M21-1 Manual / Part VIII, Subpart i, Chapter 3, Section A
General Chapter 18 Benefits Information
M21-1, Part VIII, Subpart i, Chapter 3, Section A
Overview
In This Section | | This section contains the following topics: | Topic | Topic Name |
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| 1 | Handling of Chapter 18 Benefits by the Denver Regional Office (RO) | | 2 | Impact of Chapter 18 Benefits on Other Department of Veterans Affairs (VA) Benefit Entitlements | | 3 | Monthly Monetary Allowance | | 4 | Health Care and Vocational Training |
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1. Handling of Chapter 18 Benefits by the Denver RO
Change Date | | August 3, 2020 |
VIII.i.3.A.1.a. Information on Controlling Chapter 18 Benefit Claims | | The Denver Regional Office (RO) processes all claims for Chapter 18 benefits.Use the table below to determine the action ROs must take upon receipt of a VA Form 21-0304,Application for Benefits for a Qualifying Veteran’s Child Born With Disabilities, or other supporting documents or evidence related to Chapter 18 benefits.| If … | Then the RO will ... |
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| a Veterans Benefits Management System (VBMS) electronic claims folder (eFolder) exists for the child | - upload the documents, (i.e., application and/or supporting documents or evidence) into the child’s eFolder, and
- send the Denver RO an encrypted e-mail with the Veteran’s claim number and child’s Social Security number (SSN) to VAVBADEN/RO/BDEFECTS.
| | no VBMS eFolder exists for the child | scan the documents and send them via an encrypted e-mail to VAVBADEN/RO/BDEFECTS. Note: Do not establish an end product (EP) or an eFolder. The Denver RO will create a corporate record for the child and establish the EP and eFolder. | | there is no way to identify the child’s information | - transfer documents to the Denver RO centralized mail portal, and
- e-mail the DOCUMENT ID number to VAVBADEN/RO/BDEFECTS.
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Notes:- ROs other than the Denver RO should not establish EPs for Chapter 18 benefit claims. All Chapter 18 claims will be tracked under the jurisdiction of the Denver RO.
- Concurrent EPs should not be sent to the Denver RO. The Denver RO only works the Chapter 18 issue.
- Do not transfer the Veteran’s claims folder or broker in VBMS.
- Claims for Chapter 18 benefits are worked under the child’s SSN and there is no claims folder for these claims.
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2. Impact of Chapter 18 Benefits on Other VA Benefit Entitlements
Introduction | | This topic contains information on the - impact of Chapter 18 benefits on entitlement to other VA benefits, and
- prohibition on multiple Chapter 18 allowances.
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Change Date | | March 11, 2010 |
VIII.i.3.A.2.a. Impact of Chapter 18 Benefits on Entitlement to Other VA Benefits | | Payment of Chapter 18 benefits has no effect on the right of the- Chapter 18 beneficiary to receive any other Department of Veterans Affairs (VA) benefit to which he/she may be entitled under VA law, with one exception, or
- Veteran on whose service the Chapter 18 benefits are based to receive additional compensation benefits for the Chapter 18 beneficiary.
Exception: VA regulations prohibit an individual pursuing a program of vocational training based on Chapter 18 eligibility to receive concurrent assistance under a Chapter 35 program.Examples: - An individual who is entitled to Dependency and Indemnity Compensation may also be eligible for Chapter 18 benefits.
- A child in receipt of Chapter 18 benefits is also a dependent on the Veteran’s compensation award.
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VIII.i.3.A.2.b. Prohibition on Multiple Chapter 18 Allowances | | An individual is eligible to receive only one Chapter 18 monthly allowance.Note: An individual currently receiving spina bifida benefits under 38 CFR 3.814 who has another qualifying birth defect under 38 CFR 3.815 will be paid the greater Chapter 18 monthly benefit. |
3. Monthly Monetary Allowance
Introduction | | This topic contains information on the monthly monetary allowance, including - levels of monthly allowance payable for spina bifida and other covered birth defects, and
- Chapter 18
- beneficiaries under age 18, and
- incompetent beneficiaries.
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Change Date | | November 1, 2004 |
VIII.i.3.A.3.a. Levels of Monthly Allowance Payable for Spina Bifida and Other Covered Birth Defects | | A monthly monetary allowance is payable at one of- three levels to, or on behalf of, an individual with spina bifida, and
- four levels to, or on behalf of, an individual with other covered birth defects, which may or may not include spina bifida.
Note: Individuals with covered birth defects other than spina bifida may be evaluated at a non-compensable level (level zero). Although these individuals are not compensated, they may be entitled to VA health care and vocational training.
References: For more information on the- disability levels for individuals with spina bifida, see M21-1, Part VIII, Subpart i, 3.D.2.a.
- disability levels for individuals with other covered birth defects, see M21-1, Part VIII, Subpart i, 3.D.3.a, and
- rate of the monthly allowance designated for each disability level, see the Veterans Benefits Administration website Birth Defect Rates page.
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VIII.i.3.A.3.b. Chapter 18 Beneficiaries Under Age 18 | | Beneficiaries of a monthly monetary allowance who are under the age of 18 will be paid as minor children in the custody of a parent or guardian. |
VIII.i.3.A.3.c. Chapter 18 Incompetent Beneficiaries | | Beneficiaries over the age of 18 may be determined to be incompetent under the provisions of 38 CFR 3.353. |
4. Health Care and Vocational Training
Change Date | | August 3, 2020 |
VIII.i.3.A.4.a. Availability of Health Care Coverage and Vocational Training | | VA health care and vocational training are available to individuals who qualify for Chapter 18 benefits at any level of disability described under 38 CFR 3.814(d)(1) or 38 CFR 3.815(e)(1). VA shall provide health care necessary for an eligible individual’s spina bifida and other covered birth defects and for any associated disability. (See 38 CFR 17.900-17.905.) Important: Note the below VA policies regarding the extent of health care coverage under Chapter 18 benefits.- Children born with spina bifida (with the exception of spina bifida occulta) are entitled to receive comprehensive health care coverage pursuant to Public Law 110-387, Section 408.
- For children born with certain birth defects other than spina bifida, health care coverage is limited to care for the birth defect or any disability associated with the birth defect(s).
- Health care is provided directly by VA, by contract with an approved health care provider, or by other arrangement with an approved health care provider.
- Pre-authorization for services is required in many cases.
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Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part VIII, Subpart i, Chapter 3, Section A (U.S. government work, reproduced for reference). Browse all sections →