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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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Ok.  MY opinion ONLY:  "Incontintence" is a "no brainer" for A  and A.  However, you can/should look for yourself, and here is how to do it (I dont have time now, Im gonna watch Super Bowl):

Go the the BVA OR CAVC decisons page(s):  Do a decision search using "incontinence" or "incontinece Aid and Attendance" using those search terms.  See what other Vets, who are incontinet got as far as A and A.  

CAVC search page: http://search.uscourts.cavc.gov/

BVA decision search page:  http://www.index.va.gov/search/va/bva.jsp

Use the search terms I suggested, above, and review a couple cases to see for yourself.  

I can not imagine an adult using a diaper (dopey from Toradol) not getting at least the lowest level of A and A.  Read the above criteria:  It specifically mentions needing help "for the wants of nature", that is, incontinence.  YOu should get this BUT YOU MUST HAVE IT DOCUMENTED.  Again, tell your nurse so she can have the doctor DOCUMENT that you wear a diaper for reasons you mentioned.  

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Understand THIS:

Incontinence is a reason many people go to a nursing home.  Nursing homes are VERY expensive.  Thousands of dollars per month.  

VA is paying A and A because its cheaper than a nursing home, much cheaper.  While I can not recall where it says this, you automatically are assumed to need A and A if you are a patient in a nursing home.  Else, why would you be there, needing nursing care, if you can do stuff yourself???

 

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Let me help with this regulation I posted above:

In between "inability to attend to the wants of nature" is seperated from the other stuff with a semicolon.  

This semicolon  means "OR".  It does not mean you have to have help with ALL that stuff listed.  It means if you have an "inability to attend to the wants of nature" and need assistance therof, then you should get A and A.  You need not qualify for A and A with All these things, you can qualify with ANY of these things.  

TAKE NOTICE:  At the bottom of the reg I posted, it specifically says a family member can take care of you and you still qualify for A and A.  Its not required you hire someone else..if a family member changes your diaper, then that family member probably can not work to take care of YOU.  

You see, a person needing A and A, may need it for a variety of different reasons, ONE of those is incontinence.  I dont see how VA can deny it, and make it stick, if you are incontinet BUT, dont take my word for it, read up the case law, and remember the 5 P's works when other stuff does not:  Proper Preperation Prevents Poor Performance.

If you read about other Vets, and their cases, how they came out regarding A and A and incontinence, then you have a pretty good idea on how yours will come out.  

Edited by broncovet
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23 minutes ago, broncovet said:

Let me help with this regulation I posted above:

In between "inability to attend to the wants of nature" is seperated from the other stuff with a semicolon.  

This semicolon  means "OR".  It does not mean you have to have help with ALL that stuff listed.  It means if you have an "inability to attend to the wants of nature" and need assistance therof, then you should get A and A.  You need not qualify for A and A with All these things, you can qualify with ANY of these things.  

TAKE NOTICE:  At the bottom of the reg I posted, it specifically says a family member can take care of you and you still qualify for A and A.  Its not required you hire someone else..if a family member changes your diaper, then that family member probably can not work to take care of YOU.  

You see, a person needing A and A, may need it for a variety of different reasons, ONE of those is incontinence.  I dont see how VA can deny it, and make it stick, if you are incontinet BUT, dont take my word for it, read up the case law, and remember the 5 P's works when other stuff does not:  Proper Preperation Prevents Poor Performance.

If you read about other Vets, and their cases, how they came out regarding A and A and incontinence, then you have a pretty good idea on how yours will come out.  

I was more looking at the fact that he gives me my injections and does all of my other care during my migraines, they are extreme and incapacitating which is very well documentated with the VA.  I am rated at 60% for the incontinence so not sure how that would factor in honestly.  He works at home and is self employed because of my disabilities, he works when he can around my inability to care for myself and the kids.  This has also been noted by my neuro and much of the reason he was fine with making the exception to allow him to give me the injections, as it is far to a va er and expensive to risk the va not paying my er bills (they never do)  I don't think A and A has the same requirements for him not to be employed as the caregiver program, if so we would just turn down the few hundred bucks because we honestly can't support our family without his income.  Sadly, he does have to change my pads/diapers during those time so maybe I need to ensure that is documented in my statement of claim as well as the notes from my neuro and training etc. from my healthyvet.  The va provides all my incontinence supplies as well as my injection meds so I can properly send that documentation in as well.  Thanks for you info.  I have searched the threads for incontinence and not found much on smc's for it. I will try again later when I am not so foggy from the dopamax and ativan ;)

 

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