T. A. Olson
(Pension Manager Center, Saint Paul, Minnesota)
(I can't guess their email address to ask them questions about their letters because they don't use their first names)


May25 (postal mail) T. A. Olson (PMC) to Veteran
(page 1)
Dear Mr. O'Connell:
We made a decision on your claim received January 20,2012. (***Please see question 1 below***)
This letter tells you about your entitlement amount, payment start date, what we decided, and'
how we calculated your benefits. It also tells you of your responsibilities as a veteran in receipt
of disability (***Pleasee see question 2 below***) pension, what to do if you disagree with our decision, and who to contact if you have questions or need assistance.
Your Award Amount and Payment Start Date
Your monthly entitlement amount is shown below:

Monthly
Entitlement
Amount
Payment Start
Date
Reason For Change
$482.00 Feb 1,2012 Original Award

We are paying you as a single veteran with no dependents.
You Can Expect Payment
Your payment begins the first day of the month following your effective date. You will receive a
payment covering the initial amount due under this award, minus any withholdings, in
approximately 15 days. Payment will then be made at the beginning of each month for the prior
month. For example, benefits due for May are paid on or about June 1.
What We Decided
We granted disability (***Please see question 2 below***) pension benefits effective January 20, 2012.
(Page 2)
We enclosed a VA Form 21-8768, "Disability Pension Award Attachment" which explains
important factors concerning your benefits.
How Did We Make Our Decision?
We granted pension benefits because you are:
*Age 65 or older, or
*A patient in a nursing home, or
*In receipt of disability Social Security benefits.
Evidence Used to Decide Your Claim
In making our decision, in addition to the evidence in the attached rating, we used the following
evidence:
*VA Form 21-526, Application for Compensation andlor Pension received January 20,
2012
*VA Form 21-4138, Statement in Support of claim, received February 7, 2012 (***Please see question 3 below***)
*Information data match with Social Security Administration (SSA)
What Income And Expenses Did We Use?
We used your total family income as shown below to award your pension benefit from
February 1,2012.

Income We Counted

  Annual
Earnings
Annual
Social
Security
Annual
Retirement
Annual
Other
Sources
Yourself $0 $6,468.00 $0.00 $0

On your application, you reported you receive $523.00 per month in Social Security. A data
exchange with the Social Security Administration showed that you received a gross monthly
amount of $839.00 effective December 2011. (Please show me 1the evidence for this). Therefore, we used that amount to calculate you income for VA purposes effective December 1,201 1. If this is incorrect, please send us a copy
of your most recent Social Security benefit statement.
(page 3)
How Can You Claim Family Medical Expenses?
To claim family medical expenses, complete the enclosed VA Form 21-8416, "Medical
Expense Report," and return it to this office no later than December 31,2014. We may
consider family medical expenses you paid after January 20,2012. A few examples are listed
below. More examples are shown on the enclosed Medical Expense Report form.
*Medicare/Health Insurance Premiums
*Prescriptions
*MedicalIDental expenses

Don't include unpaid medical bills,
any paid bill that will be reimbursed, or
bills that aren't for health expenses.

What Are Your Responsibilities?
You are responsible to tell us right away if:
*your income or the income of your dependents changes (e.g., earnings, Social Security
benefits, lottery and gambling winnings)
*your net worth increases (e.g., bank accounts, investments, real estate)
*your continuing medical expenses are reduced
*you gain or lose a dependent
*your address or phone number changes
How Do You Start Direct Deposit?
*Your money may be deposited directly into your checking or savings account. This is the
safest and most reliable way to get your money. For more information about Direct Deposit,
please call us toll free by dialing 1-877-838-2778.
*The Treasury Department has mandated (3 1 CFR Part 208) that all Federal benefits be
released via electronic funds transfer or Direct Express B Debit MastercardB issued by
Comerica Bank.
*You did not provide us with your banking information to allow your federal benefits to be
sent directly to your bank. Although you will receive your initial VA benefit in the form of a
paper check, this will only occur for an interim period. You need to contact the Treasury
(page 4)
Department within 3 months from the date of your first check payment to discuss how to
receive future payments at 1-800-333-1 795.
• If you choose to continue to receive paper checks you will need to request a
waiver from the Treasury Department by calling 1-888-224-2950.
• If you choose to have your federal benefits electronically transferred to your
designated financial institution (e.g. bank) please call VA at 1-800-827-1 000 with your
banking information.
• If you choose to have your federal benefits issued through Direct Express@, which
is a MastercardB issued by Comerica Bank, please call 1-800-333-1 795.
Are You Entitled to Additional Benefits?
You should contact your State office of veteran's affairs for information on any tax, license, or
fee-related benefits for which you may be eligible as a veteran (or surviving dependent of a
veteran). State offices of veteran's affairs are available at http://www.va.gov/statedva.htm.
What You Should Do If You Disagree With Our Decision
If you do not agree with our decision, you should write and tell us why. You have one year from
the date of this letter to appeal the decision. The enclosed VA Form 41 07, "Your Rights to
Appeal Our Decision, " explains your right to appeal.
If You Have Questions or Need Assistance
If you have any questions, you may contact us by telephone, e-mail, or letter.

If you Here is what to do.
   Telephone Call us at 1-877-294-6380. If you use a
Telecommunications Device for the Deaf (TDD), the
number is 7 1 1.
   Use the Internet Send electronic inquiries through the Internet at
https://iris.va.gov.
   Write Put your full name and VA file number on the letter. Please
send all correspondence to the address at the top of this
letter.

In all cases, be sure to refer to your VA file number 25 163 990.
(page 5)
If you are looking for general information about benefits and eligibility, you should visit our
website at https://www.va.gov, or search the Frequently Asked Questions (FAQs) at
https://iris.va.gov.
We sent a copy of this letter to your representative, Arizona Department of Veterans' Services,
whom you can also contact if you have questions or need assistance.
Sincerely yours,
T. A. OLSON
Pension Management Center Manager
Contact us at: https://iris.va.gov
Enclosure(s): VA Form 2 1-8768
VA Form 21-841 6
VA Form 41 07
cc: Arizona Department of Veterans' Services
21P/reg/145                         3990amc