Aid And Attendance At R1

[jeff]

Briefly here is my case:

I am SC'd for multiple sclerosis and chronic deep vein thrombosis. Just recieved in December 2008 an increase in SMC, to the M level, for loss of use of 3 extremities. Once that decision was made I decided to ask for Aid and Attendance. Now all I did was send a short letter to the RO, that I was requesting A&A. Of course I did this not knowing that there are actually 3 levels of A&A.

So here are my questions for this very confusing and complicated process. Should have I asked for A&A at the level of R1, which I am seeking? Or will the VA know that I am asking for the R1 level, because I am already rated higher than the regular A&A at the Level?

I am rated 100% for loss of use of both lower extremities, 70 percent for loss of use of right hand, 60 percent for deep vein thrombosis, and who knows what else. Im pretty sure I fit the criteria for A&A at the R1 level, but who knows? I read so many thoughts on this process that I am dizzy. Should have I asked for A&A before last decision, instead of increase to SMC M?

I need the A&A because my wife needs to assist me with my daily activities, such as bathing, eating, adjusting my right leg AFO brace, dressing me, INJECTING MY MEDICATION ,ect. So should I fill this VCAA letter fully even though all medical documentation is at the VA? Or just say expedite asap"? Also on the Medical Statement, my PCP is the VA, so should I have her fill it out or will the C&P examiner fill it out if an exam is required?

Sorry I guess this wasnt brief, but I have never had the undesirable chance for a claim being denied. I just want to make sure I have all my ducks in place before I send this back. Thanks

[Berta]

It IS complex-

I asked for R-1 for my CUE re: my husband-

I spelled out the evidence that would warrant that and certainly told them R-1 was appropriate (so they dont award the "S")

NVLSP decribes R-1 this way:

1. The veteran meets the Maximum rate of SMR "O" or a rate equal to the maximum "O" rate

and

2. The veterans also meets the requirements to basic or regular A & A under 38 CFR 3.352(a)

Then it adds the veteran must be rated at SMC "O" and be entitled to SMC "L".

You could even be eligible for R-2 as you need daily injections-

Do you have the VBM ? I am not allowed to copy too much from it- it goes into a little more detail than I could here-

Also BVA decisions under SMC R-1 ,R-2 might help you a lot-

due to weather I cant post a link and had problems getting here today-ice,wind, rain, snow, sun, wind sleet-

what a mess-

[Rich T]

Jeff,

Thank you for your service. I understand your frustrations. However, you must be in need of A&A 'over and above' your already S/C ratings to be eligible for R1. The way the VA looks at the ratings, is they have to remove the compensated disabilities as if they did not exist before they consider A&A (R1). When I was M1/2 + 2K I needed A&A, but since I was already getting more than the "L" award, I was not paid for A&A. After I lost bowel and bladder control I was entitled to "O" and thus "R1".

[jeff]

Jeff,

Thank you for your service. I understand your frustrations. However, you must be in need of A&A 'over and above' your already S/C ratings to be eligible for R1. The way the VA looks at the ratings, is they have to remove the compensated disabilities as if they did not exist before they consider A&A (R1). When I was M1/2 + 2K I needed A&A, but since I was already getting more than the "L" award, I was not paid for A&A. After I lost bowel and bladder control I was entitled to "O" and thus "R1".

Thanks;

Could you explain the O rating, because Im at the M + 1k but in need of wife to assist me with all my daily ativities including administering daily injections of meds and without assistance I am not able to put on my AFO brace. I am still going to submit this A&A response, but from what I am trying to interpret, is that my claim will more than likely get denied? Should have I asked for the A&A before this new SMC level increase?

I give credit to the examiner at last C&P exam, because he said I had other things going on and rated me for the loss of both feet instead of the 1 foot I asked for. However should have he not considered me for A&A then? Or was I suppose to ask for the A&A instead of just an increase due to LOU of 1 foot? So now I have LOU of 2 feet and 1 hand and only partial use of my left hand, bowel and incontinence rated at 40%. What is needed to get to the level to be considered for R1?

[Berta]

The 2007 Edition of the VBM Page 367 says :

SMC "0"= veteran must have conditions" entitling the veteran to TWO or More of the SMC rates (l) through (n) no condition being considered twice."

as example they give vet with vision loss bilateral -establishing the L award. The the vet also meets the regular SMC (L) due to other separate SC disabilities.

Because no condition was considered twice, the veteran meets the SMC O criteria.(4,313 for single vet -prior to COLA 2007 edition)

These SMC disabilities then could put this vet into Special A & A criteria- Special A & A under R-1 depending on medical evidence.

It helps to read SMC cases at the BVA for higher level awards.

Not only is SMC confusing but I bet many many vets do not get the proper SMC award at all-

and their reps dont understand it either most of the time.

[jeff]

Berta;

Thanks, any idea what I should be typing in on the BVA site to pull up, all I get is afew cases that are for date adjustments that were already decided"? I was under the impression that after my last decision was made and a increase in SMC was granted for LOU of 3 extremities, that under the general guide lines I could ask for A&A. That is obviously not so from what I have read here. I will continue to make searches on BVA cases on my own and see what you say.

[Berta]

I go to the 2007 decisions- because they would have any possible reg changes accounted for in them and I think I just put SMC R-1-into the search thing-

it takes some playing around at the BVA web site but worth spending the time-

By the way when I mentioned I asked VA for R-1 for Rod I also added 62,000 as the altered outcome of this CUE claim-and I said I subtracted his 100% from that for 2 years-and this is the historic rate SMC R-1 amount due vet with one wife and one child-

due to me as accrued due to their CUE.

this is funny-

Monday I sent these CUEs and all the VAola stuff to a lawyer and -in reading it all again-the amount I asked for sure seemed high- did I really substract Rods 100% for 2 years or not?? I started to fret about that and dont want to state anything to VA that isnt true-

then I realised Hell they arent going to read it anyhow so I just said-oh well it is what it is-

Maybe I better use a calculator-and check it- for sure that lawyer will read all of my stuff-

Try M21-1 too-

M21-1 is the VA manual that shows them how to interpret 38 CFR and 38 USC.

I am sure the VA web site has link to M21-1-

I often just google M21-1 then add a specific issue into the browser and usually get a good update right from the manual.