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.

[sixthscents]

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.

Edited November 20, 2007 by sixthscents

[theotherguy]

sixthcents,

I might be able to help you if you can give me some additional information. Can you give me a breakdown of your current service-connected disabilities with the evaluations along with your current level SMC? Sorry to make you post this again if you have posted it sometime before, I have not been here as often as I had in the past.

[sixthscents]

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.

Edited November 21, 2007 by sixthscents

[Berta]

I am a little confused here-

I thought A & A and the "S" Housebound award are technically included in the SMC "L" award-

???

[Berta]

The highest levels of SMC are- R-1 and R-2-

this might be a little off the main topic but it pays to explain these levels-

R-1 (aka Special Aid and Attendance)

Requirments for award:

1. the veterans is receiving the maximum rate or an equal rate to the "O" award and

2. the veteran meets the basic eligibility for regular A & A.

R-1 6164 per month for single vet no dependents

R-2 Special Aid and Attendance at a Higher Level of Care

Requirements for award:

1. the vet meets the maximum or a rate equal to the "O" award.and

2. the vet meets the requirements of regular Aid and attendance criteria

and

3.the vet needs a higher level of care as defined within 38 CFR 3.352( (2)

these involve needing the services of daily care provided by a licensed health care professional or by someone directly under supervision of a licenced health care professional.

The R-2 rate is $7,070 per month for single veteran-

RNs or LPNs etc are licensed professionals- this could involve the need for daily injections, catheter inplacements, changing of sterile dressings , physical therapy---etc

[sixthscents]

I am a little confused here-

I thought A & A and the "S" Housebound award are technically included in the SMC "L" award-

???

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...