Caregiver

[jfrei]

So the woman trying to explain to me why I don’t qualify for the program. She said you could be 100% scheduler which I am Permanent and total which I am but not require constant care by someone as it’s not in any of your doctor notes. My doctors are treating me so that I can perform my ADLs  just to be able to them. The doctors don’t talk about me needing a constant caregiver which is not even what I’m trying to show the highest tier isn’t needed but my wife helps me and  persuades me so I don’t get hurt. She says well that may be but you don’t qualify for this program. I am talking to her again tomorrow I haven’t even formally applied she said she was just giving me a heads up since she runs it at my local VA. Does anyone know of what I should ask her? I thought the requirement to being 100% for my TBI meant that I needed surpervsion at least most of time for danger of hurting myself which is easy to show if she just talks to my wife again.... but I must be missing she says a big determination factor is I am able to drive down the street to the VA hospital to go to my appointments, I was mad I live less then 5 miles away and it’s literally down the street... she like this has nothing to do with your compensation which is why you can be 100% and still not qualify as an OEF vet..

[broncovet]

The criteria for SMC L is here:

b)Ratings under 38 U.S.C. 1114(l). The special monthly compensation provided by 38 U.S.C. 1114(l) is payable for anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less or being permanently bedridden or so helpless as to be in need of regular aid and attendance.

(1)Extremities. The criteria for loss and loss of use of an extremity contained in paragraph (a)(2) of this section are applicable.

(2)Eyes, bilateral. 5/200 visual acuity or less bilaterally qualifies for entitlement under 38 U.S.C. 1114(l). However, evaluation of 5/200 based on acuity in excess of that degree but less than 10/200 ( § 4.83 of this chapter), does not qualify. Concentric contraction of the field of vision beyond 5 degrees in both eyes is the equivalent of 5/200 visual acuity.

(3)Need for aid and attendance. The criteria for determining that a veteran is so helpless as to be in need of regular aid and attendance are contained in § 3.352(a).

(4)Permanently bedridden. The criteria for rating are contained in § 3.352(a). Where possible, determinations should be on the basis of permanently bedridden rather than for need of aid and attendance (except where 38 U.S.C. 1114(r) is involved) to avoid reduction during hospitalization where aid and attendance is provided in kind.

OR 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 veteran would 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.

[jfrei]

I am also given SMC s but she said this program has nothing to do with the disability but strictly the hospital...

[Navy04]

jfrei,

 

As I and others have put on here. It depends on your disabilities as to whether you qualify or not. I have helped Vets apply for the program that were 100% for 1 condition or another, but not qualify because their disabilities do not 100% hinder them for daily living. I have not driven or worked since 2014, which I was 32 at the time. I am so far off, that my VA Docs actually submitted for me to be on the program, and I found out after the fact. This program only has a couple hundred Vets in the whole state of Texas. Very hard to get on the program and remain on it as well. In my case I do not receive the SMCs that you receive as I have had alot going on and not applied for them yet. Just try to take the battles one at a time, and remember that if you can Drive, or function in some capacity, more then likely you will not get approved for the Caregiver. I forgot if you mentioned, do you or your wife work? Hope you have a good weekend, and God Bless.

[Buck52]

13 hours ago, jfrei said:

''I am also given SMC s but she said this program has nothing to do with the disability but strictly the hospital.''..

They said you qualify for SMC S because you were hospitalized?

With All due Respect I disagree with that statement above.

  To meet the criteria for SMC it does have a lot to do with the S.C. disability and the severity of it  to meet the SMC Criteria.

As I understand they rate the TBI as all in one disability...say for you you got 100% P&T

Ok to receive SMC S H.B. you will need an additional service connected condition separate and distinct from all your other conditions and  have one rating for this at least 60% or higher.

However they also combined other smaller rated disability's to meet the criteria for SMC S H.B. Depending on the servility of the condition's.

That's hard to do for most Veterans.

Edited October 28, 2017 by Buck52

[broncovet]

Jfrei

    The caregiver is a program seperate from "Aid and Attendace" and SMC.  Remeber this tho, when someone tells you they are with the government and here to help you, you can rest assured they are probably not telling you the truth.  Apply anyway, regardless of what she told you, and get a decision which you can appeal.  You can not appeal her words.  

[SupermanCannedy]

Jefrei, I agree that the nurse gave you the wrong reasoning for your SMC S. The healthcare side of the VA often interprets the benefits side incorrectly. From what you've stated in other threads, you are rated at 100% P&T for TBI. If your claim was also submitted for those chronic headaches that so often accompany TBI,  you have 50% for that alone which leaves you just needing a combo of smaller ratings on other claims to get to the 60%. It is not uncommon for vets with 100% TBI P&T to have SMC S. Less common to have SMC L... very uncommon to have SMC T. 

   It is frustrating that the Caregiver Program and process wasn't better explained to you before the nurse came to do the assessment. It is needs based only and, as others have stated, your disability rating is not factored in. It is supposed to be a uniform system, but it seems that the criteria varies widely. My vet is pre 9/11, so he doesn't qualify for the program. But I have heard a lot about the process and changes within from other caregivers and that's who you and your wife should connect with. 

    I'd like to give you the link to a caregiver site for you wife to look into. It's called Hidden Heroes and is supported by the Elizabeth Dole Foundation. There are many on it who are in the VA Caregiver Program and will be glad to help you both through the steps, regardless of the outcome of your nurse's visit. Lots of caregivers of vets with TBI too and they share info on all aspects of things related to it. It has tons of resources!

Here is the link:  https://hiddenheroes.org/about/ . 

She will need to request to join (upper right hand corner of main page.