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Filed form for housebound/aid and attendance

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seminoles

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My pcp filled out the form and marked it was for my sc conditions, listed them and marked in box 23 that I needed help with toileting, hygiene, feeding, meds, etc. at least 7-10 days a month.  When I go on ebenefits it says under pending disabilites smc s for agoraphobia (I am not rated for agoraphobia).  I have a diagnosis of panic disorder with agoraphobia which the mh cp dismissed as secondary to my sc mh condition.  The need for aid and attendance is related to my other service connected issues.  Does this seem odd and should I submit something to correct this? 

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No, it does not seem odd, but, you need to take control over your claim..dont count on the doctor, the VSO..etc.  Many Vets have lost out expecting someone else to do it for them, and "someone" let the VEt down.  

I recommend YOU apply for A and A and housbound, by filling out the applicable forms AND CITE YOUR DOCTORS exam and get a copy of that exam and keep it, until VA looses it and you can send it to them again.  I wish I had a dollar for every time VA "lost" our forms/evidence/ information.  I wouldnt need my VA benefits I would be so rich.  

Repeat:  APPLY for these benefits on YOUR END.  Here is why.  VA "automatically" thinks when you see a doc, you are seeking TREATMENT, not benefits.  Regulations state you have to "show intent" to file for benefits, it must be "in writing" and you have to "specify the benefit sought".  

VA can say..."Oh, you wanted to apply for A and A... gee why didnt you say so..I thought you were seeking treatment, not benefits.   Go ahead and apply now."   That is, after you have waited 3 years wondering why VA did not do anything.  DO NOT LEAVE IT TO CHANCE.  Apply NOW.  If its duplicated, its ok.  Just apply.  Your doctor does not have POA for you (for benefits) and he can not submit a claim for you like your lawyer or VSO can.  

Your doctor did you a favor, but dont mess that up, by assuming he can apply for benefits for you.  He can fill out the form..and sign it.  THat is good, and its doing you a favor..but apply anyway. 

NOw..here is the deal.  SMC IS SUPPOSED TO BE PAID when you meet the criteria..you should NOT  have to apply (for SMC S), its inferred.    They are supposed to watch and award it when you qualify.  But dont count on that either.   APPLY.  They will mess it up, you apply and send it certified mail return receipt requested.  Otherwise VA will "lose" it.  

Edited by broncovet
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14 hours ago, broncovet said:

No, it does not seem odd, but, you need to take control over your claim..dont count on the doctor, the VSO..etc.  Many Vets have lost out expecting someone else to do it for them, and "someone" let the VEt down.  

I recommend YOU apply for A and A and housbound, by filling out the applicable forms AND CITE YOUR DOCTORS exam and get a copy of that exam and keep it, until VA looses it and you can send it to them again.  I wish I had a dollar for every time VA "lost" our forms/evidence/ information.  I wouldnt need my VA benefits I would be so rich.  

Repeat:  APPLY for these benefits on YOUR END.  Here is why.  VA "automatically" thinks when you see a doc, you are seeking TREATMENT, not benefits.  Regulations state you have to "show intent" to file for benefits, it must be "in writing" and you have to "specify the benefit sought".  

VA can say..."Oh, you wanted to apply for A and A... gee why didnt you say so..I thought you were seeking treatment, not benefits.   Go ahead and apply now."   That is, after you have waited 3 years wondering why VA did not do anything.  DO NOT LEAVE IT TO CHANCE.  Apply NOW.  If its duplicated, its ok.  Just apply.  Your doctor does not have POA for you (for benefits) and he can not submit a claim for you like your lawyer or VSO can.  

Your doctor did you a favor, but dont mess that up, by assuming he can apply for benefits for you.  He can fill out the form..and sign it.  THat is good, and its doing you a favor..but apply anyway. 

NOw..here is the deal.  SMC IS SUPPOSED TO BE PAID when you meet the criteria..you should NOT  have to apply (for SMC S), its inferred.    They are supposed to watch and award it when you qualify.  But dont count on that either.   APPLY.  They will mess it up, you apply and send it certified mail return receipt requested.  Otherwise VA will "lose" it.  

I uploaded the form he filled out,(i double checked to make sure that the housebound/aid and attendance form is there and I have the original) I did apply for smc online in ebenefits but for some reason when I go to work in progress is states smc s for agoraphoboia, it had also stated sinusitis secondary to migraine and when I went for that exam it was direct service connection.....I think the idiots who input the claims don't do their job correctly honestly and just put things.   I am going to write a statement of claim to support my aid and attendance claim, I should end up with at least housebound but more aid and attendance at some level.  I don't really understand how they determine those levels. 

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The criteria for A and A is here:

 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 (§ 3.351(c)(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. 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. 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's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others.

(b)Basic criteria for the higher level aid and attendance allowance.

(1) A veteran is entitled to the higher level aid and attendance allowance authorized by § 3.350(h) in lieu of the regular aid and attendance allowance when all of the following conditions are met:

(i) The veteran is entitled to the compensation authorized under 38 U.S.C. 1114(o), or the maximum rate of compensation authorized under 38 U.S.C. 1114(p).

(ii) The veteran meets the requirements for entitlement to the regular aid and attendance allowance in paragraph (a) of this section.

(iii) The veteran needs a “higher level of care” (as defined in paragraph (b)(2) of this section) than is required to establish entitlement to the regular aid and attendance allowance, and in the absence of the provision of such higher level of care the veteranwould require hospitalization, nursing home care, or other residential institutional care.

(2) Need for a higher level of care shall be considered to be need for personal health-care services provided on a daily basis in the veteran's home by a person who is licensed to provide such services or who provides such services under the regular supervision of a licensed health-care professional. Personal health-care services include (but are not limited to) such services as physical therapy, administration of injections, placement of indwelling catheters, and the changing of sterile dressings, or like functions which require professional health-care training or the regular supervision of a trained health-care professional to perform. A licensed health-care professional includes (but is not limited to) a doctor of medicine or osteopathy, a registered nurse, a licensed practical nurse, or a physical therapist licensed to practice by a State or political subdivision thereof.

(3) The term “under the regular supervision of a licensed health-care professional”, as used in paragraph (b)(2) of this section, means that an unlicensed person performing personal health-care services is following a regimen of personal health-care services prescribed by a health-care professional, and that the health-care professional consults with the unlicensed person providing the health-care services at least once each month to monitor the prescribed regimen. The consultation need not be in person; a telephone call will suffice.

(4) A person performing personal health-care services who is a relative or other member of the veteran's household is not exempted from the requirement that he or she be a licensed health-care professional or be providing such care under the regular supervision of a licensed health-care professional.

(5) The provisions of paragraph (b) of this section are to be strictly construed. The higher level aid-and-attendance allowance is to be granted only when the veteran's need is clearly established and the amount of services required by the veteran on a daily basis is substantial.

(Authority: 38 U.S.C. 501, 1114(r)(2))

(c)Attendance by relative. The performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance.

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Notice that "permanently bedridden" and A and A are "not" the same thing.  VA denied my SMC S as I was not "permanently bedridden".  That is a bogus denial.  You need not be "permanently bedriddent" to get SMC S.  YOU "CAN" get it by being permanently bedridden, but its not required to be permanently bedridden.  Its a trick VA uses to deny. 

"Bedridden" works, but its not the only way to get SMC L or SMC S, as explained above.  

Edited by broncovet
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43 minutes ago, broncovet said:

Notice that "permanently bedridden" and A and A are "not" the same thing.  VA denied my SMC S as I was not "permanently bedridden".  That is a bogus denial.  You need not be "permanently bedriddent" to get SMC S.  YOU "CAN" get it by being permanently bedridden, but its not required to be permanently bedridden.  Its a trick VA uses to deny. 

"Bedridden" works, but its not the only way to get SMC L or SMC S, as explained above.  

This is where the VA gets vague imo what is regular aid and attendance?  10 days a month?  7?  there just seems to be too much room for "interpretation" for the rater to deny........I have 7-10 days a month my husband has to do everything for me, bathe, feed, meds including injections of toradol, toilet, (I am also wearing a diaper, cuz I pee myself from the constant vomiting) I can't get to the bathroom without help or to do anything.  I don't even know what day/time it is because I am so doped up until it is over.  One would think this would be aid and attendance at some level but hey its the va so who knows lol.

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1 hour ago, broncovet said:

The criteria for A and A is here:

 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 (§ 3.351(c)(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. 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. 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's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others.

(b)Basic criteria for the higher level aid and attendance allowance.

(1) A veteran is entitled to the higher level aid and attendance allowance authorized by § 3.350(h) in lieu of the regular aid and attendance allowance when all of the following conditions are met:

(i) The veteran is entitled to the compensation authorized under 38 U.S.C. 1114(o), or the maximum rate of compensation authorized under 38 U.S.C. 1114(p).

(ii) The veteran meets the requirements for entitlement to the regular aid and attendance allowance in paragraph (a) of this section.

(iii) The veteran needs a “higher level of care” (as defined in paragraph (b)(2) of this section) than is required to establish entitlement to the regular aid and attendance allowance, and in the absence of the provision of such higher level of care the veteranwould require hospitalization, nursing home care, or other residential institutional care.

(2) Need for a higher level of care shall be considered to be need for personal health-care services provided on a daily basis in the veteran's home by a person who is licensed to provide such services or who provides such services under the regular supervision of a licensed health-care professional. Personal health-care services include (but are not limited to) such services as physical therapy, administration of injections, placement of indwelling catheters, and the changing of sterile dressings, or like functions which require professional health-care training or the regular supervision of a trained health-care professional to perform. A licensed health-care professional includes (but is not limited to) a doctor of medicine or osteopathy, a registered nurse, a licensed practical nurse, or a physical therapist licensed to practice by a State or political subdivision thereof.

(3) The term “under the regular supervision of a licensed health-care professional”, as used in paragraph (b)(2) of this section, means that an unlicensed person performing personal health-care services is following a regimen of personal health-care services prescribed by a health-care professional, and that the health-care professional consults with the unlicensed person providing the health-care services at least once each month to monitor the prescribed regimen. The consultation need not be in person; a telephone call will suffice.

(4) A person performing personal health-care services who is a relative or other member of the veteran's household is not exempted from the requirement that he or she be a licensed health-care professional or be providing such care under the regular supervision of a licensed health-care professional.

(5) The provisions of paragraph (b) of this section are to be strictly construed. The higher level aid-and-attendance allowance is to be granted only when the veteran's need is clearly established and the amount of services required by the veteran on a daily basis is substantial.

(Authority: 38 U.S.C. 501, 1114(r)(2))

(c)Attendance by relative. The performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance.

So Bronocvet if the VA has trained my husband to give me injections for a service connected condition, that should be a basis to help award me aid and attendance?  According to this ?  It is for my severe migraines, at this point I am on multiple medications and receive up to 8 injections a month (that is the maximum that is safe for my kidneys sadly).  They offer a few hours of relief so I can eat and hydrate.  

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