17 If the beneficiary is a Veteran, AMOUNTS IN PFOP, IF the amount of any funds in KNOWN, AND AMOUNTS his/her Personal Funds of WITHHELD UNDER 38 CFR Patients (PFOP) account. 3.557 the field blank if no funds exist in the PFOP account, or the beneficiary is a not Veteran. Amounts withheld Important: under 38 CFR 3.557 were withheld due to an estate limitation law that was repealed effective December 27, 2001. VA has since rescinded 38 CFR 3.557. However, it has not yet updated Item 17 of VAForm 21-592. 18 As applicable, enter REMARKS additional information for the fiduciary hub, and/or appropriate indicators to alert the fiduciary hub that the beneficiary might be a danger to himself/herself or others. 19 Enter the names and addresses of NAMES AND LOCATIONS OF the physicians or hospitals that PHYSICIANS OR HOSPITALS generated medical information VA used to rate the beneficiary incompetent. 20 Enter the date of the medical DATE OF EXAMINATION examination VA used to rate the beneficiary incompetent. 21 Enter the beneficiary’s medical DIAGNOSES diagnosis, specifically as it relates to his or her mental condition. 22 Enter the date of VA’s rating of DATE OF RATING OF incompetence. INCOMPETENCY 23 the identity of the NAME AND ADDRESS OF beneficiary’s PERSON, RECOGNIZED ATTORNEY, SERVICE power of attorney, or REPRESENTATIVE OR other legal representative COOPERATING AGENCY recognized by VA. PROSECUTING CLAIM OR CORRESPONDING IN BEHALF OF MINOR OR INCOMPETENT
17 AMOUNTS IN PFOP, IF KNOWN, AND AMOUNTS WITHHELD UNDER 38 CFR 3.557 If the beneficiary is a Veteran, the amount of any funds in his/her Personal Funds of Patients (PFOP) account. the field blank if no funds exist in the PFOP account, or the beneficiary is not a Veteran. Important: Amounts withheld under 38 CFR 3.557 were withheld due to an estate limitation law that was repealed effective December 27, 2001. VA has since rescinded 38 CFR 3.557. However, it has not yet updated Item 17 of VAForm 21-592. 18 REMARKS As applicable, enter additional information for the fiduciary hub, and/or appropriate indicators to alert the fiduciary hub that the beneficiary might be a danger to himself/herself or others. 19 NAMES AND LOCATIONS OF PHYSICIANS OR HOSPITALS Enter the names and addresses of the physicians or hospitals that generated medical information VA used to rate the beneficiary incompetent. 20 DATE OF EXAMINATION Enter the date of the medical examination VA used to rate the beneficiary incompetent. 21 DIAGNOSES Enter the beneficiary’s medical diagnosis, specifically as it relates to his or her mental condition. 22 DATE OF RATING OF INCOMPETENCY Enter the date of VA’s rating of incompetence. 23 NAME AND ADDRESS OF PERSON, RECOGNIZED ATTORNEY, SERVICE REPRESENTATIVE OR COOPERATING AGENCY PROSECUTING CLAIM OR CORRESPONDING IN BEHALF OF MINOR OR INCOMPETENT the identity of the beneficiary’s power of attorney, or other legal representative recognized by VA.
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