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evandc

21 Days In Hospital Rule

9 posts in this topic

Have vet friend that was in VA hospital in March-April 2011 for PTSD. She is S/C for Anxiety. Applied for the 21 days in hospital & she was turned down because she was admitted for PTSD and not anxiety. I was going to copy 38CFR CH.1 4.29 and pass it along to her. I have 7-1-11 Edition & I'm having a problem. Before it read something like "be admitted for what you are S/C for or TREATED FOR WHAT YOU ARE S/C FOR". Now reading different "total disability rating (100 percent) assigned...it is established that s/c disability has required hospital treatment..in excess of 21 days." Question has this rule changed to drop the part about "treated for what you are s/c"? If it changed was she in hospital before it changed? Just passing along to help this vet..and never know why she didn't get connected for PTSD..but that's another thing.

Thanks,

Don

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The VA only rates the highest (or worse) mental condition to prevent pyramiding. In my case I am rated for Bi-Polar, but was also diagnosed with PTSD. This last time I saw my Social Worker, she asked me if I was also diagnosed with PTSD and I told her I was, but it was a long time ago in a different RO. She told me that she wondered, because she couldn't find it in my notes. I guess I will have to look through my c-file to find it, because they have asked me to attend PTSD treatment in the past.

Makes one wonder if they are deleting PTSD diagnoses, with the new PTSD regulations...

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".and never know why she didn't get connected for PTSD..but that's another thing."

Was she admitted specifically for the 21 day inhouse PTSD program?

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What is her current percentage of SC ?

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Was in program for PTSD more than two months. She has 90% S/C think 70% of it Anxiety. Pending TDIU..already has Ssd.

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Let me see if I understand this correctly

veteran is rated for anxiety.

veteran is admitted to hospital for 21 days for non-service connected PTSD

Veteran is seeking temporaty 100% for the 21 day hospital stay

No the veteran would not be entitled to the temporary 100% because the conditon for which treatment was required was not service connected. The one exception is listed below:

Even when hospital admission is for a nonservice-connected (NSC) disability, hospitalization benefits are payable if, during the hospitalization, treatment for an SC disability is initiated and continues in excess of 21 days.

Now If the claim for service connected is pending and later awarded then it is possible the veteran could receive the temporaty 100% rating based on the hospitalization.

The following is a September 5, 2008 change......

a. When to Assign a Hospitalization Rating

Provided a total, 100-percent rating cannot be assigned under other provisions of the rating schedule, assign a temporary 100 percent evaluation under 38 CFR 4.29 for

  • periods of hospitalization in excess of 21 days for medical treatment of an SC disability, or
  • a disability for which compensation is payable under either 38 U.S.C. 1151 or 38 U.S.C. 1160.

b. Granting Hospitalization Benefits When Admission is for an NSC Disability

Even when hospital admission is for a nonservice-connected (NSC) disability, hospitalization benefits are payable if, during the hospitalization, treatment for an SC disability is initiated and continues in excess of 21 days.

Reference: For more information on hospitalization ratings when admission is for treatment of a NSC disability, see 38 CFR 4.29(b).

Edited by Teac

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Teac-that's my question. She would be your exception treated for what she was S/ C for during her stay. But when I read 2011 version it seems to leave out that exception.. Also if it changed 7-1-11 & she was there March April 2011 wouldn't she still be awarded temp 100%?

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A vet I personally know very well was admitted to a PTSD treatment inpatient program March 8th of last year and completed program 23rd April last year. He has a Diagnosis of PTSD. (50%) He put in for the 100% when admitted to the program. In Oct last year he received a SOC which stated "Vet eligible for 100% related to inpatient treatment program beginning March 8 th and will end the last day of the completion of the inpatient program April 30th. In Oct of last year he received a check for March only yet he is to receive it for the 2 months as if continue 21 days in each month vet is eligible. Appealed this and is waiting. It is really stupid they write the dates he is eligible to receive this, and then pay him for just the first month.

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Teac-that's my question. She would be your exception treated for what she was S/ C for during her stay. But when I read 2011 version it seems to leave out that exception.. Also if it changed 7-1-11 & she was there March April 2011 wouldn't she still be awarded temp 100%?

I don't know... since the newest verison I found was 2008.....

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