SMC L aid and attendance

[adkins7b]

I should know about my claim anyday its in last phase 70 tdiu depression anxiety asking increase and i already have 50 percent for sleep apnea.. I asked for aid and attandance and the dbq said that I need assistance and can not live indepandant.  I dont know if this will be enough to increase to 100 but i think that should be good to win aid and attandance..

 

my question is do i have to be 100 percent to win or is tdui fine. I think i asked this before my memory horrible medication. plus 50 percent would that be smc l 1/2. 

Edited November 25, 2017 by adkins7b

[FormerMember]

8 hours ago, SupermanCannedy said:

A vet has to be established with an entitlement to basic Special Monthly Compensation before being considered for higher rates of SMC.

Not true. A Veteran could be service connected for tinnitus at 10% and his AO- induced Coronary Artery Disease (CAD or IHD) causes him to have a salvage amputation above the knee. In that case, he would advance from 10% to SMC P (L 1/2) instantly [see §3.350(f)(1)(i)] without any prior SMC rating at the intermediate rates of the K/Q/S level. Always remember, SMC is due and owing only upon presentation of medical entitlement. You are correct in that it doesn't require a filing as VA's M 21 1MR Cray computer is "expected" look at the End Product code to impute the entitlement on its own. It happens successfully 33% of the time according to VAOIG's VARO statistics. VA Raters simply cannot navigate 38 CFR §3.350/§3.352 and arrive at the correct answer-let alone correctly enter it into the M 21. Hell, very, very few of us can even understand all the  "but if"s. It's worse than the Mississippi River and even permits pyramiding prohibited by §4.14. 

I gave testimony to a VLJ at a Travel Board Hearing. He was a wise fellow-Vito Clementi. I quoted  §3.350(f)(4) reg showing the bump we get from L to M if we have a separate 100% schedular for a disease or injury completely separate from the initial TDIU/100% schedular . I also referred to §3.350(f)(3) and the 1/2 step bump we get there. He was clueless. He looked it up right there on the spot and was dumbfounded it even existed. Assume everyone's a rank amateur at this game from the DRO to the VLJ and you'll probably win sooner. 

Edited November 17, 2017 by asknod

[Gastone]

Could you post a redacted copy of both your IU Award Letter and House Bound Physician's Statement.

"Any day now, in last phase" could be overly optimistic.

[broncovet]

Here is the criteria for "Aid and Attendance", noting there are "2" A and A's.  One is for pensioners, the other is for SMC L:

§ 3.352 Criteria for determining need for aid and attendance and “permanently bedridden.”

(a)Basic criteria for regular aid and attendance and permanently bedridden. The following will be accorded consideration in determining the need for regular aid and attendance ( § 3.351(c)(3): inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. “Bedridden” will be a proper basis for the determination. For the purpose of this paragraph “bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others.

(b)Basic criteria for the higher level aid and attendance allowance.

(1) A veteran is entitled to the higher level aid and attendance allowance authorized by § 3.350(h) in lieu of the regular aid and attendance allowance when all of the following conditions are met:

(i) The veteran is entitled to the compensation authorized under 38 U.S.C. 1114(o), or the maximum rate of compensation authorized under 38 U.S.C. 1114(p).

(ii) The veteran meets the requirements for entitlement to the regular aid and attendance allowance in paragraph (a) of this section.

(iii) The veteran needs a “higher level of care” (as defined in paragraph (b)(2) of this section) than is required to establish entitlement to the regular aid and attendance allowance, and 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.

(2) Need for a higher level of care shall be considered to be need for personal health-care 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 health-care professional. Personal health-care services include (but are not limited to) such services as physical therapy, administration of injections, placement of indwelling catheters, and the changing of sterile dressings, or like functions which require professional health-care training or the regular supervision of a trained health-care professional to perform. A licensed health-care professional includes (but is not limited to) a doctor of medicine or osteopathy, a registered nurse, a licensed practical nurse, or a physical therapist licensed to practice by a State or political subdivision thereof.

(3) The term “under the regular supervision of a licensed health-care professional”, as used in paragraph (b)(2) of this section, means that an unlicensed person performing personal health-care services is following a regimen of personal health-care services prescribed by a health-care professional, and that the health-care professional consults with the unlicensed person providing the health-care services at least once each month to monitor the prescribed regimen. The consultation need not be in person; a telephone call will suffice.

(4) A person performing personal health-care services who is a relative or other member of the veteran's household is not exempted from the requirement that he or she be a licensed health-care professional or be providing such care under the regular supervision of a licensed health-care professional.

(5) The provisions of paragraph (b) of this section are to be strictly construed. The higher level aid-and-attendance allowance is to be granted only when the veteran's need is clearly established and the amount of services required by the veteran on a daily basis is substantial.

(Authority: 38 U.S.C. 501, 1114(r)(2))

(c)Attendance by relative. The performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance.

[ 41 FR 29680, July 19, 1976, as amended at 44 FR 22720, Apr. 17, 1979; 60 FR 27409, May 24, 1995]

 

[adkins7b]

the doctor didnt put my social on it. can the moderator try to edit and take my name off. I can not figure out how to do it.. but since just has my name i'm not too worried. I lost my other paper work I know but I have been inbeewteen houseing and getting divorced.. Last year has been a bit hard.

 

 

 

Edited November 8, 2017 by adkins7b

[Navy04]

Asknod and Superman,

 

Thanks so much for breaking this info down. I just got my DBQ from the VA MH Doc, and I am thinking which SMC to apply for. My wife is Currently my VA Caregiver on the highest Tier. I do not know if I can apply for A&A, while have Post 911 Caregiver as well. Do you guys know which way I should go? Thanks in advance, and I apologize for interrupting your thread Adkins. Also as long as your name is on it, you should be fine. Sorry you have had a bad year bud. Good luck and keep us posted. God Bless

[seminoles]

Don't be surprised even though you are IU PT that applying for SMC S or L will probably open up and have every single one of your rated service connections sent for a new CP exam.  I don't say this to scare you, only from experience.  It happened to me,  I was then sent a proposal to reduce one of my ratings from 50 to 0, which was actually hilarious  because it was the item which was the aid and attendance and had been filled out very specifically by my neuro.  I had a cp exam by a quack doctor from qtc that lasted 90 seconds.  Not only that, I had held my 50% (that is the maximum migraines can be rated)  rating for that sc issue for over 8 years with very well documented proof of zero improvement in all of my va records, my neuro had recently had my husband trained to give me injections at home etc.  As soon as I received this "award" letter I sent off a few emails to higher ups in the Va and all of a sudden within two weeks not only did I have a new award letter but an apology and my items were deferred.  I am now 100% PT and still waiting on them to get their heads out of their a$$ about my SMC's which are still deferred.  I have 3 kids currently using Chapter 35 and if I hadn't shot off that email and let my shady RO get away with that crap they would have been screwed.  My family would have no health insurance and I am pre 9/11 so there is no caregiver money.  My husband had to quit a very good job to be self employed to work at home to care for me.   I really thought I had nothing to worry about.........all my ratings were older than 8 or 9 years and I had shown zero improvement.  But my family nearly lost their health insurance, all our added benefits of being IU PT.........not to mention the loss of $$$.  I never believed anyone when they told me not to file anything mostly because of this site.  Now, I know better.  I will never file another claim again.  The va doesn't follow any rules and I am not going to gamble for 500 extra bucks a month.  At this point, my husband wouldn't even apply to the caregiver program if they ever opened it up.  The last thing he wants is those bastards in our home.  Some things just aren't worth any amount of money.

Edited November 19, 2017 by seminoles