- 100% P&T ( to include 100% PTSD, 70% TBI ) since 2011
- SMC-S with two children.
- two documented neuropsych & forensic workups: TBI residuals well documented, aquired ADHD due to mTBI x3; cognative and social imparements compounded by PTSD.
- purple heart
I need guidence.
I am having a harder time maintining basic tasks. I am relying more on my relatives and children to help me with items such as laundry, house cleaning and such. The wife split and and left me and the children.
I have contacted my MOPH service officer and am waiting to hear back from him. I am trying to figuire out if I should file for A&A or other SMC. I feel like I am barely treading water.
I have read but tired to figuire out SMC -R1 or SMC-T applies...
Fury 1-9 out
I uploaded (last week) some of the decisions my late husband had gotten and Berta spotted a couple CUEs and gave me some help in drafting them. Berta if you are able to help with a few more questions Please?
I have only 2 more days till my year is up from the DIC/Accrued benefits claim where DIC was awarded and Accrued denied saying there aren't any. At that time also, I intended Substitution but the VA form got separated (my fault) and didn't get submitted. I, however, wrote it into the 21-534EZ form and checked it. I also included a cover letter that said explicitly I was substituting for any and all accrued benefits... They didn't address substitution in their decision. Now with the CUEs which aren't an accrued yet, do I need to address those 2 forms immediately before the deadline?
Here are some questions I still have if you could clarify these for me please:
A. Is a NOD for accrued benefits claimed with DIC a year ago needed – to appeal their conclusion that there are no accrued benefits? Would any backpay from these CUEs be considered accrued benefits that I would have to NOD the decision now for?
B. Is Substitution needed to do CUE claims or to receive any backpay on them?
C. What happens when future presumptions of ao are added to the list going forward (as a surviving spouse) does it affect anything I can act on?
1. Conditions claimed before – either rated or denied sc
2. Would conditions listed in the C-File but never claimed come into play ever as a presumptive?
D. If CUE is successful:
1. then qualifying for housebound or A&A will need to be judged and evidence has never been presented before…
a. does the judgement come only from the C-File? And if so, should I include printouts from C-File to bring attention to issues pertaining to them?
b. Can any evidence be added (from that date and before) since it was never considered before? And if so, do I include it with the CUE claim?
E. IHD was first decided as 30% and went back to one year prior to our first claim – effective 2004…the bump up to 60% was effective . But the 100% was effective 2006…Should any of those effective dates be different because:
1. SSDI was in place for IHD qualification date of 12/2000
2. TDIU decision being effective 2006 (but he was unemployable per SSDI in 2000?)
3. 100% decision?
4. 100% effective date adjusted back due to Nehmer 2010 addition listing it as a presumptive
5. Combination of all the above?
F. Many of the evidence documents we submitted are not in the C-File and none of the forms we submitted are there to prove what we submitted or said. Is that normal?
G. Also, the only SS docs in the C-File are the ones where I outline his conditions and behaviors in answer to the many questions on the intake paperwork for that SS claim. There’s 4 pages of handwritten (including along margins due to space shortage) that I doubt anyone is going to wade through but it’s filled with problems he was having. Should I type it all out and attach it to the handwritten forms?
H. We submitted the whole SS file but can’t prove it. We even wrote a letter to our Congressman to help us get a particular letter sent to us by SS along with their decision listing a myriad of restrictions to employment they concluded for him. I couldn’t find it and neither could SS but the Congressman did try for us. I have those communications too, but don’t want to drown them in paperwork with this claim. Any thoughts?
Again, thank you Berta. I did try the other people you suggested without success.
And thank you to everyone here who has helped me or does going forward!
I wanted to pass this on and share with all fellow Veteran's. The CFR for Convalescence is not just for S/C contention as the CFR indicates http://www.benefits.va.gov/COMPENSATION/claims-special-convalescence.asp
I applied for 100% Temporary Convalescence for my right foot (which is NOT s/c) due to my left ankle (is S/C). I was told it would be tough so I got all my ducks in a row. I had my podiatrist write a very good IMO to support my claim. That the left ankle was the cause of my right foot fracture. The letter is what I truly believed help this claim.
I wanted to share this so all Veteran's know that you can submit a claim of this nature even on a non-service connected contention.
So my DAV rep just called. I am so happy!!! I not only got an increase to 70%, I got 100% temporary convalescence for my broken right foot due to my left ankle! I am so amazed! I was told so many times that there was no way I would get the 100% because the right foot was not S/C, well I did! They not only gave me the 100% for 3 months because my left ankle caused the right foot injury, I got 3 months of SMC-House Bound for three months as well!
My NOD is still pending for my right foot s/c, right ankle, and left toe condition.
My effective date is January 4th, 2016 for my new 70% rating.
My three months of 100% temporary convalescence and SMC House Bound is effective July to September 2015.
I truly believe the IMO from my VA Podiatrist sealed my fate for the 100% temporary convalescence.
Keep fighting Vet's!!!
I'm 100% P & T with no future exams (lets hope not) and I've been doing a little research of my own of what other payable benefits I'm entitled to, besides the ones in my letter from the VA like clothing allowance (topical cream), SMC (K) and Education. This is what my ratings look like. Could someone give me any other possible suggestion?
60% Dermatitis with Lichen Planus and Erythema Dyschromicum Perstans
50%Obstructive Sleep Apnea
30% Adjustment Disorder w/Anxiety & Depression Mood
30% Migraine Headaches
10% Cervical Spine Strain
10% Right Ankle Degenerative
10% Left Shoulder Degenerative
10% Lumbar Spine Segmental
10% Right Shoulder Degenerative
10% Left Ankle Degernative
I am rated at 100% major depression disorder; 10% DJD left knee; 10% DJD left hip; 20% DDD lumber spine; and 30% calcified left quadriceps. I am at 100% plus 60% SMC (S-1). Yesterday I put in a claim for an increase evaluation of the lumber spine and sleep apnea secondary due to S/C major depression disorder. If I am granted an increase eval of the lumber spine and granted secondary S/C of sleep apnea, how much will I get? The VA Medical Center dx me with sleep apnea 18 months ago and put a cpap mask on me. Using VA math, how much an increase will I get. Will I get more SMC.?
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)
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:
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
This is what the examiner wrote in response to the question sought:
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???
If a Veteran who is 90%, IU P&T meets the requirements for SMC L Aid & Attendance for a combination of SC conditions, it appears that that route to SMC L is NOT PREDICATED on SC percentages. Is that correct? I think it is...
Assuming it is correct, and the Veteran also met the criteria for SMC K (for loss of use of creative organ), AND had SC disabilities of 90% (none of which meet schedular "loss of" sight, appendages, etc.) Wouldn't that mean L1/2 plus SMC K?
And if we assume all of the above except Veteran is 100% schedular, wouldn't that mean SMC M plus SMC K?
And last question - it appears one must be SMC, O in order to qualify for the higher level of Aid & Attendance, even though they clearly meet all of the other criteria - is that correct? Any known exceptions to that?
Call/Write "Bob" seems to be effective. I had a series of awards from a long standing 100% P&T to other awards that totaled more than 60% using "VA" math.
Yet, SMC was never mentioned, awarded, or denied. in addition, long standing appeals were just setting at the VARO (for years).
After reading the successes others had in getting long standing issues resolved, on a whim, I E-mailed "Bob" about a week ago.
A couple of days later, this resulted in a call from the VA. This involved rehashing the contents of the E-Mail, and adding other
details. Recently, a few days later, a second call occurred. I was told that SMC was awarded, and that a five figure amount of retro was due.
Until I see things in writing, and in my account, I'll have to take the usual wait and see position.
Both calls were made by VA personnel stating that they were veterans. (Why that was emphasized, I'm not sure.)
Update! 31 Oct
A letter showed up today - (From the area VARO) confirming the award.
There was one days difference between the date on the award letter and the mailing date.
That almost sets a record! (By the way, the lawyer still gets 20% of retro, even though what happened is due to the email I sent!)
Now for other denials that appear to be CUE!
I'm going to have to do some research. It seems that there is law and court history that might be usable to recover the lawyers fee from the government.
Something about government actions (improper)and inaction that result in loss to a person. The law and case history is usually used when there is no appeal
practically available. Unreasonable or inordinate delay is considered a loss. The odds are against me, but one never knows!
Update 19 Nov
The Eagle flew by and made a 5 figure deposit!
BUT, it may be that the lawyers cut was not subtracted, or the award was modified after
I was given the first set of numbers! With the VA, who knows!
The last word I had was that the retro was being held based upon appeals started before the award was made,
and that the VARO was sending the appeals to the BVA (after years of delay).
Claims Process – Your claim can go from any step to back a step depending on the specifics of the claim, so you may go from Pending Decision Approval back to Review of Evidence. Ebenefits status is helpful but not definitive. Continue Reading
68mustang posted a question in VA Disability Compensation Benefits Claims Research Forum,
GlennieHB posted an answer to a question,
What was the Primary Cause of Death (# 1) as listed on your spouse’s death certificate?
What,if anything, was listed as a contributing cause under # 2?
Was an autopsy done and if so do you have a complete copy of it?
It can be obtained through the Medical Examiner’s office in your locale.
What was the deceased veteran service connected for in his/her lifetime?
Did they have a claim pending at death and if so what for?
If they died from anything on the Agent Orange Presumptive list ( available here under a search) when did they serve and where? If outside of Vietnam, what was their MOS and also if they served onboard a ship in the South Pacific what ship were they on and when? Also did they have any major physical contact with C 123s during the Vietnam War?
And how soon after their death was the DIC form filed…if filed within one year of death, the date of death will be the EED for DIC and also satisfy the accrued regulation criteria.