diabetes Getting Close to BVA Decision SMC and need an opinion

[Dolphin25]

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???

 

 

 

[broncovet]

According to the NVLSP in the enclosed document (through the "purple heart" training), my opinion is, yes you should qualify if you are alread SMC O. and need the aid from a licensed health care professional.    

 

SMC(r-1) Special A&A ($6,909)  Entitled to SMC(o) AND  Meet requirements for SMC(l) - A&A (disabilities result in vet needing assistance w/ functions of daily living) SMC(r-2) Special A&A (higher level of care)  Benefit =$7,925  Entitled to SMC(o) AND  Meets requirements for SMC(l) - A&A AND  Requires health-care services provided in home daily by licensed health-care professional (or someone under supervision of professional)