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jamescripps2
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Posts posted by jamescripps2
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As a last resort, after six denied appeals with the VHA, I asked the BVA to revue my case .For the reason that I am a R-2 veteran, I asked that my level 2 PCAFC case be advanced on the Board's docket. The Board agreed and my level 2 PCAFC benefits were granted by the BVA on June 22, 2022.
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By far, I am not the expert. However, after going through the initial application process, including the exams and interviews for the PCAFC caregiver's program, not once but twice, and after six Veteran's Health Administration (VHA) appeals in the last twenty two months, I finally won level 2 benefits at the Board of Veteran's Appeals (BVA) on June 22, 2020. I am now willing and able to share what I have learned about the caregiver's program and how to defeat a VHA denied PCAFC decision, if you feel that you meet the eligibility requirements. On 7/14 / 2022, I will be getting knee deep into the nitty gritty details with Jerrell and John on the Exposed Vet podcast.
I will restrain myself in the interest of professionalism on that podcast, but make no mistake about it, the VHA put me, an R-2 veteran, through pure hell over that twenty two month period and never relented. I doubt that the VHA even knew what an R-2 veteran was. In their decision making process the VHA didn't seem give a dam what the laws and regulations said, and they didn't give a dam what the evidence said, they just arbitrarily denied the claim. The expert CEAT team in VISN 9 conceded that I needed help with five ADL's as far back as February 2021, yet they still belligerently denied level 2 benefits without offering any explanation of reasons and basis for the obviously erroneous decision. The VISN 8 CEAT team, "after a compassionate and thorough review" of my medical records, along with my submitted evidence, denied my last VHA appeal in less than 24 hours after it was submitted to the VAMC Nashville Tn. Patient Advocate. Now if you buy into that crap, I have some ocean front property in Tennessee that I would just love to unload on you.
As due to a recent court case, denied veterans and their caregivers can now ask the BVA to review denied PCAFC cases. The VHA never anticipated that one day the Board would be able to peer over their shoulder and review their work. I can only imagine the thoughts going through the BVA judges mind as he read the overwhelming evidence in my case, only to be denied six times by the VHA, so called, expert CEAT teams. As thousands of veterans and caregivers are appealing PCAFC decisions, can you imagine the backlog of PCAFC claims that is being created by the ineptness within the VHA. There will be thousands of cases, just waiting for review at the BVA.
On the bright side, there has been a really good development of late in that the Senate Veterans Affairs Committee has finally heard the loud cries of the most disabled veterans on the planet. Senator Tester, the Chair of that committee, said that the caregiver program is the most gut wrenching thing that he has ever had to deal with in his fifteen year tenure.
The podcast is 6:00 PM central time and the call in number to listen in is (515) 605-9764. To be brought into the Q so you can ask a question or make a comment dial 1 at anytime. Every dog has his day! See you there.
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That is just it broncovet, they, the VHA, gave no excuses, they just state that you don't qualify and render an arbitrary decision. Unlike the VBA they are not required to give a reason or basis for a decision. I always knew that If I could manage to get my case before the Board that it would be granted hands down because the evidence was totally in my favor and always was. The VHA just ignores the evidence.
We will hash it all out on the Exposed Vet Podcast next Thursday evening, the 14th with J Basser and Jerrell Cook.
- Vync and blahsaysme2u
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After six denied VHA appeals for level 2 caregiver's benefits I appealed to the BVA. On June 22,2022 I was awarded the maximum level 2 PCAFC benefits by the Board.
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I am almost sure that this is the very first PCAFC case to be heard before the BVA.
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In October 2020, after more than ten years of exclusion and being fenced out from participation in the program for pre 911 veterans, the Program of Comprehensive Assistance for Family caregivers (PCAFC) under the new eligibility regulations in accordance with the provisions, and as defined by the Mission act, was expanded to include Vietnam era veterans. I applied for caregivers benefits on October 7, 2002.
Due to the flood of new applications the decision took about six months. Although, according to the new regulations, my caregiver and I clearly met the eligibility requirements for level 2 benefits we were awarded level 1 benefits. I immediately appealed. I was denied with no reason or basis given. I again appealed. I was then told that two appeals was the end of the line for me in the appeal process. I then asked for a chance for recertification, as it had been a year since my original application submission. My request for recertification was approved by VISN 9 but I was warned that recertification could bring about severance from the program for myself and my caregiver altogether.
The recertification process produced a continued award of level 1 benefits. I again immediately appealed and was once again denied. I immediately appealed again and was denied the very next day, in less than twenty four hours, by the CEAT team in VISN 8. After six wrongfully denied appeals for level 2 caregiver benefits before the Veterans Health Administration, (the VHA), I was still being denied with no reason or basis for the denial which was certainly not in accordance with the laws and regulations governing the CPAFC program. I spent many hours upon hours preparing for each appeal.
During the prosecution of my claim and as due to a Court of Veterans Appeals case, the law was changed to allow more than just two VHA appeals. Now we were not limited to just two VHA appeals, we could also appeal to the Veterans Benefits Administration. (VBA). Now we could ask for a higher level review or a supplemental claims appeal which are useless as they are both adjudicated by the same folks, the VHA, who have already shown their ineptness in rendering fair and impartial decisions. The Court rendered a decision that we could also ask for a review by the Board of Veterans Appeals, and even to the Court if need be.
In compliance with the order of the Court, I was notified by the VHA that I could ask for a higher level review, a supplemental claim, or ask the Board to review my case. At the same time, I was warned by the VHA, in what I took to be a threatening way, that if I chose a Board review and the Board denied my claim, that would be the final and the end of it for me.
I asked for the HLR, and my case was quickly closed, no decision, just closed. Immediately I asked for a review by the BVA, and that my case be advanced on the docket as due to my being a R-2 vet. The Board agreed to advance my case on the docket as the evidence of record supported the advancement of my case on the docket..
On June 22,2022, the Board granted my level 2 CPAFC benefits using the exact same evidence of record as was used by the VHA to deny me so many times. The BVA furnished a full explanation of reasons and basis for its decision to grant the benefit. I will be looking for my retro back to October 2020, which is well deserved by my faithful caregiver's free labor of many years.
Let me say this in closing and you can draw your own conclusions as to whether or not I should or should not have prevailed and what your own chances are if the system isn't fixed. My VA providers and my outside providers, do and have always supported my claim for level 2 benefits with letters and record entries. I have three 100% P&T awards and many, many lesser awards for both physical and mental disabilities. I have fourteen large painful service connected and rated scars. I run on a battery. My body has been completely reconstructed from my knees to above my navel as due to service connected circumstances. More than a few doctors and providers have stated in the record that I cannot sustain in my home or community without a caregiver. No veteran of any era or branch of service has ever been awarded a higher disability rating than I carry, and no veteran of any era or branch of service draws more monthly compensation than I do. VISN 8 CEAT team conceded in February 2021 that I needed help with five of the seven listed ADLs but they ruled that I still did not need assistance so as to require level 2 benefits. Considering all that has been said here, for what reason was was I and my caregiver put through so much grief and agony to the point of loosing what little self respect that we had left ????????????
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Sorry Broncovet, you are out of touch with the caregiver program, (PCAFC). The Pcafc program is adjudicated by the VHA, not the VBA. They do not follow the same rules and regulations that you and I are accustomed to. They can and are kicking people out of the program with no reason or basis required. There are no exams required to oust you from the program. We have no defense against this situation and the appeals process is a farce as the appeals are also adjudicated by the VHA. True, one can request a revue by the BVA, but the Secretary has told the Board not to hear those kind of cases at this time. Can you imagine how this situation is going to inflate the BVA backlog who are already working 200,000 cases behind?
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My request through FOIA about the number of PCAFC appeals and how they were adjudicated
2022.03.08 FOIA Acknowledgment.pdf 475636384_Responsive22-03882-F(1).pdf
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If the issues concerning the PCAFC caregiver program are not exposed to the taxpayer and shined in the eyes of the politician, the pre 911, "Vietnam era veteran" has no chance.
The stay that was ordered by the Secretary to stop the severance from the program only concerns the post 9/11 legacy veterans.
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In my prior post above, compare VISN 5,7, and 8. I look at that as if my appeal had ben adjudicated at VISN 5, I probably would have been granted.
Considering all, the words "VA Licensed Social Worker" is fast becoming dreaded words in the world of a disabled veteran, sort of like speaking to the wicked witch of the North.
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My request through FOIA about the number of PCAFC appeals and how they were adjudicated.
2022.03.08 FOIA Acknowledgment.pdf Responsive 22-03882-F (1).pdf
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Those who are experienced and knowledgeable already know that the Veterans Health Administration (VHA) has demonstrated that it does not play by the rules and regulations that govern the PCAFC program and have no intentions of doing so, no matter what the evidence shows. That being said, If you elect a fair and impartial VHA appeal, you can expect a rubber stamped denial with no reason or basis for the arbitrary decision.
If you elect to do the Higher Level Revue (HLR), that decision is also in the hands of the VHA who has already denied you once. Expect to be rubber stamped again by the same fair and impartial entity who denied you before.
If you elect appeal using the Supplemental Claims route, guess what? The VHA gets another shot at denying you once again using the rubber stamped fair and impartial arbitrary denial process.
Understanding all of the above, the VHA would rather that you appeal to the Board of Veterans Appeals (BVA) That is exactly where the VHA would like to see your claim go, but it is a a dilemma, because the Secretary of the Department of Veterans Affairs has ordered that the board not hear those kind of cases at this time! The BVA works for the Secretary so again, guess what? The Board is obliged to follow the orders of the Secretary and the veteran is placed between the hammer and the anvil. To date, there has never been a PCAFC case heard by the Board.
In my own case, after six VHA appeals my claim is at the Board. Although the Board, as stated above, does work for the Secretary, the Board falls under the Veterans Benefits Administration (VBA), not the Veterans Health Administration (VHA).
The Board does follow the rules and regulations. With much experience, I can say that in the end, if the Board hears your case, the chances of you getting a fair and impartial revue are pretty good. At least at the Board you can expect a reason and basis for the grant or denial.
I am confident that my PCAFC case will be granted at the Board, hands down, because the evidence is solid and indisputable. I just don't know if I can outlive the process of getting the case to the Board to be adjudicated.
I can't recommend what appeal route to take but I will say that if you elect to follow the VHA, HLR, Supplemental claims route your denials will come rapidly. I went through six appeals inside three months with the last appeal being submitted on Feb 16, only to be denied on Feb 18 with no reason given for the arbitrary denial.
As part of the mission act reform of the PCAFC the process was to become more consistent and transparent. If it was indeed transparent we would have access to who the CEAT members were along with their qualifications.
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Cut and paste the link into your browser. This is just a minimal evidence sample. I have many more doctors saying the same thing. I can post more if this is not convincing.
file:///C:/Users/james%20cripps/Desktop/Three%20page%20evidence.pdf
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Here is what you are going to be up against when making application for the caregiver program which was expanded due to the passage of the Mission Act.(PCAFC)
When you compare the plainly written regulations with the evidence as presented, decide for yourself if the claim should have been granted, or if the decision was arbitrary denied and therefore cannot be defended by the VHA. The VHA adjudicates PCAFC claims, not the VBA, so there is no consideration of the benefit of the doubt, nor is a non adversarial process. The attitude of the VHA seems to be, lets see what we can do to separate this disabled veteran from his benefits.
As a last resort you can appeal to the BVA, but that is a life sentence to us older and severally disabled vets. The Board is working 200,000 claims behind and they are working 2018 claims at this time despite being given their requested extra funding.
The real kicker is the fact that the Secretary has instructed the Board to not hear those kind of cases at this time. So, the veteran is being placed between the hammer and the anvil. That is called legal abuse
If you have ample proof and have been denied PCAFC, please post your case. Just solid cases please, no whiners please.
Don't like it! Contact the Secretary, your Congressmen, and your Senators.
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03/10/2022
I am a Vietnam era 100% service connected disabled veteran. I have been awarded the maximum special monthly compensation at the “O” rating. I also have been granted Aid and Attendance at the R-2 level. No veteran of any era has ever been awarded a higher disability rating than I have been awarded. There are very few R-2 rated veterans worldwide.
In October, 2020 the Program of Comprehensive Assistance for Family Caregivers (PCAFC) program became available for application by pre 9/11, older era veterans. I read the eligibility requirements and applied for the program. According to the clearly written regulations, my caregiver and myself clearly qualify for maximum level 2 caregiver benefits, We were assigned minimum level 1 benefits instead.
I exhausted my appeal rights by appealing the maximum of twice to the VHA, I was denied both times. I then asked, and was granted a recertification. Once again, I was awarded the minimum level 1 benefits. Again, by filing the maximum of two appeals, I exhausted my appeal rights before the VHA a second time.
Please note that on the last VHA appeal adjudicated by VISN 8, the “fair and impartial” review by an expert team included a review of my appeal, a review my medical records, and a review of my prior appeals. The entire process only took less than two days, The appeal was submitted on Feb 16, 2021 and a decision to deny was rendered on the 18th of Feb, 2021, with no decision reason or basis offered.
Given no other choice, I next filed a Higher Level Review. ( HLR) That appeal was filed on March 1, 2022 and according to E benefits, it was closed on Feb, 14, 2022. And yes, there is no typo here, it was closed before it was even received. The VHA is also the assigned to adjudicate in the HLR process.
It is evident and obvious that regulations governing PCAFC are disregarded. The decisions are arbitrary. The inept general attitude of the program seems to be” What can we do to deny this veteran”. The adjudication process of the program is conducted by the VHA, and is not a “non adversarial” process.
I am sure that Congress, in the passing of the “Mission Act” never envisioned the extent of the shenanigans that are being executed by PCAFC in order to separate the most seriously ill and disabled veterans from their benefits. It is a dis respectful, unlawful, unacceptable and disgraceful practice.
Upon learning that my HLR claim had been prematurely closed with no decision whatsoever, on March 10/ 2022, for whatever it is worth, I filed a Supplemental Claim.
If the Supplemental claim is denied, I will next seek a review at the Board Of Veterans Appeals. A Board review is exactly where the VISN adjudicators want to see our claims end up. I know, and they know, that the Secretary Of The Department OF Veterans Affairs has ordered the Board not to hear PCAFC claims at this time. Those claims will be filed in a dark place, not to be opened for many years to come.
The Board, at this time, is backlogged at 200,000 cases, and are working on cases filed in 2018. That relates to a death sentence for me and many others of the most severely disabled population.
I expect that anyone prying into the unlawful PCAFC decisions to meet fierce opposition as those people have a smug way of defending the decisions that have been arbitrarily rendered. As I have discovered, they defend one another. They have no intention of complying with regulations as laid out by Congress.
Thank you for your interest,
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True hero? Nah, just a run of bad luck, but I served with, and personally know, a lot of true heroes!
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On Feb. 1, 2021 I filed for R-2. R-2 was granted on March 16, 2021. The entire process only took 36 days, start to finish, and that included a C&P exam.
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The Mission Act expanded caregiver benefits to Vietnam and Korea area veterans. Prior to the mission act the benefit was only available to post 911 vets. This has nothing to do with A&A. In fact, I have A&A in addition to the caregiver benefits. Click the link below to become familiar with the caregiver benefit under the Mission Act. You only need a 70% service connection to apply.
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The VA cannot bill medicare, no way, no how.
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My wife and I applied for the new pre 911 caregiver's benefits under the Mission Act on October 7th 2021. After going through the application process, three interviews, and the required training, we were successful. My wife was assigned as my official caregiver and received her ID card and packet.
The process took about five months. Her back pay will go back to the date of application. The problem is that she was awarded the lower pay level, level one. We immediately appealed the decision, asking for level 2 benefits. I am a R-2 rated veteran. There are no veterans, either post 911 or pre 911 that have a higher rating than I do. My wife assist me with seven ADL's and I could not sustain in the community without her help. My question in the appeal is, if she does not qualify as a level 2 caregiver, then who does?
A veteran must appeal that kind of decision through the VA hospital patient advocate. The appeal is passed up to the proper VISN and they are bound by statute to make a decision within 45 days from the date of the appeal. I am confident that we will prevail.
A level one caregiver only receives 62% compensation. A level 2 caregiver receives 100% compensation. I feel that my caregiver fully qualifies as a level 2 caregiver and I am willing to stand up for her and fight for it.
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My bank account got a boost this morning due to a retro deposit as a result of a grant for an increase from R-1 to a R-2 rating. I filed a ready to rate claim on Feb 1, 2021. My C&P exam was preformed on Feb.12, 2021 and the claim was granted on March 16, 2021. I also was awarded an increase on Chloracne from 0% to 20%. I was awarded another 30 % for painful scars. I have seventeen rated scars, most scars are from four to fifteen inches long. I did not file on the scars, they were discovered on the C&P exam and awarded as a result of VA's duty to assist.
I also have a COVA case pending for an earlier effective date of SMC R-1. I have won a joint motion for remand and the case is at the BVA awaiting a new decision at this time. I expect a decision in May or June.
I would like to thank all of the folks at Hadit for the years of correspondence, advice, and encouragement. I also must say that a lot of this would not have been likely without the experience, words of wisdom, and information provided from Alex Graham.
I began my claims process sixteen years ago in 2005. My first success and grant was on November 2, 2009 with the first ever Agent Orange exposure claim granted for exposure at a post or base inside CONUS. That win was for 100% plus an "S" award and 1-K.
“Life should not be a journey to the grave with the intention of arriving safely in a pretty and well-preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming “Wow! What a ride!”
Hunter S. Thompson STOLEN FROM ASKNOD'S BLOG!
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In my research on the subject of family caregiver compensation, I have never been able to determine if the caregiver stipend is taxable.
After seventeen years of fighting the VA stick a fork in me, I am done!
in R. 1 and R. 2
Posted · Edited by jamescripps2
I began my VA claims saga in 2005. My first success was in November 2009, whereupon I was granted the very first claim for AO exposure at a military instillation in CONUS. That award was a 100% P&T plus an "S" award and 1 "K". The award was for Diabetes due to AO exposure, ischemic heart disease claimed as secondary to the Diabetes, and Chloracne. In the subsequent years there have been numerus other claims and grants including three 100% P&T awards. I filed for, and won at 100% P&T, loss of use of right hand and right foot. In July 2020, Fournier's Gangrene dammed near killed me and I won that one too, in short order. That Fournier's Gangrene claim as secondary to chloracne, took forty five days, submission of the claim until grant. Severe anxiety and depression as due to my service connected general medical conditions claim only took thirty five days to grant. Fourteen scars, some rated as painful, were added to the mix, an implantable cardioverter-defibrillator will always get you a 100% P&T, and so will class 3 kidney failure. Severe Neuropathy x four limbs adds up quick at 40% per limb and will get you the bilateral factor too.
In 2016 I was granted R-1 for A&A plus loss of use of two limbs with an effective date of November, 2016. I banked my retro, got my vehicle grant with adaptive equipment, and initiated my specially adaptive housing grant. Next I filled an appeal for an earlier effective date back to 2011 on the R-1 grant. As one would expect, he appeal was DENIED at the RO. I filed an appeal with the BVA. The BVA DENIED the claim. I then conferred with Alex Graham who was too booked up to take my case but instead hooked me up with the CCK law folks. We then took the case up to the CAVC. At the CAVC the case was granted a joint motion for remand (JMR) and the case was sent back to the Board and, in turn, was remanded back to the RO where it was once again, DENIED. Next a higher level revue (HLR) was filed and the result was that the Veterans Law Judge (VLJ) found a failure of the VA's duty to assist. A C&P was ordered to rectify the error as to be compliant with the VA's duty to assist order and the case was returned to the VLJ for a new decision.
On October 14th 2022, a new decision was rendered. I was granted five years earlier effective date of R-1 with five years retro.
In the interim, on August, 1, 2020 was granted SMC R-2. My final rating is R-2. Considering the fact that there is no VA rating higher than an R-2, and my back pay issue has been addressed by the Court and now meets my satisfaction, I am at the end of the line as far as VA claims are concerned. The only outstanding future issue is a hard earned burial flag and a small plot of ground in the Tennessee State Veterans Cemetery just west of Nashville.
P.S. I need to add that on June 22, 2022, I won the very first PCAFC case granted at the BVA. That grant by the Board was for PCAFC level 2 caregiver benefits for my caregiver.