximately 6.5 million records. The following estimates how many records identified above are still available:

  • 20% of Army records
  • 25% of Air Force records

So, how do you know whether your records still exist? The only way is request them, if you learn the fire destroyed your records – you may request NPRC perform “reconstruction” from secondary sources by submitting two forms depending upon the type of record sought. The forms are:

If your records were involved in “the fire of 1973”, not all hope was destroyed with the records. Be sure to complete one or both of the above forms and send them to the VA for processing The VA is obligated to assist Veterans affected by this notorious fire and should not decide your case before obtaining the NPRC response to the forms listed above.

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by Eric Cook, Veterans Claims Advocate
September 4, 2014

How does my sleeping pattern affect my mental health?

Sleep, the natural periodic suspension of consciousness during which the powers of the body are restored. Research continues to reveal how and why sleep is equally essential to human survival as food, water, and oxygen. The quantity, and quality, of sleeping have profound implications on our health and inadequate sleep may cause serious maladies – both physically and emotionally. What happens while sleeping that is so important?

There are numerous phases of sleep and each is vital to overall health because our mind and body performs fundamental restorative functions including memory consolidation, hormonal regulation and even muscle repair. However, crucial functions do not take place until the later stages of sleep when Rapid Eye Movement or REM occurs. This coincides with the National Sleep Foundation reporting sleep durations of four to five hours may cause negative physiological consequences. How much sleep is required to maintain healthy mind and body?

The National Sleep Foundation recommends seven to nine hours of sleep per night for adults, although most Veterans know all too well sleep has held low priority within the military. For decades, military regulations allowed for as little as four hours of sleep per day – absurdly insufficient considering the extraordinary amount of occupational stress, particularly during combat operations. However, military personnel are oftentimes lucky to sleep for even four hours and frequently get less rest despite regulations. How does sleep deprivation interrelate with PTSD?

First, remember two major symptoms of PTSD are reliving the event and hyper-arousal. These symptoms involve memory consolidation and stress hormones related to our “fight or flight” instinct – specifically cortisol, epinephrine and norepinephrine. Abnormal memory consolidation causes similar but non-dangerous stimuli to trigger reliving stressful events, whereas hyper-arousal results from irregular levels of cortisol, epinephrine and norepinephrine. These two underlying biological processes, memory and hormonal activity, are regulated with healthy sleep cycles and become dysfunctional when sleep deprived. So, which occurs first – PTSD or sleeping disorders?

We know PTSD results after experiencing traumatic events, and PTSD sufferers frequently experience various sleep disorder symptoms such as nightmares, difficulty falling asleep or insomnia. However, studies show sleep deprivation, as well as being a symptom, actually contributes to developing PTSD and have identified “sleep therapy” as beneficial during clinical treatment. Consequently, in 2011 the US Army acknowledged that sleep deprivation leaves personnel susceptible to judgmental errors and mental illnesses and subsequently revised regulations requiring seven to eight hours sleep time for service members.

VA does not recognize most Veterans, including me, as qualified medical professionals capable of diagnosing conditions. However, every Veteran is fully qualified to report individual circumstances and symptoms of their disabilities. If applying for PTSD benefits, you should read about the paradigm shift regarding military sleep requirements and know that sleep disorders are not just symptoms of PTSD, they also contribute to developing this condition. Be sure to discuss the quantity, and quality, of your sleep during military service when receiving treatment and/or attending C&P examinations.

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by Eric Cook, Veterans Claims Advocate
September 3, 2014

If my husband and I were never officially married can I still get VA DIC benefits?

DIC for Common Law Surviving Spouse

Typically, to qualify for Dependency and Indemnity Compensation (DIC) as a surviving spouse, the spouse must have been married to a Service member who died on active duty or married to a Veteran (for at least one year prior to his death) who died from a service-connected disability.  There are a few other exceptions when minor-aged children are involved, but by and large, DIC is designated for the “surviving spouse and minor-aged dependents.”  But what about circumstances where the Veteran and “spouse” never married?  In states where common law marriages are recognized, as long as the couple meets those requirements, then the VA views them as married and the spouse qualifies for the DIC.  But in states that do not recognize common law marriage, or the couple had not been married for one year prior to the Veteran’s death, the spouse claimant may still qualify for DIC benefits[i].

VA General Counsel has established that a lack of residence in a state that does not recognize common law marriage should not be a bar for establishing a DIC claim and VA law states that, “In certain circumstances, the VA may determine a marital-type relationship to be a ‘deemed valid marriage[ii]’ even where no legal marriage was created under state law.”  However, most common law DIC claims are not always straight forward, for under VA law, a common law type of relationship would only qualify if the spouse was “unaware of the existence of the legal impediment” at the time of the Veteran’s death.

In developing such a DIC claim, the VA Rater would first have to establish whether the spouse alleges a common law marriage in a state that does not recognize common law marriage, then the surviving spouse would be required to provide a personal statement “as to whether he or she was aware that common law marriages were not recognized in the jurisdiction and the reasons for this understanding.”  The spouse would also fill out a Statement of Marital Relationship form[iii] and have at least two individuals who knew the couple each submit a Supporting Statement Regarding Marriage form[iv] attesting to their knowledge of the relationship.  Based upon the spouse claimant’s statement and any other evidence of record, the VA Rater will then make a determination on “whether the claimant was without knowledge of the impediment to the marriage.”

According to various Court of Appeals for Veterans Claims decisions[v], the VA is not limited in its ability to conduct full inquiry as required by law[vi] nor does it invalidate the Department’s responsibility to weigh the evidence submitted both as to its probative value and credibility.   If the VA Rater determines that the claimant was without knowledge of the impediment to the marriage, the other requirements of a deemed valid marriage are satisfied, and all the elements of a common law marriage are present, then the DIC claim can be established.

 

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by Matthew Hill
August 28, 2014

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