PTSD increase A&A added

[taylor88be8]

I have been TDIU P&T for over 6 years well since I medically retired from the Army for PTSD on June,26,2012 (PDRL).  

My current ratings are 70% PTSD. ,30%Migraines  30% Gerd 10% Tinnitus 0% ED  combines total of 90%

 

I was awarded VA Caregiver from 2012-2014 until my wife left me them I lost Caregiver 

 

question is if apply for a increase in my 70%PTSD and I have a DBQ signed rom a medical doctor stating “Total Occupational and Social Impairment”  and the same MD filled out the VA Form 21-2680 A&A Form stating I need it.

 I’m also on SSDI since 2012 for PTSD as well   

I already have SMC-S and SMC-K

 

What are my chances for any of this?  

 

Thanks 

 

Edited March 26, 2018 by taylor88be8

[SupermanCannedy]

On 4/1/2018 at 6:07 PM, asknod said:

Sure, Gastone. I just read his first post at the top. His wife left. Sayonara SMC (t). No caregiver = no dice. So... He says he is currently SMC (s)with a K-about $3380/mo. I could see him maybe being entitled to a 100% schedular for the PTSD but you have to be prepared to go up to the BVA to win it and especially any A&A. VA is going to choke and puke. Most guys work with VSOs and most VSOs would refuse to file it because they are good buddies with the raters and were taught never to help a Vet do this. Most don't even know what SMC is. Most attys. would shy away because he already has P&T- there's no money in it. There are about 800 Vet attys. you can turn to and 350 of us agents. That's a whole lot of you folks chasing good legal help.  I have clients literally show up dying and asking me for help who have already been waiting at the BVA two years. Their VSO forgot to ask for advancement and never filed a Waiver of Review in the First Instance to prevent a remand.

With the above disabilities mentioned, even if, arguendo, he got the 100 for the bent brain, he still has to show he meets the requirements of §3.352 regardless of what kind of fiction the good doctor writes on the 21-2680. VA wasn't born at night. They'll ask for a c&p. Does PTSD prevent you from feeding yourself? Does the MDD prevent you from attending to the wants of nature? If so, who changes your diaper? Bedridden? Can't dress yourself because your brain isn't working right? Can you heat up a Hot pocket in the microwave? Need help bathing yourself in the tub/shower? If all you can rustle up is you may be a danger to yourself or others, VA would have you declared unable to manage yourself or your affairs and assign a fiduciary to "be your financial caregiver". There are a lot of possibilities at play here. Pick the wrong one and you'll wish you hadn't. You can't recall a bullet... or a VA claim.

If you are living all by yourself and asking to be rated essentially as burnt toast and need A&A, VA is going to ask themselves if you are playing fast and loose with the dictionary.  To get into A&A, the very essence of it is what it means-AID & ATTENDANCE. If you have no Attendee to perform the Aid, how is it you could even make it to the doctor to have him fill out the 2680?  Forget that 100% homie, it's time for domiciliary care.That's VAspeak for nursing home. My advice is to get married again pronto and only then mount up the posse and file for the (t). In cases like this the r(t) caregiver stipend is the greater benefit than SMC (l) for Aid & Attendance and already a proven need. Never try to reinvent the wheel.  

Taylor88be8 lost the Caregiver Stipend because it was being paid to his spouse and when she was no longer tending to his needs, that income vanished...It could be paid to another relative living with him. There are several people on my vet caregiver forum who are siblings or parents. 

However, there is a world of difference in criteria, method and compensation between the Caregiver Stipend and an SMC, but I think that has been established later in this thread, so that’s all good. How the conversation bent toward the possibility of him receiving SMC (t) is puzzling to me as were several statements about the T.

I’d like to clarify that, unlike the VA Caregiver stipend, there is no requirement for a veteran to have a spouse or anyone else living with them to receive the T award. In fact, living alone makes the veteran all the more "helpless" and in need on regular a&a. Living alone does not mean they don't recieve a&a from others, but it does  make it harder to get all the help they need, which puts them at greater risk of being placed in a nursing home or other care facility. The T was specifically created to ensure that a vet who suffers from such severe TBI would have the funds to hire in-home care, whether they were married or not, so that they could avoid being in a facility. Although the award is large, it is still costs less than the astronomical cost of a facility. A vet in need ot the T would already be receiving regular care a couple times a week, deemed as incompetent, and be assigned a fiduciary. 

Also, the caregivers who provide in home help do not need to be trained by the VA or any other agency. The results will be better if they hire a home health aid or person with experience as a caregiver, but they can hire whomever they want. Nursing level care is a requirement for R2 and will disqualify a vet for the T.  So, don't use terms like "higher level of care" or "high level of supervision" 

I am going on and on about this because, as a caregiver for Superman Cannedy (who lost his ability to navigate the internet last year), I filed an SMC (t) claim  on his behalf and learned a lot along the way. I didn’t know any VSOs, agents or vets who were familiar with it or knew how to develop a strong claim for it.  I still haven't come across any other vet or caregiver of one who has recieved it. I had one VSO tell me that if he was so bad off, I should just put him in a home! It was incredibly discouraging.

My vet lives alone. I am not his spouse or related in any way, but have taken care of him for years because his family will not. He asked that I become his fiduciary when he was awarded 100% for TBI.  Later, he was awarded L ½ and we hired part time help. When his brain degenerated into dementia and I needed more and better qualified help, I filed for the T because a putting him in a care facility was not acceptable. He wanted to stay home and I knew his quality of life would be better there. 

Developing the claim took “forever” because there was a lot of digging into the details and dry reading. Plus, the drs took awhile to get the paperwork and testing needed. The claim was denied- because the DO who reviewed it incorrectly based his decision on R2 criteria. Even the DO got confused about the T! However, we got that straightened out in the appeal process and it was awarded! 

I am happy to help others who feel they qualify, but Taylor88be8 does not meet any of the three main criteria, regardless of his marital status. The following is not a copy of the official criteria because…it is written in an over simplified manner which deserves more insight. 

To be eligible for SMC (t) a veteran must meet these three main requirements: 

1. Rated at 100% service connected for TBI (not any other type of disability, such as PTSD, nor a combination of disabilities that combine to 100%)

2. Rated at (or at least eligible for) a&a at the SMC L rate.  To qualify for the L rate with TBI, the vet must show the need for regular aid and attendance. Regular does not mean constant or even daily.  Two or three times per week is sufficient. Aid and attendance means assistance with custodial care.  Custodial care means assistance with more than one activity of daily living (ADL).

Here is the list of ADL’s:  Bathing, dressing, transferring, eating, toileting, and personal hygiene are ADL’s.  Activities like meal preparation and medication management are not ADL’s. If he requires and receives assistance with at least two of the above activities on a regular basis, you are in need of the regular aid and attendance of another person. Most with severe TBIs need assistance in IADLs, but it can be challenging to explain why they also need help with ADLs, but not the same way as a person with physical disabilities. You need the docs to understand it though to accomplish #3.

3. Determination by a Dr (neurologist or psych ...and from the VA preferably) that the veteran is so helpless that "without regular in-home aid and attendance, the veteran would need to be placed in a nursing home or care facility".  They need to back that statement up on a 21-2680, which is tricky because the form is designed to focus on the physical, yet you have to prove the cognitive & memory deficits with a lot of yes/no answers.  You need a good relationship with a specialist who understands the condition and level of need. They also need to be willing to run tests and imaging, unless you have plenty already (an MRI and a neuropsych eval are a good start), to be able to take the time to fill out the form, AND to back it up with a support letter, addressing how the cognitive, behavioral, and memory problems prevent the vet from living independently.

**Does NOT qualify for a "higher level of care" ; aka R2

Surprisingly, a c&p exam is not always necessary. Somewhere in the regs that show the ratings officers how to determine a claim, it states that if the vet has already received a c&p to determine service connected TBI, which is the first and foremost criteria, it will suffice. They may or may not...My vet did not require one during this claim process. 

I hope this info is helpful and I wish I could give advice on how Taylor88be8 could increase his claim, but TBI claims are the only disability I have any insight into.  

 

 

[Gastone]

SC-Caretaker, a very interesting and informative read, thanks for the input. That Jarhead is lucky to have you watching his back, my compliments on your efforts.

[Buck52]

 S.M Caregiver,

I agree with Gastone  your post above will certainly encourage other veterans with TBI's  what you mention makes a lot of sense.

I admire your efforts for helping and staying with this veteran when his family turns their back at a most critical time in his life.

keep up the great work!

[Gastone]

T-88, you never answered regarding who has been doing all the Daily services that an A & A Award requires, do you have a current Care Giver? What is your Evidence for the A & A Award? You won't get the Award on the come.

As to your PTSD Increase, what's the New & material Evidence of Record supporting the bump from your 70%? How many of the 100% qualifiers have developed since the 70% Award?

[taylor88be8]

I was medically retired in 2010 for PTSD and received a 50% PTSD,                        10% Migraines, 10% Gerd and 10% Tinnitus. For a 60% Combined Rating from the VA, when I was put on the VA Caregiver Program Tier 2, my wife received $1175 a month I believe.  

Then in 2013, I backdated of the PTSD increase to 70% back to my June 2010 medically retired date or the day after retired date also awarded the TDIU P&T with that increase.    

So I was actually put on VA Caregiver with a 50% PTSD Rating, which was way underrated, but still put on VA Caregiver Program.  

One would think, it would be more complicated getting the VA Caregiver then A&A since, we had to have a nurse do home visits, every 3 months, and they constantly checked on appointments.

My wife had to attend some caregiver courses as well.. 

Do you have to do, any of those things once awarded A&A? 

[taylor88be8]

Also, my mother lives with me now, when she didn’t back then, do to my wife and mom not getting along.

 A lot of the same questions that were on the VA Caregiver, were on the A&A form, so I don’t see why it’s not impossible to ask for the 70% PTSD TDIU P&T increase to 100% and after the 100% is awarded, to then award A&A based on the 100% Rating for PTSD. 

This is something I should have filed for along time ago, since the army has already awarded me 100% PTSD (PDRL) since 2013 and social security disability awarded for PTSD since 2010 as well,  100% CRSC as well

Edited April 5, 2018 by taylor88be8