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

[Buck52]

I think I am lost here about your ratings??

...you are 70% for PTSD and been getting IU for the last 6 years based on a 90%combined rating..ok I understand that  but then you say the Army rated you 100% for PTSD?

With all the ratings you mention here how did you get the Caregiver program? if your under a 100% s.c. rating?

Not meaning to be dis respectful to you sir but

I mean to get on the caregiver program a veteran needs to be pretty disabled and can't help himself ect,,,ect,,  if you are helpless & can't care for yourself  then your ratings should reflect that?

Do you get a  full retirement from CRSC? AS Well as SSDI/VA benefits at 90%combined rating  for IU Paid at the 100%rate and also on the VA Caregiver program?...So you were getting all these benefits before your spouse left you?

YOU QUOTED

''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''

Unless you have a 100%TBI Rating and all these others combined ratings and you can't  help yourself with things around the house like getting dressed cooking bathing or missing arms/legs  blind 20-200 ect,,ect,,or mentally incapacitated?

I just don't understand this at all? SOMEONE FILL ME IN HERE.

 

Edited April 5, 2018 by Buck52

[taylor88be8]

On 4/4/2018 at 2:14 AM, SupermanCannedy said:

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.  

 

 

 

[taylor88be8]

3 hours ago, Buck52 said:

I think I am lost here about your ratings??

...you are 70% for PTSD and been getting IU for the last 6 years based on a 90%combined rating..ok I understand that  but then you say the Army rated you 100% for PTSD?

With all the ratings you mention here how did you get the Caregiver program? if your under a 100% s.c. rating?

Not meaning to be dis respectful to you sir but

I mean to get on the caregiver program a veteran needs to be pretty disabled and can't help himself ect,,,ect,,  if you are helpless & can't care for yourself  then your ratings should reflect that?

Do you get a  full retirement from CRSC? AS Well as SSDI/VA benefits at 90%combined rating  for IU Paid at the 100%rate and also on the VA Caregiver program?...So you were getting all these benefits before your spouse left you?

YOU QUOTED

''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''

Unless you have a 100%TBI Rating and all these others combined ratings and you can't  help yourself with things around the house like getting dressed cooking bathing or missing arms/legs  blind 20-200 ect,,ect,,or mentally incapacitated?

I just don't understand this at all? SOMEONE FILL ME IN HERE.

 

 

[taylor88be8]

I was medically retired from the Army in 2012 after being Injured in a Roadside bomb in 2010 received Purple Heart, but had to spend the next 2 years in Fort Campbell, going through medical TBI,PTSD day in and day out. 

Army rated me originally 50% as the VA rated me 50% for PTSD in 2013 had a review from DOD Army as my PTSD was (TDRL) “temporary”  went to Fort Benning for Review, my mother drove me and after that review, they set 100% PTSD (PDRL) “Permenent” I get “ tricare for life” or pretty much anything any retiree gets. 

Sorry, a bounce a little all over the place, just try and bare with me.  

So in 2012 when I finally got home my wife was complaining of serious differences in me and wanted me to be closely monitored with mental health or group therapy, my PTSD Rating is “PTSD with Post Concussion Syndrome”

 I assume from the blast...  

They recommended me to go for review with a VA doctor, to see if the Caregiver was a fit for me.  And I ended up with “Tier 2”.. 

They said because at the time, I had a NOD against my 50% PTSD Rating which would eventually turn to 70%PTSD TDIU P&T.  

Like I say I don’t know all the wordings for every thing, but I do know that’s what I got since suicidal ideation and past issues they may have signed off off on it do that.   

Remember this was in 2012 after medically retiring, they did not want me to take my own medicine due to self harm, I had to sign a agreement with the VA that since I was so medicated that I would not drive,

these are all things my Caregiver stayed with me to make sure.

Now Social Security Disability awarded be back to 2010 they said my disability’s for SSDI were PTSD,Adjustment Disorder, Migraines and Traumatic Brain Injury.  

All those disabilities they listed were military related.  

Edited April 5, 2018 by taylor88be8

[Buck52]

Roger that taylor88be8

It just seems to me you should have higher ratings for your TBI or PTSD  Although VA Rates them seperate, both should be 100%.

you quoted

They said because at the time, I had a NOD against my 50% PTSD Rating which would eventually turn to 70%PTSD TDIU P&T.  

you should NOD this rating or NOD the TBI rating  for the 100% (just my opinion) if your ok with your ratings then leave things alone.

I think they are going by POST CONCUSSION on your TBI for you to meet the upper tier 2 for SMC Because you basically can't care for yourself  like Drive/take your medications on time or the correct ones/you may harm yourself or others  ect,,ect,,

so this explains it...and I am so sorry your going through this from your TBI Injury, you can get a friend or family member to be your caregiver  I'm pretty sure...they don't have to be  medical professional  like a Nurse or someone trained in the medical field to be your caregiver.

I heard the VA has a TBI Care program,  you might want to check that out  its for TBI Vets to learn how to check on any major progress or changes with the TBI medically speaking. or any new reports from medical research for the TBI Vet.

Edited April 5, 2018 by Buck52

[Gastone]

I could be mistaken, but unless there is a Dent or Scar from the TBI, for VA Rating purposes it all comes down to the residuals; such as PTSD. You won't necessarily get (2) separate SC Ratings, just the PTSD. That is unless another SC can be NEXUS'd to the TBI.