lumbosacral Clothing Allowance - Should I Even Apply?

[Vync]

Hello everyone,
This is a bit lengthy, but if you guys can help provide advice on some or all of the questions I have, I would really appreciate it. I have never applied for a clothing allowance (CA), but am asking for advice as to whether I should even try filing for it. I did some reading about the clothing allowance changes and some of it seems to be confusing and possibly misleading.

I'm 100% P&T effective 2008 and here are the related details:
- 30% cervical rating + 20% bilateral upper extremity radiculopathy, both effective 2008 (assume my condition is considered static)
- 40% lumbar rating + 10% bilateral lower extremity radiculopathy, both effective 2008 (assume my condition is considered static)
- Multiple nerve surgeries on both legs/feet and one arm/hand (dominant) during 2012 and 2013
- VAMC issued one lumbosacral back brace and two wrist braces in 2013

My 2013 brace no longer closed properly and fabric holding one of the metal stays wore out, exposing it and poking holes in clothing. I went to the VAMC and was fitted for a new lumbosacral brace after waiting forever for my primary care doc to write the referral. The new one has plastic buckles/loops instead of metal ones. Here is a link to the new brace. It states "four removable pre-contoured rigid posterior stays".

The dude at the VAMC prosthetics desk said that none of the over the counter braces qualify for clothing allowance and then rambled on about how veterans try to file CA requests for irrelevant things like braces damaging bed sheets, other things, and how it ties up the system, but he still gave me the CA form.

I found a topic here on Hadit where elcamino_77us posted a PDF VA letter stating off the shelf braces no longer qualify for CA because the manufacturers stated "they do not damage clothing". Others on that topic stated they had to bring in damaged clothing to prove it to the VA.

I also found the VA Handbook 1173.15 regarding Clothing Allowance as of May 14, 2015, which raises some questions.

8. PROSTHETICS, ORTHOPEDIC APPLIANCES AND SKIN MEDICATIONS: While the ultimate determination is left to the individual treating provider, the following guidance is provided:

a. Examples of items that tend to tear and wear clothing include: Prostheses, rigid braces, ankle/foot orthosis (AFO) with hooks, rigid AFO, manual wheelchairs without clothing guards, specialized wheelchairs with sliding board/sliding transfer functionalities, and wheelchairs with positioning and posturing adaptations, crutches, wrist braces, prosthesis, rigid orthotics, service dogs, colostomy or ileostomy, cervical braces.

A guide and updated listing created by the Orthotic and Prosthetic (O&P) Field Advisory Committee identifies prostheses and orthotics that may cause wear and tear to outergarments. It is available under the Clothing Allowance folder on the Prosthetic and Sensory Aids SharePoint at:
http://vaww.infoshare.va.gov/sites/prosthetics/default.aspx. NOTE: This is an internal VA Web site and is not available to the public.
Prostheses and orthotics not included in the guide should be reported to VHA’s Rehabilitation and Prosthetics Services (10P4R). The O&P Field Advisory Committee will review the prostheses and orthotics to determine its impact on clothing. Consultation with local VHA Orthotists and Prosthetists can substitute when a prompt decision is needed.
This list is updated by the O&P Field Advisory Committee on a semi-annual basis, provided new prostheses and orthotics may qualify for the clothing allowance benefit.

b. Examples of items that do not tend to tear and wear clothing include:  Soft orthotics, transcutaneous electrical nerve stimulation (TENS) units, shoes, shoe inserts, non-specialized wheelchairs (sedentary/sitting purposes), scooters, canes, rollador, walkers, elastic/flexible braces, items with Velcro stays,
hinged braces covered in fabric(metal stays covered), braces with plastic stays covered in fabric.

6. CLINICAL EVALUATIONS/RE-EVALUATIONS:

b. The treating physician will re-evaluate the Veteran to determine whether the prosthetic, orthopedic appliance or skin medication is still medically necessary for their service-connected disability or disabilities. An annual re-evaluation of the Veterans prosthetic, orthopedic appliance or skin medication is recommended. NOTE: In no circumstances will the Veteran be instructed to provide any articles of clothing for clinical evaluations/reevaluations (e.g., requiring Veterans to bring in clothing to VA medical facility). For unusual circumstances Veterans can submit pictures to certify their prescribed prosthetic or orthopedic appliance, or skin medication causes wear, tear or irreparable staining. Submission of pictures by the Veteran is considered sufficient evidence.

Question 1
8a and 8b seem contradictory. 8a states "rigid braces" qualify. 8b states "elastic/flexible braces" and "hinged braces covered in fabric (metal stays covered)" do not qualify. My brace is a bit of both. It contains four "rigid metal stays" that are covered in fabric, so I guess it is a "rigid brace". It is not a "hinged brace covered in fabric (metal stays covered)" because it does not have hinges. It is partially "elastic/flexible", but not like a flimsy slip-on ace bandage. Based on the definitions in the policy alone, would the lumbosacral brace qualify?

Question 2
Despite being covered with fabric, friction by the "rigid metal stays" wore holes in my shirts and frayed the top of my pants. 6b is regarding denials of evaluations and states pictures can be used to show damaged clothing. I found it interesting that others here mentioned being forced to bring in damaged clothing, even though the policy says not to do that. Unfortunately, when clothing got wore out I donated most of it to the nearby Goodwill box, but still have a few left. If I get denied, would bringing in photos of damaged clothing be helpful?

Question 3
My non-VA Chiropractor said I should always wear the lumbosacral brace when sitting/working at the computer. Would it be beneficial to get a letter from my Chiropractor opining that the brace is required when sitting and friction from the "rigid metal stays" would cause eventual wear on my shirts and pants?

Question 4
I am SC for radiculopathy in both arms and wear wrist braces while sleeping. My former VA primary care doctor said they could help relieve some cervical radiculopathy by keeping the wrist in a neutral position, alleviating related carpal tunnel problems. I didn't believe it at first, but he was actually right. Would it even be worth it to apply for these wrist braces?

Question 5
If I file for CA, will I have to come in for a C&P exam? Or only if I am denied?

Question 6
I won 100% P&T and the above listed spine/radiculopathy ratings in 2013 which were backdated to 2008. I did not know the specifics of what entails a CA until recently. I read that you have to apply by August and will be paid later. Is it possible to request retro CA back to 2013 when the braces were issued or is it go-forward only?

 

Is it worth it for me to apply for CA?

 

Thanks

[JayBrown1]

I would apply if I were you. If they deny you appeal it. A couple of years ago they denied me and I appealed it and won. You won't have to do a C&P exam for clothing allowances.  I have a rigid back brace and a knee that has metal and plastic material. One year when I went to get a new brace they handed me one of the shelf and I was told it was not eligible for CA because the manufacturer stated that it would not cause wearing of your clothing. I contacted the manufacturer and asked them if I bought this brace can I be guaranteed it won't wear out my clothing and they said they couldn't guarantee that. I have not received my allowance as of yet for this year but the lady that does the paperwork takes her time in doing them. I submitted my application in April. If the VA had any common sense they would know that when you have two things rubbing together it's going to cause wear. Since they came out with this dual allowance they have changed the qualifications for allowance. I am willing to bet they will change it again next year.

[Vync]

Hi Jay,
I appreciate the information. The dude at prosthetics said they received over 3000 applications for CA by the beginning of August and estimated 40% were duplicates.

[JayBrown1]

What happens is that a lot of veterans apply early in the year then the central VA system sends out letters to those collecting clothing allowance to apply for the yearly allowance so some of the ones that applied earlier apply again. If they change the wording in the letter stating "if you haven't already applied we encourage you to do so at this time" then it would stop the duplication but if the prosthetics department would make a list of annual clothing allowance recipients and check them off as they receive them they wouldn't have this duplication confusion that hinders the processing of applications.

[Vync]

You would think they might have the foresight to do this... I guess it makes too much sense.

I am kind of disillusioned by the negative attitude of the guy at the prosthetics window. Apparently he views veterans as moochers and spent more time on talking on his soap box than he did focusing on giving me the devices requested by my doctor.

[TALON II FE]

You would think they might have the foresight to do this... I guess it makes too much sense.

I am kind of disillusioned by the negative attitude of the guy at the prosthetics window. Apparently he views veterans as moochers and spent more time on talking on his soap box than he did focusing on giving me the devices requested by my doctor.

Report it.  That type of BS will stop if we ALL did this.  I have lodged complaints for things like that since I was on AD, and it does make a difference sometimes.  My favorite one was getting put in an exam room by myself for 2 hours while the whole flight medicine dept went to a going away party.  That being said, I was known as the 'ICE comment guy' for over a year.  So much for an anonymous reporting system, right?  Regardless of that, my quality of service went up dramatically.  Of course, I never saw that particular flight surgeon again, I think he got butt sore but not as sore as my butt was after waiting for him for 2 hours.  Management can't fix the problem until it is reported.