Jump to content
VA Disability Community via Hadit.com

VA Disability Claims Articles

Ask Your VA Claims Question | Current Forum Posts Search | Rules | View All Forums
VA Disability Articles | Chats and Other Events | Donate | Blogs | New Users

  • hohomepage-banner-2024-2.png

  • 27-year-anniversary-leaderboard.png

    advice-disclaimer.jpg

  • donate-be-a-hero.png

  • 0

Appealing Denial for SMC T based on SMC R2 criteria

Rate this question


SupermanCannedy

Question

Has anyone on this site put in a claim for SMC-t? Do you know of anyone who has been awarded it? I am the sister of a pre 9/11 veteran who has been rated at 100% for TBI P&T. I am his full time caregiver and have been appointed his fiduciary. I also have helped him with his claims...and have done well, until this one. I do my best to give him a high quality of life, but need to hire because his body is fit, but his memory and cognitive skills are in constant decline.

He is a textbook case for SMC T because, in addition to the first 2 requirements, his VA neurologist has also filled out the forms to state that "Without regular in home care the veteran would need to be placed in institutional care". That is a major requirement for an SMC T. We submitted the claim for an SMC T 2015 and they granted him A&A at the L 1/2 rating, which we didn't realize is also required to qualify for SMC t...actually SMC L or higher. We submitted the SMC t claim again April 2016 and they denied it based on R2 criteria. After not knowing what to do about that and not getting any help from the local VSOs (they aren't familiar with this SMC T) a pro bono attorney offered assistance, so we took it.

The decision board came back with a "We got your new claim...we can give you an answer within 30 days or you can have up to a year to submit more evidence." I have NO IDEA what that really means or what to do...So, I submitted for the extra time. Now, I need some guidance.

Should I have people we know write up some buddy letters to explain how much help the vet needs in his daily life? Should I hire one of those VA lawyer firms that take 20% of whatever award is granted? Do any of you know of anyone who has worked on an SMC t? The last report I read was from Dec of last year when the congressional coding was recommended to be changed in order to make the criteria more clear and the "open". The charts show that as of 2011, when the Fast Letter first went out, only 120 or so veterans have been awarded this SMC. So, that's why I am hitting brick walls!

We appreciate any help. Thank you!! 

 

 

 

Link to comment
Share on other sites

Recommended Posts

  • 0
  • HadIt.com Elder

One thing I can tell you is that if your vet was placed in a facility you must be able to visit every day or his health and life will be at risk  unless he is constantly monitored .    My mother was placed in a more distant nursing home due to a legal battle where a legal guardian was appointed by the court.  Because we could not visit every day she died from neglect by the staff.    I sued but my mother was still dead.

So I guess my point if that if you want your brother to live no matter what happens you must have daily involvement in his care.  If you see a bandage on his hand or foot you must demand that they remove so you can see for yourself.  When I demanded that the staff of the nursing home remove a bandage on my mother's heel it turned out she had gangrene.  It killed her eventually because the doctors had to amputate her leg and she was already very ill.   Now if you are able to care for your brother you can get on top of those things.  The home my mother was sent to by the court killed her within a few months.   I could do nothing since my hands were tied in legal handcuffs.   So it is well worth a lawyer to get the money to help you and it is well worth the IMO's to straighten out the VA since your brother's life may depend on it.  You know the VA outsources its nursing home patients and some homes are OK and some are "God's Waiting Room" and not in a nice way.

 

 

                    John

                       

Link to comment
Share on other sites

  • 0
  • HadIt.com Elder

I agree with jonh999

I had an Uncle had to go to Nursing home because he lost his mind and could not care for himself '' Alzheimer Disease ''  his son could not keep an eye on him on a daily bases because of his job  and my Uncle Died after one month in the Nursing home   his son had suspected his Dad choked to death before help arrived..they just bring in the food and leave it...with someone that has lost there mind well no telling what they might do? being alone   like they may eat the bones from fried chicken or bones from fried fish ect..ect..  no telling what my uncle died from ? but it pissed me off he was my favorite Uncle and had tough me many good  things in life.

Link to comment
Share on other sites

  • 0

Im know being scheduled for an inpatient rehab next year for a few weeks after I get my family taken care of so I can afford to leave alone as far as getting my wife who works part time the help she needs. I am also getting a SSDI for SSA assessment done for my hearing next month tired of not knowing what to expect when working causes me more harm then good as my family will state if needed too. I asked for this independent assessment by a Patrick Clifford as his voc assessment was help when it came to my increase for my TBI. I honestly don't know what SSA wants and I figure the assessment would help me and my attorney or at least me so I try to understand what my limitations are. I know I try to think  I am capable but as my wife will show I start projects and never finish them like taking a light apart in my basement and 4 months later its in pieces and no light.

Link to comment
Share on other sites

  • 0
On ‎11‎/‎2‎/‎2017 at 12:30 PM, Buck52 said:

I agree with jonh999

I had an Uncle had to go to Nursing home because he lost his mind and could not care for himself '' Alzheimer Disease ''  his son could not keep an eye on him on a daily bases because of his job  and my Uncle Died after one month in the Nursing home   his son had suspected his Dad choked to death before help arrived..they just bring in the food and leave it...with someone that has lost there mind well no telling what they might do? being alone   like they may eat the bones from fried chicken or bones from fried fish ect..ect..  no telling what my uncle died from ? but it pissed me off he was my favorite Uncle and had tough me many good  things in life.

Buck, what happened to your uncle is horrible! I am so sorry he had such a terrible experience at the end of his life. It is everyone's worst twilight years nightmare scenario. I appreciate what you and John are saying and you can be certain I will not place my vet in a nursing home. Every elderly person in my family was cared for in the comfort of their own home until the end and, even though his level of care is higher than theirs, it will be the same for our adopted marine. I just need a few extra hands to keep his world bright, full of activities and as stress-free as possible. 

Link to comment
Share on other sites

  • 0

SMC t appeal Update:

I sent a statement letter to the VA county office where my vet's NOD is sitting with thousands of others. It is to explain the severity of his need and to urge them to pull his out of the pile, so it can be decided by a judge sooner rather than later. I will let you know if it helps get his claim moving along.  I really appreciate the advice and support from you all! 

Link to comment
Share on other sites

  • 0

There is a possibility that those of you who have helped me will not see the addition to this thread, however.. I have very good news: 

I got a call from my vet's lawyer to notify us that the SMC T appeal has been awarded!!

We didn't even have to go to court! I wrote a statement letter expressing the urgent need to get it out of the county level and within 10 days the file was pulled for review. They read it and approved it right then and there! Apparently, three other signatures are required to sign off for it because it is a higher level award, so it may be awhile before I get notice in the mail. I looked in Ebenfits and it states that the appeal is closed, but there is no more information, but I will keep checking the mailbox and the site.  

I appreciate the help you gave without judgement. I knew he was eligible and I believed his claim was denied in error, but I just didn't have the strength or stamina to work on it anymore...until you stepped up to give direction and encouragement. A potentially 3-4 year appeal process was completed in a fraction of the time!  This is not info I will be sharing with anyone else in real life or online. I wanted to tell you guys because...well, I want to tell someone!...and you've got my six. 

My vet will be cared for round the clock in his own home instead of a facility and I will get the help I need so that I don't die before him from stress and exhaustion.  I am so relieved!!

THANK YOU Buck52, John999, Jfrei, R3dneck, Gastone and Broncovet

If there is anything I can do to encourage or assist you in your endeavors, please let me know and I will do my best. 

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...

Important Information

Guidelines and Terms of Use