Aid And Attendance

[sixthscents]

Since I am undergoing this process for R2 or R1 (whichever they decide) I thought it might be a good idea to start a topic and discuss what others went thru to receive it....

Currently my VA Primary Care doctor has stated that I would require skilled care 24-7 at home, or a referral to a nursing home. I filed the claim stating that if they couldn't provide the necessary funding, or some sort of home healthcare providers.. well they would need to place me in a nursing facility.

They came back with this huge list of claims... I was actually shocked.

I wrote them back stating that no I was not attempting to claim this or that... (I thought that listing my claims 1-5 and printing them in bold would be clear enough).. and restated my case. I then went to the medical C&P, and a VERY nice doctor did the eval. I had my primary care person (a CNA I pay for myself) present, and my sister.. a director of nursing at the closest VA contract nursing home.. also an RN. We had a care plan, etc.... and I gotta say the doctor was really really incredible. Now you never know exactly what they type until you pull the record, but she said things like "I not going to check that... its obvious and isnt going to improve" etc. etc... She had a LONG list of things she was supposed to check though, and with my sister/RN and the CNA I am paying a fortune for... $12 hr... (sigh) she was able to answer them without asking me almost anything. I do know that for all the rotation questions she answered no rotation possible due to injury and pain... or at least most of them.

I didn't realize that the VA does not provide home health care except for short periods. This is looking to be a long term issue, and I am honestly debating going into a nursing home. The ONLY thing stopping me right now is my 8 year old daughter.... (sigh)

Anyway, they also set up a psych C&P... thats going to be a joke though, they have me in weekly counseling now so they should have a fairly clear picture with me walking-wheeling in, but I expect a million and one questions. Just me and the wife for this one though.

Like I said its an issue between R1 & R2... I wondered if anyone had any experience with the differences... the applicable reg is CFR 38 3.350 and 3.352, but they are a bit vague to be honest I meet all the critrea for both. Obviously for those who know me this is all new. I have been out of the loop for quite a while, and am only VERY slowly poking around again from my bed (hey it gave me an excuse to buy the 22 inch LCD monitor and wireless keyboard etc.).

Anyway... just wondering. I am classed as "skilled" care if I was in a nursing home... so I wonder if that would make a difference?

Mmmm... probably need to know the new injuries... rupture at L5-S1/L4-L5 L2-L3... incontinence/w indwelling catheter... major pain major muscle spasms constant... (the doctor actually saw and felt them - I thought that was a good thing)in legs and lower back. Loss of ability to balance, loss of memory (pain meds I guess) etc etc..... loss of streangth, mobility, inability to dress or put on ortho aplliances by myself, bath etc. The CNA cooks, cleans -lightly, etc. Rehab has written me off not Voc-rehab... rehab. They say until this is fixed or the muscle spasms reduced physical therapy will do more harm than good. They even annotated this into my records so as to make sure no one tries...

How did it happen? You got me. One day I was bad but stable (had been for 2-3 years)... next morning I woke up with this... go figure.

Anyway... opinions accepted.

[john999]

Nam Vet

Your Uncle in entitled to nursing home care at the VA or another nursing home if the VA is full. If he is bedridden it may be better for him to be in a good nursing home. He may not want to go but he may live longer under constant and watchful care.

[john999]

I think as soon as my appeal for an EED for TDIU is decided I will apply for housebound. My diabetic neuropahty is making it hard for me to get around and I need help with many things.

[Stretch]

My father in-law was Army in WW2 and US Navy (Chief) in Korean war. Bill, had both his legs shot out from under him. Bill, has been sitting in a chair for the last 20 years. Bill, is 87(?) years old, and he is dying now (dead weight). He never was service connected, because he was put-off by the VA over the years with their redundant denial process.

All I need to get him AA, is his DD-214. My mother in-law is so torn up with resentment of the VA and Bill's condition that she will not/cannot even look for the record. This is the secondary reason and concern that I have for AA.

I think that there was discrimination against US Air Force and US Navy Vets years ago and now. Even though Bill was US Army in WW2, his last discharge was US Navy. Bill, worked as a cripple for many years before he became glued to his chair. The VA system, designed for discrimination of a class of Vets (US Navy, US Air Force), has caused so much resentment that these Vets have rejected the VA system and maybe even the misinformed Government that would let this happen.

Knowing what I know now, I try to help. Even mentioning the VA, only makes these past victims (family inclusive), of the litigious VA system, re-feel old wounds and pseudo dishonor presented to them by the VA.

DoD service Lifers, within the service who have intentions of loyalty to the DoD, tried to minimize, alter, and discard injury records that were service related in much the same way that the VA seems to lose or withhold the most vital records that are presented to them from injured Vets.

This disposal of injury records is premeditated and the Veteran left in the dark about the disposal not even thinking that this could or would happen until years latter (unwitting).

To see this VA problem, just look at and watch Haas vs. Nicholson.

Bill's wife, will not see a dime from the VA as she struggles trying to bath him, feed him, and the rest of what she has to do 24/7. To put that responsibility on a 75 year old woman is cruel. Evonne, has been doing this chore for about the last 10 years.

The mind set that a VA budget trumps the disabled conditions, to the detriment of any Vet, needs to be challenged. Ask Bill, to provide evidence. Bill, can't even talk. This would be chalked up as a win for the VA.

[sixthscents]

OK I went to the psych C&P today and pulled the records dating back to the last C&P to see what was actually said. I'll fill you all in but I want to answer some questions first.

OK SMC is Special Monthly Compensation - Aid and Attendance is PART of SMC... it is, for all intents and purposes just another name for SMC. The requirements to qualify for the different rates of SMC are covered in CFR 38 section 3.350-3.352. A simple search will pull up these pertinent sections, SMC is also covered in section 4 (Schedule for Rating Disabilities) under CFR 38....

SMC is money in ADDITION to compensation that is paid for aid and attendance of an individual. It is supposed to cover things like a person to help clean, a person to help cook, etc. It ALSO goes even further and if the veteran qualifies it will pay for full time care, R1 being essentially CNA's or just people hired who are following an established care plan by a licensed individual (primary care physician, nurse etc.... mostly nurses write care plans) R2 provides even greater funding for skilled care (LPN's and CNA's) who are there to provide wound care, injections, insertion and removal of catheters etc.

If you look up the compensation tables at www.va.gov, you will see a section below compensation labeled SMC... this is the rate one is paid if they qualify for SMC at the various levels. Again, a great many things go into determining each claim and the level of SMC they qualify for.

Now in paticular, in answer to the the person whos father is a vet with compensation etc. I would file for SMC and see what they came out with. It is important to note that if the SPOUSE of a veteran is also disabled (like say receiving Social Security Disability - or had prior to age 65) then there is additional funds paid... they list this fact at the bottom of the SMC chart and show how much extra, its not much but its something.

Financial Income has NO bearing on a veteran who is receiving compensation at the rate you described... or at any rate. It is not means based for vets who receive compensation, it is based upon the mad qualifying factors laid out in CFR 38 3.350-3.352 and the VASRD.

Honestly read the sections and the qualifying factors.... by what you say I would think that your father would qualify for SMC at an R1 or R2 rate... but it all depends on the primary care physician and what they say, the C&P doc, and what THEY say, and how the Rater interprets this information.

Personally after reviewing the statements made by MY C&P doctor, she was just as great as I thought. Based upon what she stated as fact, and what my primary care stated as fact... I feel comfortable that if the rater even has one wheel on the ground I'll get R1 at least. The C&P rater stated that I required assistance with everything, from walking to cooking, to well everything except eating... every other category she put requires assistance. She noted the muscle spasms, the loss of feeling and complete (almost) loss of streangth. She stated that I would be permanently bedridden for the rest of my life. While this fact does NOT fill me with joy and happiness, the idea that I might get some assistance in paying for my CNA's is really great. If we had not been financially very stable prior to this, well I dont know what we would have done. As it is, its like pouring money out a boot every week paying for these baby-sitters out of pocket. Again, hopefully they will back pay me.... I can dream right?

Now, you asked what are the differing requirements between R1 and R2... from what I can see one is care by cna's or lessor qualifications simply following an established care plan, with periodic follow-ups with the case manager (telephone monthly is fine)... R2 on the other hand is "skilled" care where the care givers need to be a little higer certified CNA's LPN's etc to do the necessary functions... like injections, rehab therapy, wound crae, etc...

So, it all boils down to the level of care the VA deteramines is necessary for the individual, and how much....

The rating tables for SMC start at K (I dont know why they didnt start at A, but K it is) an thats like only an additional $90 dollars ($87 i think) that goes on top of a veterans normal compensation... the rates then go L,M,N,O/P R1,R2, and S... plus there are half-rates... so there is an L1/2 rate, and an M1/2 rate... this does NOT include R1, R2 or S... there is no R1 1/2 rate. As the rateings go up the money significantly increases... hang on Ill cut and paste ONE section...

This is ONE section of the SMC rate table...

--------------------------------------------------------------------------------

Without Children, SMC-L through SMC-N

Dependent Status L L½ M M½ N

Veteran Alone $3,075 $3,233 $3,392 $3,626 $3,860

Veteran with Spouse $3,214 $3,372 $3,531 $3,765 $3,999

Veteran with Spouse and One Parent $3,326 $3,484 $3,643 $3,877 $4,111

Veteran with Spouse and Two Parents $3,438 $3,596 $3,755 $3,989 $4,223

Veteran with One Parent $3,187 $3,345 $3,504 $3,738 $3,972

Veteran with Two Parents $3,299 $3,457 $3,616 $3,850 $4,084

Additional A/A spouse. See footnote (:) $126 $126 $126 $126 $126

Normal Compensation table with the same qualifiers...

70% - 100% Without Children

Dependent Status 70% 80% 90% 100%

Veteran Alone $1,135 $1,319 $1,483 $2,471

Veteran with Spouse Only $1,232 $1,430 $1,608 $2,610

Veteran with Spouse & One Parent $1,310 $1,519 $1,708 $2,722

Veteran with Spouse and Two Parents $1,388 $1,608 $1,808 $2,834

Veteran with One Parent $1,213 $1,408 $1,583 $2,583

Veteran with Two Parents $1,291 $1,497 $1,683 $2,695

Additional for A/A spouse (see footnote B) $88 $101 $113 $126

So in comparison a rate of N of SMC is $3,860, while simple comp at 100% rate is $2,471... that a difference of $1389. The veteran gets this 1389 in addition to the compensation rate.

PLEASE NOTE that you still get additional compensation for a disabled spouse under NORMAL compensation as well as SMC.....

Now the veteran can be rated at 10% comp, and get an additional SMC rating... its kinda improbable but a vet could get 10% comp and an SMC rating of say N, and get that additional $1389 paid on top of their 10%... not likely but possible I suppose.

OK so, I HOPE this helps explain SOME of the things about Aid and Attendance (also referred to as A/A) aka Special Monthly Compensation. You are going to have to do SOME of the research on your own because its just too much for me to type... please go to the references and read them. Then hit me with some questions...

Further, If a rater or ex-rater would like to chime in here and ask me what the doc and rater said and give me an idea if I'll get R1 or R2 I'd REALLY appreciate it. I think I know the deal, but it NEVER hurts to get expert opinion... and dont worry if you say I am completely wrong I am a big boy, and can admit error. I am just trying to make sure I am reading this stuff right in my own case...

OK... I can type no more... this is killing me.... sorry.

Bob Smith

[sixthscents]

Streach...

I am personally sorry that this has happened. Yeah the VA raters sometimes are just idiots... not all but some. I am trying to be fair because I have met some really decent ones.... but I gotta say they are not the majority. I already ranted today about this... so all I can say is... I'm sorry. I wish it were different.

[Stretch]

Sixth, there is nothing that we can do about changing the attitudes for formerly snubbed Vets. I have tried smooth approach and even mentioned money that could be gained. They just don't care about the VA. Bill, isn't even going to last long enough to go through it anyway.

My C&P is tomorrow. Thanks for the information and the time you spent getting it.