Aid And Attendance, criteria and testing Options

[sixthscents]

Yeah, my situation is that I need 24/7 care and the HBPC doesn't provide it. We did an intake and they essentially said that I needed a greater level of care than they provided.

So, the A&A route is best for me right now for the reasons I stated.

Thanks to all. I am expecting an answer from them fairly quickly, so we will see what they decide probably this month.

[Pete53]

Morgan:

Thank you and I am glad that the VA is treating your Vet like they should.

[Brandy]

Hello Bob,

Just like you, I have not been here at hadit for a while. I am very sorry to hear about your additional health issues. You were such a big help to me in working on my husband's claim. I had forwarded you information on the decision from the VA and I just wanted to mention that we did not complete the below mentioned form for Housebound Status and we did not request to be considered for it, but the VA awarded it to my husband. As you may remember this was a complete surprise to all of us. They awarded this but denied some obvious SC disabilities.

"VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, should be completed in response to the examination request."


If I can help you with anything please don't hesitate to contact me.


Brenda

[Guest_morgan_*GuestMember]

I knew nothing about the HBPC until I came across a doctor with the VA in Washington and told him about my husband's poor care at the VA clinic. He was sincerely concerned and got on the phone and in short order guided me to the home-based care. My husband has been in the program for almost three years, and now his HBPC is staffed with geriatric specialists. His geriatric nurse told us last week when she brought his cancer treatment that the VA is implementing changes to do even better things for homebound geriatric patients. The changes are expected in February.

HBPC is even monitoring my husband's warfarin every two weeks with a new finger-stick gadget that gives instant results so we know right away whether we need to make medication adjustments. Warfarin is a dangerous drug that is not monitored very well in the VA system. The order for his labs goes through a new VA anticoagulation clinic and the pharmacist calls me after every lab result to ensure that we have the right dose of medication going. I can hardly believe this kind of care is coming from the VA.

We were told that home nurses can come more often under Medicare if the doctor orders it, and the VA HBPC told us to let them know if he needs more visits. Of course, it doesn't cost the VA anything, but we are grateful that HBPC is cooperative with calling in orders when he needs it. One of my husband's private doctors ordered a nurse three times a week and another ordered daily. We thought three times a week was sufficient, as I am able to be with him 24/7, and we let them know that. They said if anything changed they could increase it to the daily visits. At one time, he had nurses and phys. therapists twice a day. All of that was paid by Medicare, no co-pays at all. So check with your veteran's doctor and ask for an increase in the number of visits if you think that would help.

We changed home health companies many times until we found the one we have now. They are excellent--some we've had were idiots. Don't hesitate to change providers for home health if they aren't doing a good job. One of my husband's private doctors told us that home health services directly affiliated with a good hospital is usually best. It defintely has been that way for us.

Sorry about going on and on. Just know that I wish you the best in helping this veteran. If I can help in ANY way, let me know.

[Guest_morgan_*GuestMember]

I'm not sure which post I replying to, as I lost track of the original question. I'll keep this directed toward the excerpt:


The only problem is that he is no longer able to come to the VA Clinic for his VA PCP to see him. He is unable to leave the house. Can the VA come to his house to document his disabilities? It is very risky to try to get him in the car. He has fallen 5 times in the last 6 months, broke his back, etc. One time, he fell on my Aunt and almost broke her hip. Its a bad situation and not going to get any better.... only worse. (IMG:http://www.hadit.com/forums/style_emoticons/default/unsure.gif) I will go for the highest possible SMC assistance and make the worst-case write-up and see what happens. Currently, he has not even made application or a claim for A&A, yet, but will bypass that and go for the highest SMC assistance. The VA can determine it from there. All his recent hospitalizations (3) in past 4 months are in his VA electronic patient file to include his emergency care at the private Lakeland hospital that was paid for under VA Fee Services (Basis).

At the Lakeland VA Clinic, the Social Worker has been some help. But, getting in to see his VA-PCP is a problem, not only for him, but also just making an appointment that might be 2 or 3 months out. Again, he's really not capable of coming to the clinic, anymore, too risky, and his legs/feet will no longer facilitate walking for him. He used a walker, but now cannot even use it...... so....... ??????




You need to check into VA's Home-Based Primary Care (HBPC). This program was implemented for veterans who are so severely disabled that he or she has great difficulty receiving primary care in the outpatient setting. If HBPC is available in his area, he also needs to enroll in the Health Buddy system which uses a simple telecommunications device for daily tracking vitals and other disease management. Once admitted to HBPC, the veteran or a caregiver will have a direct phone number to a nurse practitioner/care coordinator who can adjust medications or make other changes to help manage conditions in a more timely manner. My husband is in this program and it's a huge help for him (and me) to have the nurse practitioners coming to our home for primary care appointments. They also coordinate with home health provided by Medicare for labs and more extensive skilled care. Of course, all of this is documented in his VA electronic medical record, the same as it is with outpatient services.

The veteran might also be eligible for the adaptive housing grant ($50,000, if not already changed to $60,000) due to "preclusion of locomotion without the aid of a wheelchair, walker, or canes." Based on info discussed, I also think he could get SMC-R1 or R2. These levels are rare, but I think that's because many veterans don't even know about them. And reading the regs is not the simple solution to find out, as I've found that section is the most convoluted and contradictory of all VA regs.

I think this veteran should request that his claim be expedited due to his advanced age and severe condition. I agree with the comment that when one veteran goes ahead of another, that means someone loses their place; however, in the case of a terminal illness or advanced age with severe disabilities, then I think rushing (VA version of "rush") is appropriate. JMO. To me, it's sad that many older veterans didn't know early on that they were eligible for benefits. Had they known, they would have been in line long ago. Fortunately, the VA is making an effort to better inform veterans now.

This post has been edited by morgan: Nov 28 2007, 01:34 AM

[sixthscents]

Do you have loss of control of both bladder and bowel?

Yep

I remember you saying something earlier about having to use an in-dwelling catheter,

I do as well as self-cat 5-7 times per doctors orders - with assistance. I csnt keep the indwelling in for more then 7-8 hours at a time. I am allergic to latex, and apparently the VA only has formulary latex foley catheters... go figure.


which certainly helps to support an R-2 level claim. Keep in mind that impaction is every bit as relevant as incontinence under these circumstances.

If you do not have the loss of bowel control, you can still reach "O" if your need for A&A is found to be due to your complications of IVDS under 38 CFR 3.350(e)(ii) and the combinations provision.

Yeah, this is exactly the things I needed to know. The C&P did a IVDS rating section and attributed the changes to its worsening... it's in the stuff I pasted below, just look for the header with IVDS in it.

KILLER I am weak on M21-1 compared to CFR 38 again exactly what I was looking for

The VA manual provision on this topic is found in M21-1 MR, Part IV, Subpart ii, Chapter 2, Section H, Subsection 45. This subsection provides:

A statement from a licensed health care professional, who provides or supervises daily skilled health care on a continuing basis in the veteran’s home, is a prerequisite to establishing entitlement to a higher A&A allowance.

We provided, and I am sending a copy to rater as additional information of a formal care plan. Prepared by my sister who is an RN and director of nursing, as well as my other sister an LPN.. (lots o nurses in the family) Included are copies of their licensure etc.

The statement must indicate the

• conditions justifying the need for this level of care
• nature, extent, and frequency of the services provided, and
• nature and extent of the supervision being provided, if the services are actually provided by a nonprofessional.

Once this statement is provided, they are directed to:

Request an immediate examination via the Automated Medical Information Exchange (AMIE)/Compensation and Pension Records Interchange (CAPRI) or Veterans Examination Request Information System (VERIS).

They already did this, (see pasted C&P below) so I bet the Primary care physicians statement which was "this man needs 24/7 care or nursing home" basically was strong enough,maybe it combined with my application sufficed... in any case I am forewarding the care plan again myself.

VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, should be completed in response to the examination request.

I dont know if this has been done and no one has my POA. How can I find out, besides calling the 1-800 number? Send a letter asking maybe?

The examiner will certify whether an ongoing daily need for skilled personal care is indicated by completing Item 32 of the form.

They had me do a mental C&P as well... I wonder how this impacts...Note: Provide a copy of the statement submitted by the licensed healthcare provider to the examiner.

Based on those findings, they are directed to:

Does the examination report show an ongoing need for skilled personal care?

• If yes, grant entitlement to the higher A&A allowance under 38 U.S.C. 1114®(2).
• If no, prepare a rating decision, denying the claim.
The reason I have posted this information is that it may explain the process which you have been going through. Based on what you are saying has been endorsed in those reports, it sounds to me like you should be good to go.

One thing though, I'd have your POA (if you have one) check and see if the VA examiner completed the VA Form 21-2680 or they completed just a basic A&A examination. I'm sure you have been through the CFR already and are aware of the regulatory requirements for the higher level of A&A, but I wouldn't anticipate that your representative is going to be familiar with this situation since these claims are so rare. Paralyzed Veterans of America has the best training when it comes to SMC, so it might be in your interest to seek representation by them if things don't turn out in your favor.

Thanks and if necessary I will, but to this point the VA has done a good job with all my claims. I handled them without a rep, because a rep for AmVets really tried to shaft me.. so I have handled my claims myself all the way thru... I may contact PVA if things get hinky... but Im just keeping my fingers crossed right now.

Hope this helps.

It helped a great deal and was exactly what I was looking for... if you have any other info please feel free to comment...

Thank you...
Bob Smith

[sixthscents]

I am a little confused here-

I thought A & A and the "S" Housebound award are technically included in the SMC "L" award-

???

Yeah it is, actually it is a much larger payment (at L rate) than at "s" - housebound. In my case though I am bedridden... with a need for constant A/A... which is also known as SMC. SMC and Aid and Attendance are really just the same thing. I know you know that, but just wanted to clairify. R1 and R2 as you point out in your later post are "special"... they are DRASTICALLY higher... but trust me, I'm going out of pocket for 24/7 care right now and it's incredibly expensive. Now I COULD go thru Medicare and get someone in here tomorrow practically BUT...

1. I wouldn't get to pick and choose my care providers, and a LOT of the in-home care nurses have... issues (not all) but many. We have dealt with them and my mother in law so I have seen who they send.
2. They would not provide a driver, or allow their staff to drive me to appointments etc. even in my own vehicle.. again I know this because we are dealing with this with my in-law.
3. They would only do minimal housekeeping... minimal food preperation etc. They will only do what they are assigned to do, not what I ask or tell them to do.

I can go on and on, but to be honest, it's either the VA ponies up, or I go into a nursing home. I'm not bringing some of the people they send to care for my in-law into MY home with MY 8 year old... I dont trust them. So many are habitual prescription pain med addicted it's not even funny... we have run into 3 CNA's so far who were dipping into the in-laws meds...

anyway.. you right, but this is a special circumstance are rare in the VA system.

[theotherguy]

Do you have loss of control of both bladder and bowel? I remember you saying something earlier about having to use an in-dwelling catheter, which certainly helps to support an R-2 level claim. Keep in mind that impaction is every bit as relevant as incontinence under these circumstances. If you do not have the loss of bowel control, you can still reach "O" if your need for A&A is found to be due to your complications of IVDS under 38 CFR 3.350(e)(ii) and the combinations provision.

The VA manual provision on this topic is found in M21-1 MR, Part IV, Subpart ii, Chapter 2, Section H, Subsection 45. This subsection provides:

A statement from a licensed health care professional, who provides or supervises daily skilled health care on a continuing basis in the veteran’s home, is a prerequisite to establishing entitlement to a higher A&A allowance.

The statement must indicate the

• conditions justifying the need for this level of care
• nature, extent, and frequency of the services provided, and
• nature and extent of the supervision being provided, if the services are actually provided by a nonprofessional.

Once this statement is provided, they are directed to:

Request an immediate examination via the Automated Medical Information Exchange (AMIE)/Compensation and Pension Records Interchange (CAPRI) or Veterans Examination Request Information System (VERIS).

VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, should be completed in response to the examination request.

The examiner will certify whether an ongoing daily need for skilled personal care is indicated by completing Item 32 of the form.

Note: Provide a copy of the statement submitted by the licensed healthcare provider to the examiner.

Based on those findings, they are directed to:

Does the examination report show an ongoing need for skilled personal care?

• If yes, grant entitlement to the higher A&A allowance under 38 U.S.C. 1114®(2).
• If no, prepare a rating decision, denying the claim.


The reason I have posted this information is that it may explain the process which you have been going through. Based on what you are saying has been endorsed in those reports, it sounds to me like you should be good to go.

One thing though, I'd have your POA (if you have one) check and see if the VA examiner completed the VA Form 21-2680 or they completed just a basic A&A examination. I'm sure you have been through the CFR already and are aware of the regulatory requirements for the higher level of A&A, but I wouldn't anticipate that your representative is going to be familiar with this situation since these claims are so rare. Paralyzed Veterans of America has the best training when it comes to SMC, so it might be in your interest to seek representation by them if things don't turn out in your favor.

Hope this helps.

This post has been edited by theotherguy: Nov 26 2007, 09:01 PM

[sixthscents]

Sorry for not getting back to you in a more timely manner. I'm glad to see that you have a handle on things and frankly understand that getting to "O" or "N 1/2 + K" is a requirement for you to be evaluated at "R-1." If your impairments are related to your IVDS getting this level of SMC should not be problematic if the evidence is how you have described it. Basically, if you need A&A at even the basic level and are at "O" or "N 1/2 + K" you will be bumped up to R-1.

To reach "R-2" the VA has a requirement that a higher level of care must be certified. I know that there is more information available on this in their M21-1 MR and I will do some more research and get back to you tonight.

theotherguy

Thanks, yeah I understand the prerequisite requirements, and under what I can see I meet or exceed them. Also this C&P "seems" to support the need for A/A at R1. I spoke again with my PCP, and go tomorrow to see another PCP in the same clinic to be relooked and have him write a second opinion that should match hers... a supporting secondary opinion form another VA doc (she thought it might be a good idea, and I thought it couldn't hurt). The visit is a formality since she has already discussed the case and he agreed to review it, and add supporting documentation... but he wanted to physically see me before he wrote that I was bedrideen, needing 24/7 care etc. I can totally understand that, but the doc appointments are getting out of hand it seems.

Like I said I am currently rated at L 1/2... so there's a bunch of stuff that goes in, but hopefully the rater will see that I am rated for loss of use of lower limbs, and with the incontinence catch the "o" rating... not discounting the ED (3 limbs and other stuff)

I just really wanted someone to look at all of this and see if the could see a problem or something I had missed. I have never handled an R1 or R2 claim, and it figures that the first would be my own....

Anyway, any opiniion or help would be greatly appreciated.

[theotherguy]

the vet meets the maximum or a rate equal to the "O" award.and

Actually this is a bit vague in CFR 38... but I, with my new problems qualify for "o" simply by having loss of use of 2 limbs and incontinence/loss of bladder and bowel... this is grounds for automatically awarding a rate of o.

Thats not even taking into consideration the loss of 3 extremeties now (which entitles to the next higher stuatory rate M in my case, and the schedular rating for incontinence, as well as the other stuff. Inceased loss of function I guess they'll cover under IVDS... not sure.

The biggy here is that my primary care doc, and this C&P doc both "seem" to agree that its needed... I just havent dealt with it before and am worried since I am going out tons of money each month on this. It simply a matter of them either providing it or a nursing home - thats it.

Thanks for the input.

Sorry for not getting back to you in a more timely manner. I'm glad to see that you have a handle on things and frankly understand that getting to "O" or "N 1/2 + K" is a requirement for you to be evaluated at "R-1." If your impairments are related to your IVDS getting this level of SMC should not be problematic if the evidence is how you have described it. Basically, if you need A&A at even the basic level and are at "O" or "N 1/2 + K" you will be bumped up to R-1.

To reach "R-2" the VA has a requirement that a higher level of care must be certified. I know that there is more information available on this in their M21-1 MR and I will do some more research and get back to you tonight.

theotherguy

[sixthscents]

Honestly, I think that the time frame is simply dependent upon where you live and the case load of the raters. If you live in a state with few military installations, then it seems your claim is handled much more quickly than in a state with a lot of bases. More bases means more vets in that area, means more time for a rating...

I think it is that simple. You can try and get them to move quicker on a case, but that normally requires some congressional interest.. and that doesn't always do it.

I think you Uncle is probably very eligable for some level of A/A... and I'd certainly file for it. Further, it sounds like he qualifies for adaptive vehicle grant, so he CAN go to his doctor... and probably a wheelchair.

Now.. make sure your uncle is not a pensioned vetrean but a compensated one... since you said he was rated at 100% or greater I assumed this, but make sure in any case because the rules DO change for pensioners, versus compesationed veterans.

Like I said I posted the C&P because I wanted some expert opinion, like Vike or some others. Sadly I have discovered that most of them no longer post on Hadit. Obviously some things happened while I was gone. I have discussed the issue with some of them and know some of their reasons.....

(sigh)... thats enough computer for me today. Thanks all.

[sixthscents]

The highest levels of SMC are- R-1 and R-2-

this might be a little off the main topic but it pays to explain these levels-

R-1 (aka Special Aid and Attendance)
Requirments for award:

1. the veterans is receiving the maximum rate or an equal rate to the "O" award and

2. the veteran meets the basic eligibility for regular A & A.

In my particular case I think they are going to HAVE to approve "o" rate because of the loss of use of 2 limbs and incontinence... this is think though, not know but thats what cfr 38 says... plus there's all the other junk... ED so now missing 3 appendages... periods of disorientation - disconnected or disorganized thought (meds probably - heck hopefully)


R-1 6164 per month for single vet no dependents

R-2 Special Aid and Attendance at a Higher Level of Care

Requirements for award:

1. the vet meets the maximum or a rate equal to the "O" award.and

2. the vet meets the requirements of regular Aid and attendance criteria
and

3.the vet needs a higher level of care as defined within 38 CFR 3.352((IMG:http://www.hadit.com/forums/style_emoticons/default/cool.gif) (2)

these involve needing the services of daily care provided by a licensed health care professional or by someone directly under supervision of a licenced health care professional.

The R-2 rate is $7,070 per month for single veteran-

RNs or LPNs etc are licensed professionals- this could involve the need for daily injections, catheter inplacements, changing of sterile dressings , physical therapy---etc

I fall in here for several reason, I have a foley catheter (indwelling in other words), I also "straight" cat 5-7 times a day if not wearing foley. physical therapy as well, but they are having a bit of trouble deciding WHAT physical therapy I CAN do... pads have to be changed as well as other... protective garments (what a world we live in huh?)... thats not skilled though... meds are though, I have massive narcotices, and a massive amount of other meds that I simply cant keep track of... there are just too many now. I am borderline type II diabetes as well, and hypertension, etc etc etc... lets just say if I go into a nursing home it will HAVE to be under a "skilled" care bed

[sixthscents]

[quote name='1968 Nam Vet' date='Nov 22 2007, 08:35 PM' post='68664']
How do you apply for SMC?

Like anything else you send a letter stating that you are requesting compensation for... and would further like to request an evaluation for increased SMC. Give the details of his situation.. i.e. falling, heart condition etc.

Yes a letter from SOME doctor anyway, requesting consideration of SMC for bedridden, or whatever is normally the first thing required to start a claim. As I stated my PCP (VA) wrote a consult with home health, hiospice care stating that either I would need 24/7 care or admission into a nursing care facility for the following reasons.... etc. The VA does NOT provide home health care 24/7... trust me, I spoke with their care coordinator. It's not even a program they offer... only hospice, or skilled short term care. So SMC is the ONLY route except for admittal to a nursing facility.

I suppose you could fill out a claim form but I never have for any other claim, so I doubt this is any different, and I've done hundreds. A clear, consice letter is sufficient stating WHAT you are claiming and why... and then attaching all necessary evidence in support. It's is no different than filing any other claim.

You can always try to get some senator to get the claim pushed to the top of the stack (at that point it normally falls off the stack, lands on the floor and is forgotten - but hey why not try huh?) (sigh)... I cant really answer this because its really dependent upon too many issues, and honestly pisses me off since I'm in the same freakin stack.

It takes how long the VA takes. Depressing but true. Lets see I filed my stuff in July.... and unless the rater wants MORE c&p stuff.. well I expect something by January sometime... or Feb, March... heck who knows.... honestly I do expect something within the next 60 days unless they want more C&P exams... well see, if they dont than thats what 6-7 months? I'd say thats fast too. Id normally give the VA 10 months or so for an additional claim.

I dont mean to be depressing, but... I am kinda burned out now. Personally my own money is on me going into a nursing home... but you never know. If your uncle says no, well that's on him isn't it? For crying out loud I'm 40 with a 8 year old daughter.. do you think I want to go into a nursing home?..... Your uncle is 92... his wife is 88, mines 38... how long do you think she will stay MY wife HUH?

I am putting out roughly $3K a MONTH (and thank God... honestly, thank you God... that I CAN) paying out of pocket for my care... without even a freakin nurse to come and bath me... except for the ones I pay for... (I cant do this forever though... eventually It will affect our savings etc... my daughters college money, our land and assets... nope at that point it stops and I go into a nursing home... no matter how much my family objects, my daughters college is too important and she doesn't see daddy all that much now anyway since I am either stoned in bed, or at a doctors appointment and I cant deal with watching her watch me come unglued, co if no answer by say March, you all will not hear from me until I can get DSL installed in my room in Overton County Nursing Home, or tap into their system.. doubtful)

The real funny thing here is that if the VA refuses my claim they are going to pay out the nose for "skilled" care in a contract facility run by my sister. And they dont have much they CAN say about that.... except to say they want me in another facility instead, and even then they are on shakey ground. My sister's facility just went thru their annual check by the VA and passed with flying colors...

So, file the stuff for your uncle but dont expect any answer SOON, and being housebound is NOT enopugh to qualify for R1 or R2... even bedridden at their own choice, or under doctors orders for healing is a no-go... like I said read CFR 38 3.350-3.362. So while I feel some empathy.. tell him he can room with me.

I mean you lookes at the C&P right? I odnt know what the lady could have said more to support my claim... and my PCP (VA) is saying the exact same stuff. That's why I posted it... I wanted an experts opinion on it, like Vike.... or someone who had dealt with it before, because I THINK that C&P was great, but it's only what I think....

The simple truth here dude, is sometime we just dont get to pick and choose. Your uncle is 92... he's had a long and fruitful life. If he has to go into a home, well at least he can say that. File the claim, and maybe they'll approve it, and maybe not but at least you tried.

Again though... and for the last time

IT is NOT income based, in any way shape or form. It's supposed to be based upon need. It is INTENDED to SAVE the VA money, as compared to a nursing home. You would think they would jump at the chance. I'll let you know how my stuff goes, but I am only able to do the computer for short periods...

If this came out sarcastic, and uncaring I am sorry.... it's just that to get rushed treatment means SOMEONE gets slower treatment... and on this subject I am inexperienced. Ask me about any other tyoe of claim and I can go on for days, but this ine is new to me (R1-R2 that is).....

It's like this issue of priority care for the new war vets... that means us older vets get less priority.. even if we are rated massivly higher %'s.... to me that's simply unfair.

Your uncle should qualify for some level of SMC, even if its not R1 or R2.... heck if he really is rated at 170% for differing conditions... read 3.350 "other 50% ratings" he should qualify for some... an "s' rating is housebound and thats approved at 100%+60%... of different etiology - like I said.. read the reg.

Bob Smith

This post has been edited by sixthscents: Nov 23 2007, 12:13 AM

[sixthscents]

I need some info on this subject; I'm totally confused. I seemed to have been misled by a VSO in that he said it is based on personal finacial income. WOW, I even called the VA 1-800 number and they said the same. (IMG:http://www.hadit.com/forums/style_emoticons/default/blink.gif)

I have the 2006 VBM.... and can't get definitive info on basis for financial data. But, I did read it in the VA Benefits Manual, 2007. Thus, we were discouraged to file a claim for it and did not do so. My Aunt and Uncle paid zero ($0.00) income tax for the past 3 years because of their low income.

HELP, pls....

Again.. icome is NOT a factor in A/A or SMC... period. I am certain of that. SMC is based upon need established by loss of use etc. Not income, nor does income play a deciding factor in eligability... only the rquirement outlined in CFR38.

[sixthscents]

the vet meets the maximum or a rate equal to the "O" award.and

Actually this is a bit vague in CFR 38... but I, with my new problems qualify for "o" simply by having loss of use of 2 limbs and incontinence/loss of bladder and bowel... this is grounds for automatically awarding a rate of o.

Thats not even taking into consideration the loss of 3 extremeties now (which entitles to the next higher stuatory rate M in my case, and the schedular rating for incontinence, as well as the other stuff. Inceased loss of function I guess they'll cover under IVDS... not sure.

The biggy here is that my primary care doc, and this C&P doc both "seem" to agree that its needed... I just havent dealt with it before and am worried since I am going out tons of money each month on this. It simply a matter of them either providing it or a nursing home - thats it.

Thanks for the input.

This post has been edited by sixthscents: Nov 22 2007, 01:42 PM

[sixthscents]

I am a little confused here-

I thought A & A and the "S" Housebound award are technically included in the SMC "L" award-

???

Yes they are but I am not really filing for "housebound" I am filing for bedridden, with need of increased assistance. So, since my current L 1/2 is greater than "s" I am diling for R1.-R2... which require a whole bunch more than housebound... basically 24-7 care is reqiuired by either skilled or "unskilled" care providers depending upon the level of care necessary...

[Berta]

The highest levels of SMC are- R-1 and R-2-

this might be a little off the main topic but it pays to explain these levels-

R-1 (aka Special Aid and Attendance)
Requirments for award:

1. the veterans is receiving the maximum rate or an equal rate to the "O" award and

2. the veteran meets the basic eligibility for regular A & A.

R-1 6164 per month for single vet no dependents

R-2 Special Aid and Attendance at a Higher Level of Care

Requirements for award:

1. the vet meets the maximum or a rate equal to the "O" award.and

2. the vet meets the requirements of regular Aid and attendance criteria
and

3.the vet needs a higher level of care as defined within 38 CFR 3.352((IMG:http://www.hadit.com/forums/style_emoticons/default/cool.gif) (2)

these involve needing the services of daily care provided by a licensed health care professional or by someone directly under supervision of a licenced health care professional.

The R-2 rate is $7,070 per month for single veteran-

RNs or LPNs etc are licensed professionals- this could involve the need for daily injections, catheter inplacements, changing of sterile dressings , physical therapy---etc

[Berta]

I am a little confused here-

I thought A & A and the "S" Housebound award are technically included in the SMC "L" award-

???

[sixthscents]

100% T&P loss of use foot bilateral
40% IVDS
30% Lumbar Spine - w/ radiculapathy
30% Mood disorder - depression
10% Cervical spine
10% Scar residuals
10% Tinnitus
10% peripheral neuropathy - bilateral arms/hands

There's a ton more but I dont have MY file in front of me.... anyway I am currently L1/2 rate SMC...

The C&P exam is like 17 pages long... I'd rather not paste it, but I can include it as an attachment.... I'll just send the diagnosis pages first tho.... well I boiled it down to 11 pages anyway... the rest was testing and a pilonodial cyst...etc.

This post has been edited by sixthscents: Nov 21 2007, 05:36 PM

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[theotherguy]

sixthcents,

I might be able to help you if you can give me some additional information. Can you give me a breakdown of your current service-connected disabilities with the evaluations along with your current level SMC? Sorry to make you post this again if you have posted it sometime before, I have not been here as often as I had in the past.

[sixthscents]

Aid and Attendance is not income based. The ONLY instance where it might be is for a pensioner instead of a compensation veteran...

There is NO means test for aid and attendance. Please if ANYONE can show me where SMC is rated based upon income... well I'd like to see it. It's NOT, unless the veteran is a pensioner... and even then I dont think it is, but I'll check.

The qualifying criteria for A/A is set out in CFR 38 3.350 thru 3.363, this is established by 38 USC 1114, and in NO way is income a consideration foir qualification for a veteran who receives compensation... maybe pension recepients but not regular comp recepient.

So in short, your VSO was wrong.

http://straylight.law.cornell.edu/uscode/h...14----000-.html

Thats a link to the law... and in no place ther does it say SMC is based on income... because it is not... it is paid for special loss, like the loss of a foot etc. or special needs INCURRED due to that special loss.

Please show me where you were able to see something that stated otherwise.

By the way, I have a household income in the low six figures, from investments, Social Security, VA Comp and other resources... and I receive A/A or SMC at an L1/2 rate, and will probably get R1 or R2 shortly.

This post has been edited by sixthscents: Nov 20 2007, 05:35 PM

[Stretch]

Sixth, there is nothing that we can do about changing the attitudes for formerly snubbed Vets. I have tried smooth approach and even mentioned money that could be gained. They just don't care about the VA. Bill, isn't even going to last long enough to go through it anyway.

My C&P is tomorrow. Thanks for the information and the time you spent getting it.

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[sixthscents]

Streach...
I am personally sorry that this has happened. Yeah the VA raters sometimes are just idiots... not all but some. I am trying to be fair because I have met some really decent ones.... but I gotta say they are not the majority. I already ranted today about this... so all I can say is... I'm sorry. I wish it were different.

[sixthscents]

OK I went to the psych C&P today and pulled the records dating back to the last C&P to see what was actually said. I'll fill you all in but I want to answer some questions first.

OK SMC is Special Monthly Compensation - Aid and Attendance is PART of SMC... it is, for all intents and purposes just another name for SMC. The requirements to qualify for the different rates of SMC are covered in CFR 38 section 3.350-3.352. A simple search will pull up these pertinent sections, SMC is also covered in section 4 (Schedule for Rating Disabilities) under CFR 38....

SMC is money in ADDITION to compensation that is paid for aid and attendance of an individual. It is supposed to cover things like a person to help clean, a person to help cook, etc. It ALSO goes even further and if the veteran qualifies it will pay for full time care, R1 being essentially CNA's or just people hired who are following an established care plan by a licensed individual (primary care physician, nurse etc.... mostly nurses write care plans) R2 provides even greater funding for skilled care (LPN's and CNA's) who are there to provide wound care, injections, insertion and removal of catheters etc.

If you look up the compensation tables at www.va.gov, you will see a section below compensation labeled SMC... this is the rate one is paid if they qualify for SMC at the various levels. Again, a great many things go into determining each claim and the level of SMC they qualify for.

Now in paticular, in answer to the the person whos father is a vet with compensation etc. I would file for SMC and see what they came out with. It is important to note that if the SPOUSE of a veteran is also disabled (like say receiving Social Security Disability - or had prior to age 65) then there is additional funds paid... they list this fact at the bottom of the SMC chart and show how much extra, its not much but its something.

Financial Income has NO bearing on a veteran who is receiving compensation at the rate you described... or at any rate. It is not means based for vets who receive compensation, it is based upon the mad qualifying factors laid out in CFR 38 3.350-3.352 and the VASRD.

Honestly read the sections and the qualifying factors.... by what you say I would think that your father would qualify for SMC at an R1 or R2 rate... but it all depends on the primary care physician and what they say, the C&P doc, and what THEY say, and how the Rater interprets this information.

Personally after reviewing the statements made by MY C&P doctor, she was just as great as I thought. Based upon what she stated as fact, and what my primary care stated as fact... I feel comfortable that if the rater even has one wheel on the ground I'll get R1 at least. The C&P rater stated that I required assistance with everything, from walking to cooking, to well everything except eating... every other category she put requires assistance. She noted the muscle spasms, the loss of feeling and complete (almost) loss of streangth. She stated that I would be permanently bedridden for the rest of my life. While this fact does NOT fill me with joy and happiness, the idea that I might get some assistance in paying for my CNA's is really great. If we had not been financially very stable prior to this, well I dont know what we would have done. As it is, its like pouring money out a boot every week paying for these baby-sitters out of pocket. Again, hopefully they will back pay me.... I can dream right?

Now, you asked what are the differing requirements between R1 and R2... from what I can see one is care by cna's or lessor qualifications simply following an established care plan, with periodic follow-ups with the case manager (telephone monthly is fine)... R2 on the other hand is "skilled" care where the care givers need to be a little higer certified CNA's LPN's etc to do the necessary functions... like injections, rehab therapy, wound crae, etc...

So, it all boils down to the level of care the VA deteramines is necessary for the individual, and how much....

The rating tables for SMC start at K (I dont know why they didnt start at A, but K it is) an thats like only an additional $90 dollars ($87 i think) that goes on top of a veterans normal compensation... the rates then go L,M,N,O/P R1,R2, and S... plus there are half-rates... so there is an L1/2 rate, and an M1/2 rate... this does NOT include R1, R2 or S... there is no R1 1/2 rate. As the rateings go up the money significantly increases... hang on Ill cut and paste ONE section...

This is ONE section of the SMC rate table...

--------------------------------------------------------------------------------

Without Children, SMC-L through SMC-N

Dependent Status L L½ M M½ N
Veteran Alone $3,075 $3,233 $3,392 $3,626 $3,860
Veteran with Spouse $3,214 $3,372 $3,531 $3,765 $3,999
Veteran with Spouse and One Parent $3,326 $3,484 $3,643 $3,877 $4,111
Veteran with Spouse and Two Parents $3,438 $3,596 $3,755 $3,989 $4,223
Veteran with One Parent $3,187 $3,345 $3,504 $3,738 $3,972
Veteran with Two Parents $3,299 $3,457 $3,616 $3,850 $4,084
Additional A/A spouse. See footnote ((IMG:http://www.hadit.com/forums/style_emoticons/default/cool.gif) $126 $126 $126 $126 $126

Normal Compensation table with the same qualifiers...

70% - 100% Without Children

Dependent Status 70% 80% 90% 100%
Veteran Alone $1,135 $1,319 $1,483 $2,471
Veteran with Spouse Only $1,232 $1,430 $1,608 $2,610
Veteran with Spouse & One Parent $1,310 $1,519 $1,708 $2,722
Veteran with Spouse and Two Parents $1,388 $1,608 $1,808 $2,834
Veteran with One Parent $1,213 $1,408 $1,583 $2,583
Veteran with Two Parents $1,291 $1,497 $1,683 $2,695
Additional for A/A spouse (see footnote (IMG:http://www.hadit.com/forums/style_emoticons/default/cool.gif) $88 $101 $113 $126


So in comparison a rate of N of SMC is $3,860, while simple comp at 100% rate is $2,471... that a difference of $1389. The veteran gets this 1389 in addition to the compensation rate.

PLEASE NOTE that you still get additional compensation for a disabled spouse under NORMAL compensation as well as SMC.....

Now the veteran can be rated at 10% comp, and get an additional SMC rating... its kinda improbable but a vet could get 10% comp and an SMC rating of say N, and get that additional $1389 paid on top of their 10%... not likely but possible I suppose.

OK so, I HOPE this helps explain SOME of the things about Aid and Attendance (also referred to as A/A) aka Special Monthly Compensation. You are going to have to do SOME of the research on your own because its just too much for me to type... please go to the references and read them. Then hit me with some questions...

Further, If a rater or ex-rater would like to chime in here and ask me what the doc and rater said and give me an idea if I'll get R1 or R2 I'd REALLY appreciate it. I think I know the deal, but it NEVER hurts to get expert opinion... and dont worry if you say I am completely wrong I am a big boy, and can admit error. I am just trying to make sure I am reading this stuff right in my own case...

OK... I can type no more... this is killing me.... sorry.

Bob Smith

[Stretch]

My father in-law was Army in WW2 and US Navy (Chief) in Korean war. Bill, had both his legs shot out from under him. Bill, has been sitting in a chair for the last 20 years. Bill, is 87(?) years old, and he is dying now (dead weight). He never was service connected, because he was put-off by the VA over the years with their redundant denial process.

All I need to get him AA, is his DD-214. My mother in-law is so torn up with resentment of the VA and Bill's condition that she will not/cannot even look for the record. This is the secondary reason and concern that I have for AA.

I think that there was discrimination against US Air Force and US Navy Vets years ago and now. Even though Bill was US Army in WW2, his last discharge was US Navy. Bill, worked as a cripple for many years before he became glued to his chair. The VA system, designed for discrimination of a class of Vets (US Navy, US Air Force), has caused so much resentment that these Vets have rejected the VA system and maybe even the misinformed Government that would let this happen.

Knowing what I know now, I try to help. Even mentioning the VA, only makes these past victims (family inclusive), of the litigious VA system, re-feel old wounds and pseudo dishonor presented to them by the VA.

DoD service Lifers, within the service who have intentions of loyalty to the DoD, tried to minimize, alter, and discard injury records that were service related in much the same way that the VA seems to lose or withhold the most vital records that are presented to them from injured Vets.

This disposal of injury records is premeditated and the Veteran left in the dark about the disposal not even thinking that this could or would happen until years latter (unwitting).

To see this VA problem, just look at and watch Haas vs. Nicholson.

Bill's wife, will not see a dime from the VA as she struggles trying to bath him, feed him, and the rest of what she has to do 24/7. To put that responsibility on a 75 year old woman is cruel. Evonne, has been doing this chore for about the last 10 years.

The mind set that a VA budget trumps the disabled conditions, to the detriment of any Vet, needs to be challenged. Ask Bill, to provide evidence. Bill, can't even talk. This would be chalked up as a win for the VA.

[john999]

I think as soon as my appeal for an EED for TDIU is decided I will apply for housebound. My diabetic neuropahty is making it hard for me to get around and I need help with many things.

[john999]

Nam Vet

Your Uncle in entitled to nursing home care at the VA or another nursing home if the VA is full. If he is bedridden it may be better for him to be in a good nursing home. He may not want to go but he may live longer under constant and watchful care.

[Stretch]

I found it. I had to pick up a google tool bar. Now I got to get rid of it. I have no idea what they are for but here are the ratings.

http://www.vba.va.gov/bln/21/Rates/comp0205.htm

[Stretch]

You Quoted me. I don't know. I do no that you can put it into the Hadit search engine and come up with an answer. Another alternative is to look at the VA web-site and look it up under compensation. I remember seeing it there about 4 years ago. I will dig it out for you now.

http://www.vba.va.gov/bln/21/index.htm

Half way.

[windy city]

Sixth, I admire your ability to put it all together. I don't see that you will have any problem. I know that your post request discussion from those that went through the process. I am in process and partially through it.

I have a C&P for A/A coming up next week. I have nothing to present except facts, in the now. I am home alone now, got dogs, but solitude seems to be good to focus on guitar. Think I will take my guitar to the C&P and play the song that I have been practicing for the last 6 months.

I can't keep up with the rascals. I know that the Practice Nurse, that will do the C&P, already has his agenda process to Deny. I know that the VA only gathers negative evidence for their side of the court battle. I am incapable of explaining medical, legal, and research for my claim anymore. I will go the long long legal route of getting a DC lawyer.

I just can't keep up with it anymore. I am interested to see if there will be response to your post request.

What is the difference between the a&a for r1 and r2 and also what are the requierments to meet the granting of the r1 and r2?

[Stretch]

Sixth, I admire your ability to put it all together. I don't see that you will have any problem. I know that your post request discussion from those that went through the process. I am in process and partially through it.

I have a C&P for A/A coming up next week. I have nothing to present except facts, in the now. I am home alone now, got dogs, but solitude seems to be good to focus on guitar. Think I will take my guitar to the C&P and play the song that I have been practicing for the last 6 months.

I can't keep up with the rascals. I know that the Practice Nurse, that will do the C&P, already has his agenda process to Deny. I know that the VA only gathers negative evidence for their side of the court battle. I am incapable of explaining medical, legal, and research for my claim anymore. I will go the long long legal route of getting a DC lawyer.

I just can't keep up with it anymore. I am interested to see if there will be response to your post request.

[john999]

That is an interesting idea since my feet and general pain condition are making me more and more housebound if not chairbound. I know the VBM has boilerplate language for a letter claiming housebound. The whole thing is hard for me to accept since I have an anxiety problem and now physical problems that are restricting my life and mobility.

[Guest_rickb054_*GuestMember]

When I requested housebound and or aid and attendance it was related to my back injury and use of oxygen due to sc copd. I wrote a letter as if I were my doctor and described my medical condition and justified aid and attandance. I then took this letter to my primary care doctor at the augusta va medical center. He had a clerk xerox the letter to va letterhead, and then he signed the letter as if he had wrote it. In additin he filled out the required va form for housbound/aid&attance. I submitted this information if Feb 2007 and I am still waiting a decision.

I got the idea of writing the letter myself from an article on the va watchdog. I was really surprised when the doctor agreed with my embleshment of my medical conditons and signed it. This worked great because I did not have to ask for and then wait for the letter, and since my primary care doctor had treated me for over a year he knew what I was saying was true, and it saved him time and effort becasue he did not have to dictate any letter.

So if any of you need a letter try what I did, depending on your doctor it should work.

[sixthscents]

Since I am undergoing this process for R2 or R1 (whichever they decide) I thought it might be a good idea to start a topic and discuss what others went thru to receive it....

Currently my VA Primary Care doctor has stated that I would require skilled care 24-7 at home, or a referral to a nursing home. I filed the claim stating that if they couldn't provide the necessary funding, or some sort of home healthcare providers.. well they would need to place me in a nursing facility.

They came back with this huge list of claims... I was actually shocked.

I wrote them back stating that no I was not attempting to claim this or that... (I thought that listing my claims 1-5 and printing them in bold would be clear enough).. and restated my case. I then went to the medical C&P, and a VERY nice doctor did the eval. I had my primary care person (a CNA I pay for myself) present, and my sister.. a director of nursing at the closest VA contract nursing home.. also an RN. We had a care plan, etc.... and I gotta say the doctor was really really incredible. Now you never know exactly what they type until you pull the record, but she said things like "I not going to check that... its obvious and isnt going to improve" etc. etc... She had a LONG list of things she was supposed to check though, and with my sister/RN and the CNA I am paying a fortune for... $12 hr... (sigh) she was able to answer them without asking me almost anything. I do know that for all the rotation questions she answered no rotation possible due to injury and pain... or at least most of them.

I didn't realize that the VA does not provide home health care except for short periods. This is looking to be a long term issue, and I am honestly debating going into a nursing home. The ONLY thing stopping me right now is my 8 year old daughter.... (sigh)

Anyway, they also set up a psych C&P... thats going to be a joke though, they have me in weekly counseling now so they should have a fairly clear picture with me walking-wheeling in, but I expect a million and one questions. Just me and the wife for this one though.

Like I said its an issue between R1 & R2... I wondered if anyone had any experience with the differences... the applicable reg is CFR 38 3.350 and 3.352, but they are a bit vague to be honest I meet all the critrea for both. Obviously for those who know me this is all new. I have been out of the loop for quite a while, and am only VERY slowly poking around again from my bed (hey it gave me an excuse to buy the 22 inch LCD monitor and wireless keyboard etc.).

Anyway... just wondering. I am classed as "skilled" care if I was in a nursing home... so I wonder if that would make a difference?

Mmmm... probably need to know the new injuries... rupture at L5-S1/L4-L5 L2-L3... incontinence/w indwelling catheter... major pain major muscle spasms constant... (the doctor actually saw and felt them - I thought that was a good thing)in legs and lower back. Loss of ability to balance, loss of memory (pain meds I guess) etc etc..... loss of streangth, mobility, inability to dress or put on ortho aplliances by myself, bath etc. The CNA cooks, cleans -lightly, etc. Rehab has written me off not Voc-rehab... rehab. They say until this is fixed or the muscle spasms reduced physical therapy will do more harm than good. They even annotated this into my records so as to make sure no one tries...

How did it happen? You got me. One day I was bad but stable (had been for 2-3 years)... next morning I woke up with this... go figure.

Anyway... opinions accepted.