Dolphin25

Asknod... Was that a yes??

Brocovet thank you so much for your response and yes I have requested my C-file either paper file or Disc and I have gotten responses but yet no file and let's see it has been going on 6 yrs since the first request and 4 months for the last request with no response. I have been at this for 9 years now and think I have done fairly well I just need direction that I can follow and it looks like Alex is willing to give me some and I am very appreciative of yours and his input, you guys are really a blessing to Veterans who pretty much do it on their own with help from you guys and for that I give thanks to God for your willingness to do this as your pay is not in dollars and cents but in satisfaction that what you do enabled us to overcome a great burden in attacking the beauracracy.

Can I please get a response to my post?? I realize everyone is very busy but I am on a deadline and need to get this in the mail. Thank you for your help thus far and please take care... Dolphin25

Ok let's see, I was granted Aid and Attendance at the L rate back in 2003, and then after I appealed for a higher level of Aid and Attendance I was granted an L 1/2 rate but on CUE they raised it to the M rate in 2012 because I had a 100% rate and a 60% rate. "Entitled to SMC-P(M) on account of entitlement to the statutory rate payable under 38 USC 1114(l) with an additional disability or conbination of disabilities, bladder incontinence, degenerative joint disease, lumbar spine, left lower extremity radiculopathy, left upper extremity radiculopathy, diabetes mellitus, degenerative joint disease of cervical spine due to back injury, hepatitis C, right upper extremity radiculopathy, degenerative joint disease, thorzcic spine, and radiculopathy with diabetic peripheral neuropathy, right lower extremity independently ratable at 50 percent or more from October 29, 2010." Since 2010 I have been diagnosed with loss of use of both legs and my left arm and my appeal is back at the RO and has been since January 2015. I have had two doctors state that if I did not receive a higher level of Aid and Attendance then I should be in an institution or nursing home care. Right now I am paying a nurse to come in or live in if she wants to in order to care for me plus I have my wife, kids and brother giving support also but their time is limited. It cost a lot of money to have her come in daily, more than I can really afford but I have to eat and use the bathroom. They never rated me for loss of bowel control even though I have that and have it bad and I don't know if it is too late to get that in the record or not. I have been granted SAH and they bought me a Van, used and I know you say it doesn't matter all I am saying is they recognized the fact I don't get around too well. Is there anything else I can do to give support to my claim now or just let them go ahead and rule on it???

In January 2015 I was granted a SAH housing grant and my higher level of AA was remanded back to the RO for more documentation b/c they stated Veteran may be entitled to a higher level if they get information from a company I hired to come in a help take care of me but unfortunately I could not keep them as the cost was way too much so instead I rely on less expensive means, family and a nurse I hired on a 24hr care as needed basis. My question is since I was granted the housing grant and from what I can read, the requirements for a higher level of AA, R-2 are the same as it is for the housing grant so why would they grant me a housing grant and not a higher level of AA?? I am at the M rate now.

My claim was filed in 2008 heard at RO in 2010 and denied, appealed and a decision was rendered on one part of my claim and remanded on the other. I was granted SAH and remanded for a "Higher Level of Aid and Attendance" on January 16, 2015. Had another C&P in September 2015 for the Higher Level of AA. I think I have a good chance of getting my Aid and Attendance moved from an "M" rate to a higher rate of either R-1 or R-2 and would like someone to read what the BVA requested from the C&P examiner to look at and the decision he rendered at my exam. Here is a link to the BVA decision http://www.va.gov/vetapp15/Files1/1502273.txt What the BVA stated is that since it has been so long since my last exam there may be more information available to render a better decision based on new information. 4. Thereafter, schedule the Veteran for a VA examination to determine his need for a higher level of aid and attendance. The claims file and a copy of this remand must be made available to the examiner prior to the examination. Any necessary tests and studies should be accomplished. The examiner must evaluate the nature and severity of all of the Veteran's current service-connected disabilities. The Board notes that the Veteran is service-connected for PTSD; bladder incontinence; DJD of the cervical spine, thoracic spine, and lumbar spine; right and left upper extremity radiculopathy; right and left lower radiculopathy; diabetes mellitus; hepatitis C; and loss of erectile function. The examiner is asked to address: a. Whether the Veteran needs a higher level of care (that is, the need for personal healthcare services provided on a daily basis in the Veteran's home by a person who is licensed to provide such services or who provides such services under the regular supervision of a licensed healthcare professional). b. Whether in the absence of the provision of such higher level of care the Veteran would require hospitalization, nursing home care, or other residential institutional care. (I have two Doctors stating if I did not receive a higher level of Aid and Attendance then I would require residential institutional care.) Now this is what the BVA requested the C&P examiner should do: COMMENTS: "In rendering the requested opinions, the examiner should reconcile his or her opinion with the October 2010 letter from Dr. Keller indicating that due to his chronic medical problems absent twenty-four hour attendant care the Veteran would require a long- term care placement and the January 2012 correspondence from Dr. Lippert stating that the Veteran would probably benefit from a higher level of care and absent such care, might require hospitalization, nursing home care, or other residential institutional care." And this is what the C&P examiner wrote in his conclusion: Clarification: In review, I did not see opinion or rational from Dr Keller in the VBMS or VA medical system records. There does not seem to be a conflict in the opinions or either provider that I can see. They both indicate that assistace would be needed but Keller indicates this wasnt arranged he would need full time facility placement. It should be noted that the client's wife, who was previously a RN and care provider, has significant medical problems and she herself is in need of full time care support. Client states his daughter comes and helps them some, but he is paying out of pocket for caregiver to come in daily and help with meals and bathing. I personally am skeptical of the entire evaluation process and would suggest an estensive in home Social worker evaluation for feedback on his and her abilities to live safely independantly vs need for long term care facility placement for both of them. WAS A MEDICAL OPINION REQUESTED? No I would appreciate any honest assessment of what is in the examiners review and is he stating that I do need a higher level of AA???

I filed for a higher level of AA in 2008 along with a Special Home Adaption Grant. In January 2015 the BVA granted me the SHA Grant and remanded the higher level of AA back to the RO. A request for a new C&P was granted and in September 17, 2015 I was seen by the VA Hosp in Fayetteville, Arkansas. The examiner was a Nurse and still in the Military, he was really kind and nice and since I was taken to the VA via a wheelchair van and had no one to push me he did so with out any problem. I couldn't do anything, like stand, walk and needed physical help to get on the gurney. I am unable to stand or walk or use my arms or hands to any degree as my disabilities are spinal related from a broken back in the service from a Helicopter crash. I already receive SMC at the "M" rate b/c of a 100% rating and a 60% rating plus a whole lot of 10's 20's and 40's. I also receive the K rate. I received my C&P exam notes a few days after the examination that lasted all 15 minutes and from what I could read the only thing the RO or BVA wanted answered was concerning 2 letters from 2 Doctors about whether there was any conflict in whether or not I need to be in a residential facility or in my home. Both Doctors stated that if I do not receive a higher level of AA then I should be housed in a residential facility to be better taken care of. The examiner stated he did not find any conflict and that was basically it. Here they granted me the SAH Grant: CONCLUSION OF LAW The criteria for entitlement to a certificate of eligibility for assistance in acquiring specially adapted housing are met. 38 U.S.C.A. §§ 2101, 5107(b) (West 2014); 38 C.F.R. § 3.809 (2014). Now the criteria for the SAH Grant are as follows: For a certificate of eligibility for assistance in acquiring specially adapted housing, the evidence must establish permanent and total service-connected disability due to: 1) the loss, or loss of use, of both lower extremities such as to preclude locomotion without the aid of braces, crutches, canes or a wheelchair; or 2) blindness in both eyes, having only light perception, plus the loss of use of one lower extremity; or 3) the loss, or loss of use, of one lower extremity together with the residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes or a wheelchair; or 4) the loss, or loss of use, of one lower extremity together with the loss, or loss of use, one upper extremity which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes or a wheelchair; or 5) the loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbow; or 6) full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk. 38 U.S.C.A. § 2101(a) (West 2014); 38 C.F.R. § 3.809(b) (2014). After reviewing all the evidence and resolving any doubt in favor of the Veteran, the Board finds that the Veteran's service-connected disabilities manifest in the loss of use of one or both lower extremities as to preclude locomotion without the aid of braces, crutches, canes or a wheelchair. 38 C.F.R. §§ 3.102, 3.809 (2014). Therefore, entitlement to a certificate for assistance in acquiring specially adapted housing is granted. In the C&P exam notes the only question the BVA wanted answered is this: COMMENTS: In rendering the requested opinions, the examiner should reconcile his or her opinion with the October 2010 letter from Dr. Keller indicating that due to his chronic medical problems absent twenty-four hour attendant care the Veteran would require a long-term care placement and the January 2012 correspondence from Dr. Lippert stating that the Veteran would probably benefit from a higher level of care and absent such care, might require hospitalization, nursing home care, or other residential institutional care. This is what the examiner wrote in response to the question sought: Clarification: In review, I did not see opinion or rational from Dr Keller in the VBMS or VA medical system records. There does not seem to be a conflict in the opinions or either provider that I can see. They both indicate that assistace would be needed but Keller indicates this wasnt arranged he would need full time facility placement. It should be noted that the client's wife, who was previously a RN and care provider, has significant medical problems and she herself is in need of full time care support. Client states his daughter comes and helps them some, but he is paying out of pocket for caregiver to come in daily and help with meals and bathing. I personally am skeptical of the entire evaluation process and would suggest an estensive in home Social worker evaluation for feedback on his and her abilities to live safely independantly vs need for long term care facility placement for both of them. My question is since it looks as though I have met the criteria for the SAH Grant and the grant and the R-2 require both the same criteria, then to me it stands to reason if I meet the one then I meet the other. Am I looking at this wrong???

"So, the next time your PCP or any other doctor tells you that you might get addicted you tell him to do some research that shows people who have chronic pain does NOT get addicted, period. The stats are online." You are right about not getting high on pain medication after so long, I have been on my methadone for the past 12 years and don't get high but what I do get is pain relief. To me this is the best pain medication I have ever taken and I have taken the whole gamut of that stuff. Been on the Gaba and other stuff that makes you goofy as hell, something I don't need in my life so I gave it up and take the methadone and a breakthrough pain med Hydrocodone. But now my Doctor has taken me down from a very effective dose to one that is completely ineffective. How can one argue with them, I told him you are treating the policy not the veteran, where do I fit in all of this. I told him you don't know what pain is..his reply..."oh yes I know what pain is I see it everyday.." Hate to inform you Doc but that is not the same thing by a long shot. I have to use a Catheter and since I have no one to change it regularly I end up using it longer than it is suppose to be used for and this has ended up causing me kidney problems and kidney stones. I can't walk or stand and he knows this but yet will still try to make appointments for me to place over a 100 miles away, why would he do this?? I have been seeing this guy for the past 3 years and he knows my situation, even wrote me a letter stating if patient doesn't receive a higher level of Aid and Attendance then he will be forced to go to a nursing home or other similar place God forbid. I refuse to go to a place like that, but if they would approve my Appeal for a higher level of AA then I could hire someone legitimate to come in a help me, the cost is way to prohibitive for me right now..I get about 4500 dollars a month for 100% disability and Aid and Attendance at the "M" rate. I am not sure how it works but since I have 2 letters from 2 different doctors stating I need a higher rating of AA and my inability to walk or stand with weakness in my hands and shoulders should make me eligible for a rate increase. I fear they will deny me because of the amount of retroactive pay which could be around a half million dollars, would that make me a half millionaire?? I need someone besides the DAV to represent me as I fear they won't do the cut up job they think they can do with the BVA, I read the decisions on the cases just released from the BVA and just about all are denied, some I can see why they are denied but there are some that should be a shoe-in for an R-1 or R-2. I don't know which way this VA medication policy is going to go but I fear it will not be good for the Veterans any time soon. I am eligible for Medicare beginning in May next year, guess I need to read up on it to see if I want to apply for it or not. Good luck to everyone....

The pain clinic at the VA Hosp in Albuquerque N.M. put me on Methadone in 2002 and was successfully on it since then with not one problem until last year when I was told I would be weaned down, well they did and now they are taking me off Hydrocodone completely, so I went to a Methadone clinic and also had to tell them I was addicted to narcotics just to get on the program but they knew I was on it for Pain control but they can't treat pain at a methadone clinic. I did what I had to do and they will give you a 28 day dose if you are clean for however long. I ask the VA to pay for it but they refused, now the VA in another area pays for their veterans to go to the clinic but not mine. The medical director doesn't think methadone is for pain, I ask him to research that b/c the Germans invented it during WWII for pain b/c of the morphine shortage back then. I don't think this thing with Chronic pain is going to change, it is here to stay and screw the veterans. I don't know what the doctors really think about veterans who are on chronic pain medication but probably they think we are all drug chasing addicts or are selling. I wouldn't know who to sell to and wouldn't risk my freedom anyway for a few pills, no way no how. Good luck to everyone.

I received a letter from the VA Medical Center in Fayeteville, Ark stating that on May 6, 2013 the VHCS is looking at the safety of prescription narcotics. Your primary care team will work with you and review the narcotics you are taking. This may result in a change to your medications. The goal is to reduce the side effects that occur from narcotic use including: Depression Impotence Suicidal Ideation Decreased ability to breathe We want to find a plan to fit your needs. VHSO has many ways to help you with this goal. The first step is to review the pain medicines you are taking and decide if you need to make a plan. You and your primary care team can explore ways to help you safely manage pain like: using non-addictive pain medicine, acupuncture, or other methods we have here at the VHSO. We want to keep your pain under control and make sure you are safe at the same time. Thank you for your support as we begin working on this safety plan. If you have any questions, please call your primary care team. Apparently this letter has gone out all over the VA Health Care system. Tonight I received a phone call from the nurse of my primary care team telling me my Doctor is sending me a letter detailing how he will be withdrawing me off of my pain meds. Now this is totally contrary to what the above letter states but anyway I will wait for the letter. This past month he decreased my dose without discussing anything with me. I have been on pain meds with the VA for about 12 to 15 years now and I am at a point where my pain is controlled and really don't need any tinkering with anything. I have never complained about any of the side effect and don't experience any. I have taken the whole gamut of pain meds and have now been on Methadone for over 10 years. One thing Dr.s don't understand about Methadone is one does not "get high" on this medication. It last a long time in your system so one does not have to take it but once a day, unlike other pain meds where you take them every 4 to 6 hours. I have never had any problems with my UA's I am required to take. I am unable to walk and really do have serious pain levels daily at or above 7 on the pain scale...feels like someone has hit me in the back with a baseball bat as the pain takes my breath away..but with my pain meds I can manage to at least eat food. I receive AA and need someone to help me daily with everything I do so living in my body is no easy task. I am wondering do I have any recourse with something like this...I don't understand why they don't treat Vets on a one by one basis instead of Systemwide. Is anyone else experiencing this, have you received your letter, if not then beware...the nurse said they are doing this with Medicare also but the VA is ahead of the curve...yeah!!

I have two claims on appeal and need to file a new claim. Can anyone tell me if this would be a detriment to my current appeal?? I don't want to have to wait forever how long my appeal could take to file this....it's not really for me but for my wife, I want to file for AA for her. I heard but don't know if it is true that if I file they will stop my proceedings on my appeal and send my file back to the RO where I would file the new claim...any truth to that...seems logical. Thanks for any help here...

Thank you Berta..if you could help me understand something...all along I have been seeking an increase in Aid and Attendance simply for what it implies that I need someone inside my home to help me in all phases of living and taking care of myself...so I ask for an increase but then I read about an increase in SMC..am I requesting the wrong thing?? Are they both considered the same, SMC and AA??? I know I should have a higher rating than L 1/2 but I am unable to get the RO to read the file where it documents a loss of use of my lower legs and loss of use of an upper extremity. I mean the Dr.s have clearly stated on the findings, plus I have two doctors who have stated that if I don't get an increase in AA then I will be forced to enter into some kind of nursing home or living facility, something I just refuse to give into. I had a dream if I went into one I would end up dying, pretty vivid dream. I had applied back in 2009 for an increase and was denied by the RO so I filed an appeal in Feb 2012, now somehow in 2010 the RO states I have a claim pending for about 12 different claims and one of them being an increase in AA again...I don't remember filing that claim but I do remember complaining in a letter to the RO about when they denied me for the claim I filed in 2009 why they didn't hear me on those issues that the C&P Dr's stated were wrong with me at that time, one being incontinence in which I already had a 10% rating. What happened was I filed in 2009 for a higher level of AA and in April 2010 I was denied..and then I filed for a hearing by the DRO and eventually I filed my appeals for AA in 2-2012. In October 2010 they state a claim was filed for all of those issues I wrote to them about in my letter. So how does this affect my Appeal?? I have an appeal for an increase in AA and now have this current decision in which I was granted the half step to an L 1/2 rate. What happens if I file an appeal and the BVA ends up getting two claims for the same thing. I one going to cancel the other one out, are they going to say since I was awarded the increase it is now a moot point?? So many damn questions and no answers. It's so confusing to me I can't even write about a decent timeline on all of this. They gave me retro pay from the Oct 2010 date for the 1/2 step, but shouldn't they have gone back to the date I first filed for a higher level of AA in 2009, even though that case was denied and is now on Appeal?? How screwy is this..?? Any help is appreciated and thanks for the case..I had read that one before an yes it is a good one...

Can someone tell me whether I have the SMC P rate or the SMC L 1/2 rate, as this is what is stated in my decision...and what would be the next rate available should I prevail on appeal?? I have been rated for numerous conditions since 1999 including Aid and Attendance at the L rate but was recently rated a higher percentage, so I now have a 100% P&T for PTSD and a 60% rate for incontinence plus the other conditions for my back, legs and diabetes all rated at 40%. What they did in effect was increase my monthly compensation rate $69 more dollars per month and that is for the increase from L rate to L 1/2 rate. I just don't understand the P rate and how they have it stated.... 1. Entitlement to special monthly compensation based on aid and attendance. Entitled to SMC-P(L 1/2) on account of entitlement to the statutory rate payable under 38 U.S.C. 1114(l) with an additional disability or combination of disabilities, bladder incontinence, degenerative joint disease, lumbar spine, left lower extremity radiculopathy, left upper extremity radiculopathy, diabetes mellitus, degenerative joint disease of cervical spine due to back injury, hepatitis C, right upper extremity radiculopathy, degenerative joint disease, thoracic spine, and radiculopathy with diabetic peripheral neuropathy, right lower exgtremity independently ratable at 50 percent or more from October 29, 2010. What would be the best way to go in order to obtain a higher level of Aid and Attendance???

I contacted Patient Advocate and she stated to write everything down that happened and submit it to her office. She said this Dr. has had numerous complaints filed against her. I then wrote to the OIG Hotline and filed a complaint also but also am looking at the State Medical Board to file also, then on with a TORT claim against her. I want to file a Medical Malpractice but have to check with attorneys.