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Clothing Allowance


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#1 luvHIM

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Posted 30 July 2009 - 06:06 PM

I was denied my clothing allowance by VAMC Prosthetics dept. Their reasoning makes no sense.

I am 100% TDIU/P&T. I wear a back brace and two knee braces, as well as use a neck brace. I also use a cane to assist with ambulation. But I applied based on the back and knee braces that were issued back in 2004/2005.

I use to get the CA and then got a letter saying it would be stopped back in 2006.

I reapplied after getting my new rating and am still being denied. How do I fight this? They say if I disagree with their decision to appeal. Well, last time I appealed the same dept handled the appeal. So, who would I appeal to in order to get an unbiased review of the claim?

#2 sharon

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Posted 30 July 2009 - 06:11 PM

Are you service connected for your back and knees?

#3 Philip Rogers

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Posted 30 July 2009 - 06:44 PM

If you are SC for back and knees, I'd file an appeal w/the prosthetics dept, in addition to filing for a second CA, for the knees, or back. Since they each wearout different clothing, you should be able to get two awards. I believe the appeal process is the same, as for standard comp claims.

pr


I was denied my clothing allowance by VAMC Prosthetics dept. Their reasoning makes no sense.

I am 100% TDIU/P&T. I wear a back brace and two knee braces, as well as use a neck brace. I also use a cane to assist with ambulation. But I applied based on the back and knee braces that were issued back in 2004/2005.

I use to get the CA and then got a letter saying it would be stopped back in 2006.

I reapplied after getting my new rating and am still being denied. How do I fight this? They say if I disagree with their decision to appeal. Well, last time I appealed the same dept handled the appeal. So, who would I appeal to in order to get an unbiased review of the claim?



#4 pete992

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Posted 30 July 2009 - 06:57 PM

If you don't mind can you post their reasons, what was your past clothing allowance approved for? Knee braces should not be a problem especially if you got an increase on them. What type of back brace and knee braces do you use?

#5 rentalguy1

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Posted 31 July 2009 - 09:22 AM

service connection does not matter when it comes to a clothing allowance. If it has been more than a couple of years since you've seen your docs about your braces or since you've received new braces from prosthetics, then you will likely be denied. The record would paint a picture that you are no longer wearing the braces, and therefore have no need for a clothing allowance. I typically wear out my knee braces about once per year, and my back brace takes a bit longer than that. I don't know how long my new AFO will last, though, since it's made out of carbon fiber.

#6 sharon

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Posted 31 July 2009 - 11:22 AM

§3.810 Clothing allowance.



(a) Except as provided in paragraph (d) of this section a veteran who has a service-connected disability, or a disability compensable under 38 U.S.C. 1151 as if it were service-connected, is entitled, upon application therefor, to an annual clothing allowance as specified in 38 U.S.C. 1162. The annual clothing allowance is payable in a lump sum, and the following eligibility criteria must also be satisfied:



(1) A VA examination or hospital or examination report from a facility specified in §3.326© discloses that the veteran wears or uses certain prosthetic or orthopedic appliances which tend to wear or tear clothing (including a wheelchair) because of such disability and such disability is the loss or loss of use of a hand or foot compensable at a rate specified in §3.350(a), (:angry:, ©, (d), of (f); or



(2) The Chief Medical Director or designee certifies that because of such disability a prosthetic or orthopedic appliance is worn or used which tends to wear or tear the veteran’s clothing, or that because of the use of a physician-prescribed medication for a skin condition which is due to the service-connected disability irreparable damage is done to the veteran’s outergarments. For the purposes of this paragraph “appliance” includes a wheelchair.



(:o Effective August 1, 1972, the initial lump sum clothing allowance is due and payable for veterans meeting the eligibility requirements of paragraph (a) of this section as of that date. Subsequent annual payments for those meeting the eligibility requirements of paragraphs (a) of this section will become due on the anniversary date thereafter, both as to initial claims and recurring payments under previously established entitlement.



© (1) Except as provided in paragraph ©(2) of this section, the application for clothing allowance must be filed within 1 year of the anniversary date (August 1) for which entitlement is initially established, otherwise, the application will be acceptable only to effect payment of the clothing allowance becoming due on any succeeding anniversary date for which entitlement is established, provided the application is filed within 1 year of such date. The 1-year period for filing application will include the anniversary date and terminate on July 31 of the following year.



(2) Where the initial determination of service connection for the qualifying disability is made subsequent to an anniversary date for which entitlement is established, the application for clothing allowance may be filed within 1 year from the date of notification to the veteran of such determination. (Authority: 38 U.S.C. 1162)



(d) If a veteran is incarcerated in a Federal, State, or local penal institution for a period of more than 60 days and is furnished clothing without charge by the institution, VA shall reduce the amount of the annual clothing allowance by 1/365th of the amount otherwise payable for each day the veteran was incarcerated during the 12-month period preceding the anniversary date for which entitlement is established. No reduction shall be made for the first 60 days of incarceration. (Authority: 38 U.S.C. 5313A)

#7 rentalguy1

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Posted 31 July 2009 - 02:55 PM

I stand corrected. What I meant to say was that a clothing allowance does not come from the VARO, and that a veteran's rating percentage does not matter. When the last prosthetic or orthotic piece of equipment was prescribed or replaced does matter a great deal, though. In other words, if you are sc'd at 0%, and got a replacement knee brace last year, then you would be able to get your clothing allowance. If you are a 100% P&T vet who has not had a new or replacement orhotic prescribed in the last 5 years, then you will not get a clothing allowance. The reason for this is because it would appear that you no longer wear the piece of equipment.

Thanks for posting the reg, Sharon.

#8 luvHIM

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Posted 31 July 2009 - 04:07 PM

Are you service connected for your back and knees?



Yes, my SC award is for chronic lumbosacral strain with ankylosing spondylitis, which effects the lumbar and periphal(splg ?) joints; and secondary fibromyalgia. My knees, neck and back have been put under the lumbosacral strain and AS.

I received the CA in 2004/2005. Then a new director came on board for the Prosth dept. and I have been denied every year since.

Pete...the reason shown is: The braces that were issued to you by this prosthetic department are designed to not cause wear and tear to the clothing, even when worn for an extensive amount of time. Therefore we must deny your claim for clothing allowance based on this reason.

That is bull crap. The first time I appealed they had me bring in my braces. I did that. I was still denied.

When I wear my knee braces they stretch out my sports pants at the knees. These type clothes are primarily what I wear, except to church. The back brace does cause wear and tear on my shirts/t-shirts.


I use an ointment because one of my medications causes me to break out from time to time.

But other than my wrists bands and cane...that's it. I guess I just don't understand why I got it two years straight and now I don't...for the same devices.

#9 luvHIM

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Posted 31 July 2009 - 04:17 PM

service connection does not matter when it comes to a clothing allowance. If it has been more than a couple of years since you've seen your docs about your braces or since you've received new braces from prosthetics, then you will likely be denied. The record would paint a picture that you are no longer wearing the braces, and therefore have no need for a clothing allowance. I typically wear out my knee braces about once per year, and my back brace takes a bit longer than that. I don't know how long my new AFO will last, though, since it's made out of carbon fiber.



I was just recently seen by Chief of Ortho for my knees and am being scheduled for surgery on my right knee.

I wear the back brace and also use the INF unit. I haven't requested a new back brace because it is not falling apart and my back condition requires me to wear the brace when I drive...sit for long periods...do grocery shopping, etc. I also receive other ortho and prosthetic deivices/equipment all the time.

The knee braces I use are designed to keep my knee stable because I have no cartilage in either knee. I have a chipped bone that is seen on xray exam that needs to be removed because it is actually causing me serious problems when I walk due to locking.

#10 sharon

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Posted 31 July 2009 - 04:18 PM

Write up a rebuttal and appeal the decision. They are wrong.

#11 pete992

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Posted 31 July 2009 - 04:54 PM

Does your braces have metal in them? Do they leave rust or stains on your clothes? You may need your PCP or your rheumatologist to write in your progress notes that your braces may causes damage to your clothes. Most likely they had a doctor to review your claim for clothing allowance an it was his/her opinion that it does not damage your clothes. You will need a doctor to say that it is possible that they can damage your clothes. You can also try to take them some of your clothes as proof. All situations are not normal it maybe that in normal situations that they may not damage your clothes but in your particular situation they do damage your clothes but it will be up to a doctor to decide if it is possible, you can only ask. If I am off someone else will chime in and correct me

#12 luvHIM

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Posted 01 August 2009 - 10:09 PM

Write up a rebuttal and appeal the decision. They are wrong.



Okay...will do...thanks!

Pete, my back brace has a metal rod insert that runs down the two sides (inside).

Edited by luvHIM, 01 August 2009 - 10:12 PM.


#13 luvHIM

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Posted 10 August 2009 - 01:07 PM

Write up a rebuttal and appeal the decision. They are wrong.



What should my rebuttal say? Couple of years back I did one and apparently it was not good enough because I was still denied.

#14 sharon

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Posted 10 August 2009 - 03:20 PM

What should my rebuttal say? Couple of years back I did one and apparently it was not good enough because I was still denied.


Have your doctor write a statment B)

#15 entropent

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Posted 10 August 2009 - 07:50 PM

Your denial stated, "The braces that were issued to you by this prosthetic department are designed to not cause wear and tear to the clothing, even when worn for an extensive amount of time. Therefore we must deny your claim for clothing allowance based on this reason."

Back when you were approved for the clothing allowance, the decision was still the responsibility of the RO. If the record showed that prosthetics issued some type of device for a service connected knee (for example), the rater would have no way to know if you were issued a simple elastic knee sleeve or a high speed unloader brace. He would therefore not be able to tell if the type of brace was designed not to cause wear and tear on the clothing, and would routinely approve the claim. VBA has now delegated the decision making authority to the prosthetics departments precisely because they are the ones who can make that determination. A lot fewer vets get clothing allowance now.

#16 deltaj

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Posted 31 August 2009 - 01:14 AM

I was denied my clothing allowance by VAMC Prosthetics dept. Their reasoning makes no sense.

I am 100% TDIU/P&T. I wear a back brace and two knee braces, as well as use a neck brace. I also use a cane to assist with ambulation. But I applied based on the back and knee braces that were issued back in 2004/2005.

I use to get the CA and then got a letter saying it would be stopped back in 2006.

I reapplied after getting my new rating and am still being denied. How do I fight this? They say if I disagree with their decision to appeal. Well, last time I appealed the same dept handled the appeal. So, who would I appeal to in order to get an unbiased review of the claim?

Perhaps the best way to appeal the denial of the clothing allowance would be to argue that the topical medication which was prescribed for your service connected condition causes clothing to be stained. It would probably also be helpful to mention that application of the knee brace also stretches out your polyester stretch pants at the knees. Try measuring a new pair at the knees in the same size and comparing them to your used pair that has been stretched out at the knees and include the data and photo with your appeal. I think I would also take a dictionary and include the meanings of that word designed. While it may be true that a manufacturer may have developed design specifications with the intent to design a brace that did not tend to wear out clothing, manufacture of a brace design does not necessarily mean that the manufacturer succeeded in producing a brace that actually does not wear out clothing. Ask V.A. in your appeal the name of the brace manufacturer and ask them to supply you with the product data sheet on that brace. Also ask them to supply you with a copy of the patent application on that brace. I would be willing to be you that neither the product data sheet or the patent application mention the brace tends to not wear out clothing. I suggest you search online under knee brace AND product data sheet. This will show you some examples of knee brace product data sheets. You might even be able to find a material data sheet for the brace you have so that you could include the product data sheet with the appeal. I wonder if there is a tag on the brace that includes a patent number and if the patent application for the brace which touts advantages of the brace design would mention whether the brace is designed to wear out clothing. If you could get the brand name of the brace from a label on the brace or from V.A. prosthetics department, maybe you could visit the manufacturer's website to determine if the manufacturer has made any representations or statements to the effect that the brace does not wear out clothing. I think you should also tell them in your appeal that you wear 4 braces which were prescribed by V.A. doctors for your service connected conditions including a neck brace, 2 knee braces, and a back brace and that accordingly you are asking for 4 clothing allowances as authorized by Sursely v. Peake.

Edited by deltaj, 31 August 2009 - 01:29 AM.


#17 luvHIM

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Posted 10 September 2009 - 07:20 PM

I know I haven't been checking in much like I use to. It seems that I was awarded my claim and my condition grew worse. Go figure...

Anyway, I thank everyone for their input. I will attempt to get my doc to write something. I now have a new PC and this would be my third one, since the actual issuance of my devices. I'm going to ask for new knee braces on Wed at my Ortho appointment and see what he can write.

I don't even know if it's too late for this year or not. But...nothing beats a fail but a try.

#18 broncovet

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Posted 13 September 2009 - 06:19 AM

Their reasoning is faulty: Are any prosthetic appliances "designed" to wear clothes out faster? I don't think so. That would be like saying they designed a car to be unsafe.
It really would not matter what the prosthetic appliance was "designed" to do..after all, you body was not "designed" for prosthesis!
The design of the prosthesis has nothing to do with whether or not it wears your clothes out. Did they ever hear of faulty design? Is it your fault they designed the prosthetic device to not wear out clothes, but they do anyway?