ptsd A&a

[Annie M]

First I want to thank Berta for the help she gave us in filing my husband's claim. He was, eventually, given 100% for PTSD. He was denied for his brain stem meningioma/agent orange claim. I guess I will have to find the energy to argue that one, but we found out I had leukemia and needed a bone marrow transplant- it worked, but I'm tired.

Now I have a question regarding Aid and Attendance. Our service officer said that the disability to claim A&A does not have to be service related, to have any doctor we see regularly to fill out the form, and to make sure he/she "checks the TOP box" (requires daily personal health care services of a skilled provider without which the veteran would require hospital, nursing home, or other institutional care), otherwise we're "just spinnin' our wheels". (form 21-2680). My husband is hemiplegic, my daughter and I prepare his food, dress him, take him to therapies, give him his medications, check his blood sugar, etc. He is never left alone as we're afraid he'll have a panic attack without us. We moved a bed to the first floor so someone is always near at night. Do I believe the SO? We have an appt. with his private internist in a couple weeks, but I could contact his VA primary care. Thank you!

[Berta]

Annie-I am so glad he did get the 100% SC but I sure am confused here:

"Our service officer said that the disability to claim A&A does not have to be service related"

BUT a vet on a VA NSC pension can also receive A & A-

so he must be right-it makes sense-but I just dont know-and hope others will chime in-

It seems to me that his panic attack potential- which I assume is due to his PTSD would certainly qualify him for the Housebound status and that his NSC conditions must surely be "aggravated" by his PTSD and some could be rated as secondary SC due to aggravation.

By all means apply for this benefit-but I think any medical statements would have to be carefully worded.

Did the rep see the possibility of SMC S for Housebound? (the same rate as A & A I think)

I have to give this all some thought and read what the VBM says on it-

You are dealing with a lot yourself-

was he given 100% with P & T? That would give you the CHAMPVA health care benefit.

[Berta]

PS-did the VA fully rule out his meningioma as not being a soft tissue sarcoma?

Did they provide a good medical rationale for that?

[john999]

Annie

I think your SO may be giving you bad information on this. I think the AA has to be the result of the SC condition. I am not sure either but I would look into this. If your husband was in a nursing home it might be different. It just does not sound right to me knowing the VA to be as stingey as they are. I read a case where a vet who was 100% for a mental condition and also blind from NSC condition was denied A&A because the blindness was not SC. Like Berta says the wording is important so as not to get automatic denial. Surely housebound is an option because that has been proved by Pete right here on Hadit.

[Ricky]

From my understanding he is right. However, anxiety and panic attacks should be due to his PTSD. If not surely the PTSD aaagravates it. This will be a medical question that will have to be answered by his physc doc.

I would get a positive medical opinion and then apply for the A&A. It seems as though he meets the requirements all that is missing is the nexus.

[sixthscents]

A lot of people seem to confuse Aid and Attendance, and Special Monthly Compensation. For VA purposes Aid and Attendance IS Special Monthly Compensation.. at ANY rate from K and up to R2...

Since I have been dealing with this same issue myself, A/A that is I do feel somewhat qualified to make a few observations. A/A does not require that the illness be service connected... HOWEVER there are a BUNCH of qualifiers if it isn't. Simply put it's MUCH easier to get A/A for a service connected condition, as opposed to a situation arising from service RELATED condition. It's a sublte distinction but let me give you an example:

A veteran rated above 50% ends up requiring "age-appropriate" nursing home care.. the VA is obligated to provide it. Reguardless the circumstances.

Now Special Monthly Compensation is provided for specific cases where Congress has dictated certain amounts of monies to compensate for the necessary expenditure of money for care...

For instance: loss of use of two appendages is an L rate... as outlined in CFR38 3.350. If you call the VA they will refeer to this SMC AS aid and attendance.. since its to offset the cost of said someone to help clean your house, maintenance that you cannot perform yourself anymore etc.

Now.. when you get to nursing home level care we are talking about R1-R2 SMC rate... and all that is required to fullfill the need for it under CFR 38 (3.362? its somewhere close to that look up 3.350 and it'll give you the exact reference)... further M21-1MR has quite a bit to say about it.

Personally I would file for an SMC rating of R1 or R2 and then let the VA file the necessary C&P exams (there's 2 - a psych and a medical)... your primary care physician WILL have to make the reccomendation for nursing home care, but this can simply be annotated in the medical record, and that used to file.

The medical exam I posted last month or so should still be around in this section... look up my user name and go thru my past posts. I actually posted the majority of my medical C&P for R1-2, and it will give you some idea of the questions which will be asked. You should also note that the doctor is filling out an electronic form... in essence they are simply answering the questions the computer presents them on your case... does that make sense? Anyway feel free to look at mine, check the reg and ask anything else you may need.

[Pete53]

The VA should have considered HB or S rating when they awarded 100% for PTSD. Right now I have it but I am fighting for an earlied effective date and lots of back pay cause it was not considered when I was awarded 100%.

However, get the form filled out and your husband will be given a C&P and you should go and explain to the Doc what is involved with your husbands care. Its a slam dunk in my opinion.