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Denied For Higher Level Of Aa

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I forgot-yes you are still in the appellate period for a NOD-

I am not a SMC expert and will ask the Moderators to move this whole topic up to Claims Research where more will be able to respond to it.

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Berta...I think what they do is review a new claim with all the attorneys and it is a firm decision not just the one who appeared on the show...I wouldn't want to state it was her directly but the firm decision. I think they also make their decision on what amount they can receive for taking the case on contingency and in my case since I am already 100% and have no retroactive money coming then they see where their investment doesn't warrant any return, however, if I were granted even the R-1 rate that would be almost a $4000 difference between what I now receive and what I would receive should I prevail on my case and that amount times the number of months of retroactive pay should give them quite a sum of money for their investment....but then they probably also look at the merits of the case and the percentage of cases won on an appeal are much lower than on a claim for higher compensation. That is just my guess but I am sure there are more issues in their decision than just helping a veteran in need.

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What they are telling you is that since you do not qualify for m,n or o then you can not make it to R. In order to get to R2 (based upon your listed disabilities) you are going to have to get a VA doc or a contract doc to say that unless you are placed in a nursing home or other assisted living situation you can not live at your house because you have to have DAILY CARE FROM A LICENSED HEALTH CARE PROFESSIONAL.

Not trying to be a smart butt or anything but you can say that you need daily care all you want to but unless a VA doc says it you are not going to get an R2 rating. I know that money is tight but it would help if you would hire someone (a licensed health care person) to do medical things such as give you your shots and medicine along with some one to conduct your daily living activities - house cleaning, bathing etc....... Then the licensed provider could provide her/his opinion on whether you would have to be placed in a home or not if it were not for their daily care. You could then provide this to the VA doc doing the exam on you. Berta is right on the money when she told you to appeal the decision!!!!!!!!! Do it now and then work on getting your living situation in order.

I understand your situation but the VA assumes that unless it is qualified medical supervised assistance needed or you will have to be placed in a nursing home then there are voluntary organizations that can offer limited self help services with things such as shopping, cooking, bathing etc........

Are you on medicare or some type of medicaid? If so a treating doc (civilian type) can assist you in applying for and getting limited in home medical care which will include limited daily living type services. I know you say you need full time help but this would be a start.

This is just my honest opinion and understanding of how you get to the SMC you are seeking. I am no expert but once again based upon your listed disabilities you best shot is R2. And to get there you are going to have to have the required opinion from a VA doc.

I have not been around for a while but there is a vet sixthcents who I hope still reads this board. He is very, very sick and disabled but he is an expert when it comes to R SMC's. If he sees your post and is able to he will more than likely chime in.

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Ricky...thanks for the response..first let me answer your questions...I do not have medicare or medicaid or any other insurance to see another provider. Also, my Doctor at the VA that I have been seeing for the past 15 years has already asked me if I wanted to go to a nursing care facility but I most definately do not want to go there, I would much rather stay in my own home...for one I can keep my weapons here..but he would do it for me again..Are you saying that once he makes that recommendation he is in essence saying my situation is bad enough that I need a higher level of care??? Would I actually have to go to a nursing care facility or just his letter or recommendation is good enough?? After that then I would submit that letter as new evidence or evidence in support of my NOD ?? I have read somewhere while I was researching SMC that the VA would rather for one to stay at his/her home instead of going to a nursing care...do you know if that is something they would rather the veteran do??

Thank you for your insight.....

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Dolphin - What I am saying is that the medical evidence must show that without the required daily care your only other option is a nursing home etc.....

If you treating VA Doc thinks that your condition is at the point that without the proper in home daily care from a licsened medical professional your only option is to be placed in a nursing home or other assisted facility then he should put that in your medical records. Such a piece of evidence would support your claim during a NOD. However, I do not think they would award a R2 level only on his word. They would still more than likely have you examined again for an opinion just as they did during your last C&P.

Yes it is the intent of the VA to have a vet live at home and be as productive as he/she can be. Although it is a govermental system and comes with all of the red tape of a government system that we must wade through it is still the best damn disability system in the world. You can be declaried 10-100 percent disabled and still work and make a million dollars (schedular). You can be declared 60 percent disabled and still be awarded 100 percent and receive payment for 100 percent! It will send you kids to college, you wife to college. etc...etc....

Hang in there and good luck with your claim. Listen to the much wiser than I on this board and simply gather the best medical evidence you can to support your claim.

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Ricky -that was an excellent explanation of the Step levels of the higher SMC levels.

There are also half steps (intermediate rates),for L 1/2, M/1/2,N 1/2 too

Dolphin I understood your L award was not based on any consideration of your extremities.That is unusual but possible of course but it concerns me that they did not consider the 3 levels of disability in your extremities that could warrant possible higher SMC rating or additional K Awards.They can determine each level of loss of use of in each extremity.

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

Or you can ask them to rate this as peripheral neuropathy due to your SC DMII:

"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"

The VA wont rate anything we don't formally claim.

These as well:

"blood pressure, heart," should be claimed as secondary to the DMII which hopefully a doctor would also medically agree to.

Some service reps can make house calls for veterans unable to feasibly get to their offices.

A good vet rep needs to really look over your disability situation well and even be willing to look through your medical records to present a well written NOD and to raise other new secondary claims such as the HBP and heart disease as potentially secondary to your DMII.

Hopefully if you have contacted the DAV National Commander or the head of their National Service Officer program-they will be more willing to help you with this claim.If not there is probably a Veterans County Service center and/or a state funded Veteran's claims rep Division or Commission in your area which could help with the NOD and then determine what other issues should be raised for a SC rating.

Do yo have a copy of all of your VA medical records?

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