sixthscents

hayley3, In your circumstance, since you are not sure really what and when things happened. I would first request your c-file. Now it may cause you to miss a claim date... so keep an eye on your current limitations, and submittal dates. Dont miss those waiting for the c-file, but it will give you a much clearer picture of what happened, and when and give you copies (hopefully) of the documentation you are missing. Like I said, dont just wait for the c-file to pursue your claim. Go to it now, and then you may or may not be able to use the paperwork in the c-file to support an earlier claim date... I will say that I have never seen the VA change a date based upon the vets inability to file their paperwork due to illness... maybe they do, I just have not seen it, so personally (and this is solely MY opinion... you might have a difficult time if that is your only argument) In any case get the c-file and pursue your current claim now.

When you agree to accept the VA prescriptions, you also agree to NOT request them from an outside sourse... hence her referral to a drug test etc. Pain meds work funny in the VA compared to private practice... doctors (PCP) doctors are only allowed to write a certain level of pain med. The system will simply DENY them the right, based upon their care level... Most chronic pain sufferers have to go thru pain management to get the appropriate level of medication. The doctor simply CANNOT write it. Now she, or he may be a bit upset and try to cover it up saying that you shouldn't be on such and such... Personally I would just ask for a referral to pain management... and take this doctor out of the loop. If you are taking high level pain meds, (unless waivered due to location), you are going to have to go thru them for them anyway. Now once pain management signs off, the PCP can continue the meds (submit refills) - but the INITIAL perscription has to come from pain management. Also, a LARGE number of our PCP's are nurse practitioners... and they are even MORE restricted from writing scripts. They have to get the actual MD on staff to write anything over a hydrocodone... like a percocet. They simply cannot write the script, so they drag their feet to write anything other than what they are allowed. I would certainly see the patient advocate... and I would also immediatly ask for a referral to pain management who can write what you need. Just take your civilian scripts to them... not the PCP who is probably a nurse practitioner, and not even an MD. Also take them copies of your civilian records (if practicle) so they can see you have been on these meds for a long time... They dont tell you this stuff, and getting one to admit it is like pulling teeth. My sister who is an RN, is MY case manager... she went with me to my PCP appointment, where they had to schedule an appointment with the actual MD in the clinic just for this reason... and he HAD to do a pain management referral because he couldn't write the scripts I need. It was incredible the lengths they went to before they finally admitted that... trying to say (like yourself) that I didn't need the med. The funny thing is I am ALREADY in the pain management system, I just hadn't been perscribed the med my sister said I needed. (It po'd them that a mere RN was telling them what I needed, but she deals with chronic pain all day long as DON of a nursing home). Now with all that said I STILL like my PCP... I just am more aware of her limitations, and her likelyhood to balk when we hit them... understand? Some of these care providers act like we are on welfare - especially in the VAMC POD's... I got away from them as quick as I could and into a local CBOC clinic... and am MUCH happier. Even with this med issue they were polite and seemed really concerned. My PCP is the one who really kicked off this claim for R-1/R-2 I have going and she has been totally supportive - except when we hit this limitation, and even then she did eventually set up the appointment with the MD, and she also did the referral to Pain management at the same time. So, I am still happy with the level of care I am getting, I just understand how the system works now and know to ask for a referral from the start.... They do get REALLY pissy (not with me... just what I have seen with other vets) about vets getting meds from other sources as well as the VA... especially pain meds. I was clearly told that by accepting pain meds from the VA I agreed NOT to seek them from any other source. I haven't so I haven't hit that barrier, but I've seen it happen. OK, so this is how I THINK the stuff works... and we just went thru it last week, so hopefully it wasn't a load. I dont think so, because they had to schedule all the appointments etc, and that is a lot harder than simply writing a script. I have been in the VA system now for 6 years I guess, and I can honestly say that while we have decent VAMC's here in Tennessee, I am MUCH happier with the CBOC... it's closer, a WHOLE lot easier to get an appointment (normally within 2-3 days), and they seem.. well they dont seem to treat me just like a number. Personally, by my experience, I reccomend them.... but all this has been based solely upon MY experience.

And while I understand your frustration.... that concession (section 1145) is actually a very big one. It removes a BIG rpoblem with veteran records in Vietnam, and elsewhere and is because a lot of soldiers were treated at an aid station and the documentation from it never hit their medical records. Some people fought long and hard to get the VA to make this concession...

It helped a great deal and was exactly what I was looking for... if you have any other info please feel free to comment... Thank you... Bob Smith

Yeah it is, actually it is a much larger payment (at L rate) than at "s" - housebound. In my case though I am bedridden... with a need for constant A/A... which is also known as SMC. SMC and Aid and Attendance are really just the same thing. I know you know that, but just wanted to clairify. R1 and R2 as you point out in your later post are "special"... they are DRASTICALLY higher... but trust me, I'm going out of pocket for 24/7 care right now and it's incredibly expensive. Now I COULD go thru Medicare and get someone in here tomorrow practically BUT... 1. I wouldn't get to pick and choose my care providers, and a LOT of the in-home care nurses have... issues (not all) but many. We have dealt with them and my mother in law so I have seen who they send. 2. They would not provide a driver, or allow their staff to drive me to appointments etc. even in my own vehicle.. again I know this because we are dealing with this with my in-law. 3. They would only do minimal housekeeping... minimal food preperation etc. They will only do what they are assigned to do, not what I ask or tell them to do. I can go on and on, but to be honest, it's either the VA ponies up, or I go into a nursing home. I'm not bringing some of the people they send to care for my in-law into MY home with MY 8 year old... I dont trust them. So many are habitual prescription pain med addicted it's not even funny... we have run into 3 CNA's so far who were dipping into the in-laws meds... anyway.. you right, but this is a special circumstance are rare in the VA system.

What you are bumping into is that certain meds are classified as "restricted", and ONLY certain doctors within the VA system can write a prescription for them. The Oxycontin MUST be wriiten by pain management, unless done by waiver. Oxycodone must be written by a MD, not an nurse practitioner... so its all staged and thats why you are doing these appointments backward. They are getting the major meds prescribed by the required department first. This is a GOOD thing, since you PCP probably couldnt write them. I ran into the same thing and asked the same questions of the doc's and thats when it was explained to me. If you look under the formulary table, you will see the VA offers certains meds but they are characterized as "restricted"....

I always end up going by release of info when I am at A VAMC for some other test or special exam etc... Since it seems like I am there at least every other month I have never had to mail in a request... I may do so for my latest psych C&P just to see how long they take. I am curious.

Thanks, yeah I understand the prerequisite requirements, and under what I can see I meet or exceed them. Also this C&P "seems" to support the need for A/A at R1. I spoke again with my PCP, and go tomorrow to see another PCP in the same clinic to be relooked and have him write a second opinion that should match hers... a supporting secondary opinion form another VA doc (she thought it might be a good idea, and I thought it couldn't hurt). The visit is a formality since she has already discussed the case and he agreed to review it, and add supporting documentation... but he wanted to physically see me before he wrote that I was bedrideen, needing 24/7 care etc. I can totally understand that, but the doc appointments are getting out of hand it seems. Like I said I am currently rated at L 1/2... so there's a bunch of stuff that goes in, but hopefully the rater will see that I am rated for loss of use of lower limbs, and with the incontinence catch the "o" rating... not discounting the ED (3 limbs and other stuff) I just really wanted someone to look at all of this and see if the could see a problem or something I had missed. I have never handled an R1 or R2 claim, and it figures that the first would be my own.... Anyway, any opiniion or help would be greatly appreciated.

Honestly, I think that the time frame is simply dependent upon where you live and the case load of the raters. If you live in a state with few military installations, then it seems your claim is handled much more quickly than in a state with a lot of bases. More bases means more vets in that area, means more time for a rating... I think it is that simple. You can try and get them to move quicker on a case, but that normally requires some congressional interest.. and that doesn't always do it. I think you Uncle is probably very eligable for some level of A/A... and I'd certainly file for it. Further, it sounds like he qualifies for adaptive vehicle grant, so he CAN go to his doctor... and probably a wheelchair. Now.. make sure your uncle is not a pensioned vetrean but a compensated one... since you said he was rated at 100% or greater I assumed this, but make sure in any case because the rules DO change for pensioners, versus compesationed veterans. Like I said I posted the C&P because I wanted some expert opinion, like Vike or some others. Sadly I have discovered that most of them no longer post on Hadit. Obviously some things happened while I was gone. I have discussed the issue with some of them and know some of their reasons..... (sigh)... thats enough computer for me today. Thanks all.

OK I was wrong.. at least I thikn I was.. the HISA (at this time as far as I can find is a ONE time grant)... but... please look at this case and the chapters 15 and down: http://www.va.gov/ogc/docs/2001/prc06-2001l.doc The guy was awarded dual, because he was requesting something totally different for Independent living.... They agreed to buid a sceened in back porch... so the guy could (paint, and commune with nature)..... I am fairly vertain that you can work around a bunch of this thru other programs.. Further, I dont know if you qualify for the SAF grant or not, but that can be used multiple times, up to the maximum benefit now.... So while adapatation may have already been provided under medical necessity, that does not preclude benefits under IL or independent living... they just cant be for the same things. Bob

OK, I think... I said THINK, I read that they had changed the lifetime alloowance to a rollover one. I will check and see.. howevere, these devices are NOT charged against the HISA grant so you might want to look at them... if they apply to your case. http://www1.va.gov/vhapublications/ViewPub...asp?pub_ID=1578 I'll get back to you if I can find the change or if I am wrong... in either case. Bob

Each day I become more bitter... and I dont want to die an old angry bitter man. It is getting so bad I wonder if its just not me. (sigh)... I am suffering from burnout, and my own medical condition isn't helping. They had the gall to send me to a neurologist (for this new issue) who insinuated I was lying. After YEARS of tests, and other much more experienced neurologists stating I was suffering from a whole slew of issues, after a rating of 100% for loss of use of legs alone, not counting all the others, and she acts like I am faking this crap. For the 1st time I called the patient advocate for myself. I told them I would refuse ANY further appointments with that... person. So well just have to see if they try and schedule me to see her again. I'm not worried about my rating, it wasn't a C&P exam or anything, and I am T&P with massive amounts of VA medical evidence and opinion to back me up.... it's just galling to have to listen to this junk from a lady whos has been licensed for less than a year (I looked her up). I dont know... I just dont know. I have stopped most of my advocacy until I get better, but even if I do, I dont know if I can continue...

Again.. icome is NOT a factor in A/A or SMC... period. I am certain of that. SMC is based upon need established by loss of use etc. Not income, nor does income play a deciding factor in eligability... only the rquirement outlined in CFR38.

the vet meets the maximum or a rate equal to the "O" award.and Actually this is a bit vague in CFR 38... but I, with my new problems qualify for "o" simply by having loss of use of 2 limbs and incontinence/loss of bladder and bowel... this is grounds for automatically awarding a rate of o. Thats not even taking into consideration the loss of 3 extremeties now (which entitles to the next higher stuatory rate M in my case, and the schedular rating for incontinence, as well as the other stuff. Inceased loss of function I guess they'll cover under IVDS... not sure. The biggy here is that my primary care doc, and this C&P doc both "seem" to agree that its needed... I just havent dealt with it before and am worried since I am going out tons of money each month on this. It simply a matter of them either providing it or a nursing home - thats it. Thanks for the input.

Yes they are but I am not really filing for "housebound" I am filing for bedridden, with need of increased assistance. So, since my current L 1/2 is greater than "s" I am diling for R1.-R2... which require a whole bunch more than housebound... basically 24-7 care is reqiuired by either skilled or "unskilled" care providers depending upon the level of care necessary...

100% T&P loss of use foot bilateral 40% IVDS 30% Lumbar Spine - w/ radiculapathy 30% Mood disorder - depression 10% Cervical spine 10% Scar residuals 10% Tinnitus 10% peripheral neuropathy - bilateral arms/hands There's a ton more but I dont have MY file in front of me.... anyway I am currently L1/2 rate SMC... The C&P exam is like 17 pages long... I'd rather not paste it, but I can include it as an attachment.... I'll just send the diagnosis pages first tho.... well I boiled it down to 11 pages anyway... the rest was testing and a pilonodial cyst...etc.

Huh, yet again the VA is inconsistent. I got it no problem with letter but I DO have a spinal chord injury... go figure.

Aid and Attendance is not income based. The ONLY instance where it might be is for a pensioner instead of a compensation veteran... There is NO means test for aid and attendance. Please if ANYONE can show me where SMC is rated based upon income... well I'd like to see it. It's NOT, unless the veteran is a pensioner... and even then I dont think it is, but I'll check. The qualifying criteria for A/A is set out in CFR 38 3.350 thru 3.363, this is established by 38 USC 1114, and in NO way is income a consideration foir qualification for a veteran who receives compensation... maybe pension recepients but not regular comp recepient. So in short, your VSO was wrong. http://straylight.law.cornell.edu/uscode/h...14----000-.html Thats a link to the law... and in no place ther does it say SMC is based on income... because it is not... it is paid for special loss, like the loss of a foot etc. or special needs INCURRED due to that special loss. Please show me where you were able to see something that stated otherwise. By the way, I have a household income in the low six figures, from investments, Social Security, VA Comp and other resources... and I receive A/A or SMC at an L1/2 rate, and will probably get R1 or R2 shortly.

What!... I would NEVER reccomend dropping Medicare... never.

Also if you have a worsening condition requiring further modification... I think the HISA rolls over again... like I said let me check this is "what I think" and not what I know, but I am CERTAIN that you can use it more than one time, at the FULL benefit amount each time.

Have you changed addresses? If so I think you can. Its not a one time deal, and I know of no time constraint. Is there one? I'll check and see. Also, 2 years ago the dealership I bought my Lincoln at received the $11,000 check in 2-3 weeks.

Please let me clarify to all... this is really a question for what I should advise people to do. I am already total and permanent, so it's not a question with my own claim... but for my advocacy. I was NOT, in any way attacking you luvHIM... I was asking a question for myself. I was in no way attempting to judge you ok?

No no... I wasn't saying anyone was flaming... sorry I wasn't clearer. I was asking a possibly inflammatory question so I was asking that it not turn into a flame.... because of what I said? OK? I was not saying that ANYONE prior to my statement was flaming, I was just asking a question I knew could lead to some hightened tempers and widely differing opinions, so I was asking that people please respond but in a calm manner.