Pete Has It On The Ball For A & A

[gdsnide]

PETE

U were right in answering A & A is added to 100% Comp. where all the others said "NO"

Thank U again for the good answer & know wife wouldn't be worth much on her own A & A but will take every penny I can get.

Now all I have to do is win the damn thing. HA Have favorable opinions from every VA Doc I see

GARY

[windy city]

If possible, and you are not in dire straits for the money, then I would hold off on filing it until your appeal is resolved. If you file a new claim during an ongoing appeal, it can gum up the works.

rentaguy1

I have a question is it true that if you recieave a&a at the L rate and recieave another L for loss of use of an extremity that will put you at the R rate?

[john999]

One thing is that if you think you may be rated 100% schedular it is good to also apply for housebound. What might happen if you don't is you get 100% and then apply for HB and they use the date you applied for HB as the effective date and not the date you got 100%. This is all wrong, but the VA will do it. When you get rated 100% you have an inferred claim for HB, but the VA will not adjudicate it. They may pretend they did when you ask for it five years later. Then you have to file a CUE, like Pete, and fight that battle. The VA knows exactly what they are doing. They know that most vets don't know these facts and will not ask for retro HB via a CUE because they don't even know what that is ,and their VSO does not either. I think it is the same with all A&A. You have an inferred claim but the VA just ignores that until you actually claim it. Just like if a VA social worker documents you are unemployable you have an inferred claim for IU.

[rentalguy1]

windy city...I am not that good at combining rates of SMC, but I think that would be "S." Don't quote me on that, though. I pretty much only know what qualifies a vet for the HB and the different levels of A&A, as well as SMC "K."

John: I'm not sure how a 100% rating automatically infers a claim for HB. Take me for instance; I stand to get a schedular combined rating of 100%, plus A&A, yet I am not HB. It isn't inferred anywhere that I am HB. Yet all of my records say that I need the assistance of my wife to bathe, dress, drive, and avoid the hazards of everyday life. Also, unless a claim is actually inferred by the VA, the effective date is the day that the claim was filed. Not the day that you got the rating, and could possibly have had the claim inferred, if the VA happened to see the 2 progress notes out of 200 that mentioned that you are unable to leave your house.

[john999]

Rentalguy

What I am saying is that when you are rated 100% schedular for one disability the VA is supposed to consider you for HB. They are supposed to make a determination as to you being HB or not. They don't have to award you HB, but they are supposed to consider you. It is like if you are unemployable and rated 70% or above the VA is supposed to make a determination about IU. I have to tell you that unless until you are rated 100% for a single disability I don't think you are going to get any A&A. The easiest A&A to get is HB. The rest are much harder. If you are rated 100% and are still working I don't see how you are going to get A&A. If you can point out a case where a vet is rated 100% and still working and getting A&A I would appreciate it. Most getting significant A&A are so disabled they need help getting to the toilet. Work is out of the question. You need to be 100% for a single disability and not a combination of disabilites. 100% plus other disabilies is what gets A&A. If I am wrong about that then I am wrong. The VA I know about does not give A&A to vets who are working. Most vets getting A&A are in wheelchairs or nursing homes. Plese point out exceptions.

[rentalguy1]

John...the BVA site is down right now, but you can search and find plenty of people who are not in a wheelchair, or a nursing home getting A&A awarded. The regs do not say anything about needing any of that, or a single disablity rated at 100%, or a single disability rated at any percent for that matter. The reg says:

Sec. 3.352 Criteria for determining need for aid and attendance and ``permanently bedridden.''

(a) Basic criteria for regular aid and attendance and permanently

bedridden. The following will be accorded consideration in determining

the need for regular aid and attendance (Sec. 3.351©(3): inability of

claimant to dress or undress himself (herself), or to keep himself

(herself) ordinarily clean and presentable; frequent need of adjustment

of any special prosthetic or orthopedic appliances which by reason of

the particular disability cannot be done without aid (this will not

include the adjustment of appliances which normal persons would be

unable to adjust without aid, such as supports, belts, lacing at the

back, etc.); inability of claimant to feed himself (herself) through

loss of coordination of upper extremities or through extreme weakness;

inability to attend to the wants of nature; or incapacity, physical or

mental, which requires care or assistance on a regular basis to protect

the claimant from hazards or dangers incident to his or her daily

environment. ``Bedridden'' will be a proper basis for the determination.

For the purpose of this paragraph ``bedridden'' will be that condition

which, through its essential character, actually requires that the

claimant remain in bed. The fact that claimant has voluntarily taken to

bed or that a physician has prescribed rest in bed for the greater or

lesser part of the day to promote convalescence or cure will not

suffice. Determinations that the veteran is so

helpless, as to be in need of regular aid and attendance will not be

based solely upon an opinion that the claimant. It is not required that all of the disabling conditions

enumerated in this paragraph be found to exist before a favorable rating

may be made. The particular personal functions which the veteran is

unable to perform should be considered in connection with his or her

condition as a whole. It is only necessary that the evidence establish

that the veteran is so helpless as to need regular aid and attendance,

not that there be a constant need...They must be based on the actual

requirement of personal assistance from others.

You do not have to have a 100% single or combined disabilty.

You do not have to be bedridden.

You DO need medical records that state that you need help to bathe,

and clothe yourself, and need the assistance of someone else to

avoid the hazards of your normal environment.

I have all of these in my records. Also, the BVA has stated many, many times

that the veteran does not need to meet all of the criteria, or that the need

for A&A be constant, just as the regs state.

Let me add that I am not able to get in or out of the tub/shower, bathe myself below the waist, dress myself below the waist, or even walk at the VAMC unattended. That qualifies. But, you are right in that none of us know exactly what the VARO is going to do until they do it. I can only base my chances of it on Nashville's track record, which is good about sticking to the regs. They have to, because the small team that performs quality control checks on claims is based at that VARO, so you can guess where all of the QC checks are performed.

Edited May 11, 2008 by rentalguy1

[rentalguy1]

A&A granted to a vet who does not have a single disability rated at the 100% level, but who is not working (or the case eludes that the vet is not working): BVA Case

A&A granted to a morbidly obese female vet who was able to do some of the functions of ordinary living. It was denied initially because she only requested assistance 2 hours per day, two to three days per week. She does not have a single disabilty rated at 100%, but she is TDIU: BVA Case