Enclosure A

DEPARTMENT OF VETERANS AFFAIRS RO NAME STREET ADDRESS CITY, STATE ZIP

In reply refer to: Month Day, Year Mx. Beneficiary’s Name Street Address Cty State Zip Dear Mx. Beneficiary’s Name:

RO/Section No. Claim Number

This letter is to inform you that a new fiduciary has been appointed to manage your Department of Veterans Affairs (VA) benefits. A fiduciary is a person who acts on your behalf in the management of your VA benefits. Upon appointment by VA, your fiduciary is obligated to you to act with care and loyalty in managing your benefits. After careful consideration, we have decided that your interests will be best served by appointing Mx. Fiduciary to serve as your fiduciary. Pursuant to the provisions of 38 U.S.C. § 5507, VA must conduct an investigation prior to certifying an individual as a fiduciary for a beneficiary. As a part of that investigation, VA should consider, to the extent practicable, the individual’s credit and criminal history, a face-to-face interview, and evidence of a bond in order to make an assessment of suitability to serve as a VA-appointed fiduciary. We conducted the required investigation in this case. Based on information obtained from that investigation, we have determined that Mx. Fiduciary is best suited to receive your VA benefits in a fiduciary capacity. If we are declining to appoint a person the beneficiary requested, add the following paragraph: We recognize that you requested Mx. X to serve as your fiduciary. However, based on the investigation required by section 5507, we have determined that Mx. Fiduciary is better qualified to manage your financial affairs. Your fiduciary’s contact information is: Name of Fiduciary Mailing Address City, State Zip Telephone (XXX) XXX-XXXX

Page 2 Mx. Beneficiary’s Name Your fiduciary will begin managing your VA benefits effective with the Month Day, Year payment. Your fiduciary will use your monthly VA benefit payment to pay the following expenses: EXPENDITURE MONTHLY Mortgage $581.35 Car payment (Honda) $524.02 Car payment (Toyota) $181.35 Cox cable, phone, and internet $135.00 Auto insurance (AllState) $229.57 Home owner's insurance (AllState) $102.76 Monthly spending allowance $500.00 Cell phone (AT&T) $160.00 Electric (CommEd) $120.00 Natural gas (Natural Gas, Inc.) $40.00 Fiduciary Fee $116.76 Total $2,690.81 The balance of VA funds remaining will be conserved for your additional needs. Please forward all billing statements for the above expenses to your fiduciary so that he - she can make the necessary arrangements to pay your expenses in a timely manner. Be sure to tell your fiduciary if you move, go to jail or prison, get a job or stop working, get married or add a dependent, or are admitted to a hospital. If you should disagree with our fiduciary selection, you should write and tell us why and whom you prefer to be your fiduciary. Please review the below information regarding your appellate rights: YOUR RIGHTS TO APPEAL OUR DECISION If you disagree with our choice of fiduciary, you may: • • appeal to the Board of Veterans' Appeals (Board) by telling us you disagree with our decision and want the Board to review it, or give us evidence we do not already have that may lead us to change our decision.

The following information will tell you how to appeal to the Board and how to send us more evidence. You can do either one or both of these things. WHAT IS AN APPEAL TO THE BOARD OF VETERANS' APPEALS?

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Page 3 Mx. Beneficiary’s Name An appeal is your formal request that the Board review the evidence in your VA records and review the law that applies to your appeal. The Board can either agree with our decision or change it. The Board can also send your case back to us for more processing before the Board makes its decision. HOW CAN I APPEAL THE DECISION? How do I start my appeal? To begin your appeal, write us a letter telling us you disagree with our decision and wish to appeal. This letter is called your "Notice of Disagreement.” Send your Notice of Disagreement to the address at the top of our letter, not to your fiduciary’s address. You may also submit any additional evidence in support of your appeal. What happens after VA receives my Notice of Disagreement? We will review your case and consider any additional evidence you provide. If we change our decision, we will notify you in writing. If we make no change in our decision, we will send you a Statement of the Case. A Statement of the Case describes the facts, laws, regulations, and reasons we used to make our decision. We will also send you a VA Form 9, Appeal to Board of Veterans' Appeals, with the Statement of the Case. You must complete this VA Form 9 and return it to us if you want to continue your appeal. How long do I have to start my appeal? You have one year from the date of this letter to submit a Notice of Disagreement. Your letter saying that you disagree with our decision and wish to appeal must be postmarked or received by us within one year from the date of this letter. What happens if I do not start my appeal on time? If you do not start your appeal on time, our decision will become final. Can I get a hearing with the Board? Yes. If you decide to appeal, the Board will give you a hearing if you request one. The VA Form 9 we will send you with the Statement of the Case has complete information about the kinds of hearings the Board offers and provides check boxes for requesting a Board hearing. The Board does not require you to have a hearing. It is your choice. Where can I find out more about appealing to the Board? • You can find a "plain language" booklet called How Do I Appeal on the Internet at: http://www.bva.va.gov/How_Do_I_APPEAL.asp. The booklet also may be requested by writing to: Mail Processing Section (014) Board of Veterans' Appeals 810 Vermont Avenue, NW Washington, DC 20420

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Page 4 Mx. Beneficiary’s Name

You can find the formal rules for appealing to the Board in the Board's Rules of Practice at Title 38, Code of Federal Regulations, Part 20. You can find the complete Code of Federal Regulations on the Internet at: http://www.gpoaccess.gov/cfr/index.html . A printed copy of the Code of Federal Regulations may be available at your local law library.

Can I get someone to help me with my appeal to the Board? Yes. You can have a veterans service organization, an attorney-at-law, or an "agent" help you with your appeal. However, you are not required to have someone represent you. It is your choice. • Representatives who work for VA-recognized veterans service organizations know how to prepare and present claims and will represent you at no cost. You can find a listing of these organizations on the Internet at: http://www.va.gov/ogc/apps/accreditation/index.asp A VA-accredited private attorney or claims agent can also represent you. Your local bar association may be able to refer you to an attorney with experience in Veterans' law. VA accredits only attorneys who are licensed to practice in the United States or in one of its territories or possessions. An agent is a person who is not a lawyer, but who VA accredits as being knowledgeable about Veterans' law. Information about the attorneys and agents currently accredited by VA is available at http://www.va.gov/ogc/apps/accreditation/index.asp.

Do I have to pay someone to help me with my appeal to the Board? It depends on who helps you. The following explains the differences. • • Veterans Service Organizations will represent you for free. Attorneys and agents can charge you for helping you under some circumstances. Paying their fees for helping you with your appeal to the Board is your responsibility. If you do hire an attorney or agent to represent you, he or she must send a copy of any fee agreement to the following address within 30 days from the date the agreement is executed (See 38 C.F.R. §14.636(g)): Office of the General Counsel (022D) 810 Vermont Avenue, NW Washington, DC 20420.

CAN I GIVE VA ADDITIONAL EVIDENCE?

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Page 5 Mx. Beneficiary’s Name Yes. You can send us more evidence to support your position whether or not you appeal to the Board. If you want to appeal, though, do not forget the one-year time limit! If you have more evidence to support your position, it is in your best interest to give us that evidence as soon as you can. We will consider your evidence and let you know whether it changes our decision. Please keep in mind that we can only consider new evidence that: (1) we have not already considered and (2) relates to our fiduciary selection. You may give us this evidence in writing. To support your position, you may send documents and written statements to us at the address on the top of this letter. Tell us in a letter how these documents and statements should change our decision. WHAT HAPPENS AFTER I GIVE VA EVIDENCE? We will review the record and other new evidence. We will then decide if we should change our decision. If we cannot change our decision and you appeal, we will send all of the evidence to the Board. DO YOU HAVE QUESTIONS OR NEED ASSISTANCE? If you have any questions, you may contact us by telephone, e-mail, or letter. If you Telephone Use the Internet Write Here is what to do. Call us at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the number is 1-800-829-4833. Send electronic inquiries through the Internet at https://iris.va.gov. Put your full name and VA file number on the letter. Please send all correspondence to the VA address at the top of this letter.

In all cases, be sure to refer to your VA file number xxx xx xxxx. If you are looking for general information about benefits and eligibility, you should visit our web site at http://www.va.gov, or search the Frequently Asked Questions (FAQs) at http://iris.va.gov. We have no record of your appointment of a service organization, agent or attorney to assist you in this matter. You can contact us for a listing of the recognized veterans service organizations and VA-accredited agents or attorneys. This information is also available online at http://www.va.gov/ogc/apps/accreditation/index.asp.

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Page 6 Mx. Beneficiary’s Name

OR We sent a copy of this letter to your representative, Name of Accredited POA, whom you can also contact if you have any questions or need assistance. Sincerely,

Manager, Veterans Service Center / Fiduciary Hub Manager cc: Any POA of record

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