diabetes Denied For Higher Level Of Aa

[Dolphin25]

I have been receiving AA at the "L" rate and "K" rate since 2002. My current disabilities are:

PTSD 70%

Deg joint disease of cervical spine 20%

Deg joint disease of lumbar spine 20%

Left upper extremity radiculopathy 20%

Left lower extremity radiculopathy 20%

Diabetes Type II 20%

Deg joint disease thoracic spine 10%

Hep C 10%

Incontinence 10%

SMC K

SMC L

Since I was granted these disabilities back in 1997 I am 100% P&T and things have gotten much much worse for me where I have loss of use of my legs and loss of feeling in arms and butt. I need help in everything I do and I don't have the monetary resources to pay for someone to come in daily or even a couple of times a week. I pretty much live in my own filth to the point I bathe so infrequently unless I can get some money to have someone come in. I don't have family to help and it is really embarrassing to have anyone see me. Last year I filed for an increase in AA from the "L" level to a higher level but was denied in May for that but was granted 10% for incontinence. The DAV who has been my Rep for 40 years now won't respond to my letters or faxes. A rep did call me and ask me what I wanted to do and I told him I wanted to file a NOD but he stated I didn't have anything coming and I was getting all I am going to get and that is the last I heard, don't know if he did or didn't file b/c I can't get in touch with them. Everyone I have contacted doesn't want to do an appeal and basically try to fence me off to someone else, attorney's don't want to deal with it either b/c I am not close by or they don't handle complicated cases like mine, what it really is they don't see any money as this is not a straight forward compensation claim that will take years to get and build up a large settlement...how about the 37 cent cure then???????

My day is constant pain and I can't get any relief really, I take volumes of pain meds and now am addicted like a junkie...I urinate on myself and can't control my bowels. I have had 3 C&P's this year and either the Doctor is not listening to me or they are writing down what they want on their summaries, the document the RO uses when deciding one's claim. I specifically told my C&P Dr. that I urinate at least 6 times a night and at least 4 times a day b/c I take diruretics b/c of edema, but he only put down 2 times a night and 4 times a day....not 6 times a day but way more and most of the time I end up going on myself unless I can catch it in time as I can't feel the need to go. He stated the reason was b/c of the narcotics I take but 2 other Drs stated it was b/c of diabetes neuropathy and yes I had the nerve conduction test which showed positive for nerve problems but still the RO didn't hear any of that.

There are many more issues that have been piling up on me that I have just dealt with it over the years but it is now to the point where I can't take care of anything for myself and I don't have the money to hire what I need. The girl I can get to come in sporatically charges $15 an hour and my outgo is more than my income as I am in debt. I have had my medication stolen by these people and have had someone try to break in while I was here but I keep my 357 close by at all times. My life and my day are miserable, I don't bathe or clean anything b/c I can't, in order to get to my VA Dr. appt in which I have to cancel most often b/c I don't have anyone to take me and the VA doesn't have a wheelchair van to come get me or push me around. I have been trying to see my Doctor for the past 8 months but the last 4 months he has been out having surgery. I know he will recommend me to go to a live-in facility if I could get into one but I don't want to go as I would be so damn paranoid and couldn't take my weapons I woudn't be comfortable but I would let someone come in my home and help me with my needs. If he made that recommendation would I have to go to a live in facility??? I read in the VA Regs where if a Vet requires a nursing facility then they can be granted a higher level of AA, I may have read that wrong b/c it is very confusing to me and I seem to forget so much these days...I forget to take my meds or take them more than once a day and I know that can be dangerous especially with this friggin methadone...I take 180mg a day and Lortab 10mg 4 times a day on top of that plus a host of other stuff for blood pressure, heart, diabetes and nerves medications.

I don't know how to go about filing anything right now as I need a direction and how best to put what I have in a coherent appeal. I know if I ever go to another C&P I will go as is and not worry about offending them in the least. On other C&P they write down how you came to the exam but this Dr. didn't state anything plus it took 3 big men to lift me onto the exam table and he didn't write any of that down but he did write I didn't smell of urine and I wasn't wearing my diaper...things that he knew would be negative for me so that is why I think he did this deliberately....he was nice enough and compassionate enough but still he wrote down things incorrectly stated to him and didn't disclose things that may have helped.

Do you know how I should best approach this?? With a higher level I can pay for therapy and a daily attendant to come in to make sure I eat and take my meds correctly. These pain meds make me forget so much at least I hope that's what causes it. A suggestion, an attorney or something to help me would be really appreciated. Remember I cannot do anything but use my laptop, watch tv, use a built-in fax machine and scan documents that I type and send to the fax to send. The mailman will come and knock on my door, I have direct deposit and my meds are mailed to me and I have a cabbie that goes to the store for me when I call him and all I get is basically junk food or can order out but I am never really hungry and don't have an appetite for anything. Sorry, I am gone..this is too long already.

[Berta]

How many K awards do you receive?

Can you post their basis for denial of the next higher level of SMC?

They should have sent you the SMC regs with the decision-you need to fit your medical evidence into the higher criteria.

"I don't know how to go about filing anything right now as I need a direction and how best to put what I have in a coherent appeal. I know if I ever go to another C&P I will go as is and not worry about offending them in the least"

Do you have loss of use of both feet or loss of use of both legs?

You need to file a Notice of Disagreement:

A letter to the VARO that sent you this decision-

Put Notice of Disagreement in bold type or CAPS and then tell them why you feel their decision is wrong.

Cite the reasons they used and then correct anything they said that is incorrect.

Also tell them of any medical evidence they failed to properly consider.

It would help if you can scan and attach their reasons and bases for denial here.Cover any personal info.

[Berta]

You are seeking a higher level of SMC A & A but the steps from L to R-1 etc set the stage for this higher benefit.This is why it would be good if we could read the VA's denial reasons.

I wonder if the woman who does come in from time to time could prepare a buddy statement for you,if needed,as to the daily state of your disabled condition.

As I understand the higher levels of SMC they are added by steps to L based on the medical evidence.Maybe VA has overlooked (or doesnt have yet) evidence that puts you into the higher levels of A & A.

[Dolphin25]

Berta....

Thank you for your input...here are some answers to your post...can you give me an email to send you the decisions..

I receive (1) K award

I receive (1) "L" award

I have a loss of use of both legs and loss of feeling in hands and arms although never sought a rating for this..

I think the deadline for filing a NOD has past as the date on the denial of April 5, 2010

I had a decision for Bladder Incontinence on July 14, 2010 granted 10% SC w/continued denial of Increase in AA

Also, I did have a letter from the woman who use to come in giving the job duties she was doing for me. Again, the VA took the things I had at one time, like I had someone coming in to help me and also had a relative helping me but the contrast i was trying to draw in my letters to them was

what i had I no longer have and that is the reason I need an increase. I didn't use to be in as serious condition that I am now faced with which made it easier for the help, but now that I have gotten worse they require more money and the work is harder, plus they can't steal my medication anymore...you just don't know how many people take this kind of job just to get to my medication. Why the VA would look at my letter of what use to be and try to imply that is what I have today, no that is not the case...there are so many inconsistencies in the C&P doctor's summary that it

is blatantly obvious she contradicted herself so many time you would think the RO would want clarification. On one paragraph she states that I cannot walk or use my legs and another paragraph stating that I can walk in my house with a helper or a walker. Either she mixed what I had told her I could do at one time as opposed to my reason for being there that day or she did it deliberately or they really are boderline incompetent.....Can I file a NOD or Appeal based on what I told the Doctor as opposed to what her summary suggest showing the discrepencies/contradictions?? I mean they should have been able to see that quite obviously or else they go by the letter of the summary.

What I find interesting is in the VA Regulations under a higher level of care stating...."In the absence of a higher level of care you would require hospitalization, nursing home care or other institutional care...." What I think they are saying is that if I don't have that higher level of care but my Doctor recommends that I be housed in a care facility then the RO can grant me that higher level on the Doctor's recommendation. My Doctor has already offered moving me to a care facility but I can't live in one of those places but I know he would recommend it again if I ask him....should I take that recommendation and submit it to the RO and is that what that regulation is really saying???

[Berta]

I regret I don't use email for claims stuff.

You have one year after the denial to file a Notice of Disagreement.

"I have a loss of use of both legs and loss of feeling in hands and arms although never sought a rating for this" You should make a formal claim for these disabilities.You get one K now and possibly could get 3 more K awards if this numbness hinders your use of your hands. That would have to be a medical determination by a doctor however.

There is considerable SMC info here at hadit under a search.

As I understand it one cannot jump from L to the highest A & A level without meeting the criteria for the M,O, P and R awards.

SMC is a very complex issue.In the decision the VA should have stated exactly why you do not meet the next level of SMC.That can be challenged in the NOD by referring to any specific evidence you have that you believe should warrant a higher rating.

Also the VA web site where the BVA decisions are posted is another way to see how they determine the evidence for the higher levels of SMC.

Would the doctor you mentioned be willing (with the regs ( 38 USC 1114) and the decision)

to access your complete medical records and then prepare an independent medical opinion that would warrant a higher SMC rating?

Or at least -with the criteria for SMC "K". maybe they could provide an IMO that would cover 3 additional K awards.It is hard for me to say not knowing the etiology of the numbness but I assume this is peripheral neuropathy from your SC diabetes mellitus and should be compensated.

The IMO format is here under the IMO forum.

If you file a NOD within the first year after receipt of the decision, you also have the right to obtain a lawyer for the claim.Their fee is only payable if the claim succeeds.

If you get the additional K awards compensated -that right there would be a higher comp check

and in the meantime you could still pursue higher levels of SMC.

Can you tell us what the VA said as to denying you an "M" award?

Edited August 10, 2010 by Berta

[Dolphin25]

I have quite a few issues that I need to have addressed that I don't feel I have the resources or ability to present to the RO so having said that do you know of any attorney's that would be willing to

at least look at what I have and give me an honest appraisal of my position???