VA always prolongs the inevitable

[eli]

25 minutes ago, broncovet said:

You might try the NVLSP's training program for SMC, and it may give you what you need as it explains the diffences between SMC T and R 1.  

http://www.purpleheart.org/ServiceProgram/Training2012/10-M- SMC final.pdf

Thank you broncovet for reinforcing using the NVLSP's training!  That is the same pdf I posted earlier in the thread when trying to show that smc t is not the tiered caregiver program that was being called smc t.

Many thanks!

[Buck52]

I understand all what all these regulations are saying here

However  SMC is based on the severity of the S.C. Disability Entitlement!

Notice in the link broncovet posted about  it starts off with the lesser SMC's and goes all the way up to the Highest Level...so actually the more severity a  S.C. disability is and can worsen or improve over time (obviously) So   this is just a basically of the lay out of the SMC Criteria, &  there for for the particular SMC  (t) as Alex mention can be Temporarily.

  some disability do show improvement  but most severe ones don't  and TBI is so New & the secondary conditions it is related to & not even the Drs can say a TBI Vet can Improve on his server TBI  That is pure speculation if they do ,and only time will tell... (jmo)

  However if a Veteran has(The upper tier SMC's )Including SMC (t) that Veteran is in pretty bad shape at this point  and I would have my doubts he would improve  but VA sees this differently...I don't know of any Veteran that reaches the higher levels of SMC had a Reduction because he improved.  simply because at this stage there's much doubt he ever will.

[FormerMember]

SMC, in its entirety, is a quality of life rating for daunting medical conditions far above and beyond the normal scope encompassed by the ratings schedule in the VASRD. I fight these battles for Veterans trying to attain the higher tiers due mostly to the effects of battle damage or Agent Orange side effects. As such, my grasp of TBI is imperfect and I readily admit it. Just as a doctor cannot possibly be a specialist in every field of endeavor, so too am I somewhat limited in how much I can absorb. To give some of you an idea of the parameters VA uses to grant TBI at various ratings percentages, I reprint DC 8045  below from the §4.124a schedule of rating neurological deficits. No other DC uses this convoluted method as a yardstick to grant (or more often deny) Veterans. I do have clients who have attained 70% ratings under 8045 and still have "rump" ratings for PTSD they attained prior. There is usually no pyramiding or overlap as the TBI deficits are physical rather than mental. There is much disagreement in this field and VA always errs in their own favor. 

This VA propensity to lowball is not unique. Thus, I try to push for the highest and best ratings under less subjective criteria where I can obtain the highest and best ratings with the least judicial effort. At this point, I'm sorely tempted to hire several attorneys to help me keep up with the influx. The reason I don't is elementary. The normal VSO rep has 250 Vets he "works" for and s/he cannot possibly devote enough time to any one Vet to make an appreciable difference. Hence, they lose 85% of the time. I'm 67 and "retired" -or was- due to my disabilities. I've gradually crept up to about 60-70 Vets and more knock on my door every day. It would be a great disservice to accept one of you ahead of others who have waited months-if not years- for me to help you. Worse, I take a personal interest in any Vet I rep. If one of my employees were to drop the ball, I would feel personally responsible for his or her errors. I have enough on my plate without that added burden.

I would like to apologize to Eli as I tend to zoom through these posts sometimes without reading the thread in its entirety. He is correct that I have described two different compensation packages regarding this subject and essentially have lumped them into one subject. As most will never attain R1/R2/T for TBI without a knock down, drag out fight and exceptional legal assistance, I oversimplify sometimes or am guilty of lumping financial pathways to remuneration into one conversation instead of segregating them into their proper subject areas. 

Theresa might want to create a separate discussion  for the Caregiver's stipend so as to help clarify the entitlement. There is a lot of misconceptions as all here can see. It would be logical to include here in the SMC heading even though it is vastly dissimilar from SMC as well as being administered by the VHA. 

Here's why it is so difficult to get T. Certain symptoms are like Tinnitus-only the Vet can report as to the  medical deficits.  We all know how much VA trusts us to report our own subjective complaints. Generally, if you can't measure it with a goniometer or a thermometer, you're malingering in their eyes. So too, PTSD. 

To give you an idea of how hard it is to qualify for the highest tier of SMC, read some of the cases just in 2018.  https://www.index.va.gov/search/va/bva_search.jsp?QT=SMC+R&EW=&AT=&ET=&RPP=50&DB=2018

Most that are won are accomplished by my friends at CCK ( Robert Chisholm and Zachary Stolz). The number of attorneys (or agents) who can navigate this minefield and win can almost be counted on one hand. It took me over two years of reading hundreds of cases to grasp all the various pathways to win-and that was just for R1-R2-not for T specifically.  

My mission is to get my Vets every entitlement that can be supported by law. I take the path of least resistance to do so. If I have been remiss in reading this by coming in late and shooting from the hip, I sincerely apologize for my error. I assure you it was not born of arrogance-just expediency or laziness. So many Vets; so little time. 

 

DC 8045 Residuals of traumatic brain injury (TBI):
There are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation.
Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”
Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table
Evaluate emotional/behavioral dysfunction under § 4.130 (Schedule of ratings - mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”
Evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.
The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations
Consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc
Evaluation of Cognitive Impairment and Subjective Symptoms
The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.
Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition.
Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation.
Note (3): “Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.
Note (4): The terms “mild,” “moderate,” and “severe” TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045.
Note (5): A veteran whose residuals of TBI are rated under a version of § 4.124a , diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran's disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 CFR 3.114 , if applicable.

[eli]

23 hours ago, asknod said:

I would like to apologize to Eli as I tend to zoom through these posts sometimes without reading the thread in its entirety. He is correct that I have described two different compensation packages regarding this subject and essentially have lumped them into one subject. As most will never attain R1/R2/T for TBI without a knock down, drag out fight and exceptional legal assistance, I oversimplify sometimes or am guilty of lumping financial pathways to remuneration into one conversation instead of segregating them into their proper subject areas. 

********************************************

Theresa might want to create a separate discussion  for the Caregiver's stipend so as to help clarify the entitlement. There is a lot of misconceptions as all here can see. It would be logical to include here in the SMC heading even though it is vastly dissimilar from SMC as well as being administered by the VHA. 

********************************************************

My mission is to get my Vets every entitlement that can be supported by law. I take the path of least resistance to do so. If I have been remiss in reading this by coming in late and shooting from the hip, I sincerely apologize for my error. I assure you it was not born of arrogance-just expediency or laziness. So many Vets; so little time. 

 

Alex, apology accepted, Eli is a she. :)

Enough of my VA battle is posted within this site for reference.  As a TBI vet suffering and dying from one of the non-curable neurological diseases I tend to help  where I can and on the subject matter I know best - tbi's.  My first marriage was to a vet with ptsd, although at the time tbi, ptsd and vet services were unknown terms to most of us.

*****************

I really do hope that Theresa reads this or those moderators that know her best will ask her to create separate discussion areas for said topics.

*******************

Alex you do a great job for vets and people appreciate your time and efforts.

*********************

Given I am usually dealing with tbi vets, many of my vet friends are dealing with ptsd and as I said my first husband was a vet with ptsd I am very aware of many of their issues.  Confusion, OCD, short and long term memory loss to name a few.  So I know I end up repeating a lot of the same information to them repeatedly.  So I try to maintain a lot of loving patience with them.

My refractory epilepsy is bad enough.  And as I often say to my caregivers, esp after I've been postictal (and don't know who they are, who I am or where we are) or after they've just spent hours in the hospital holding my hand (April 2018 - praying God doesn't take me during this round of status) while I was status epilepticus for six hours......I tell them I don't know how they deal with the stress of being a caregiver.

Unfortunately there are many side effects and neurological problems caused by tbi's.  It will be years if not decades before the VA fully grasps this.  But tbi vets have given the medical field many research subjects to study, evaluate and write research papers on.

Edited September 1, 2018 by eli
spelling

[Buck52]

Great post Alex,

  It takes a man now days to admit his mistakes & were all not perfect and subject to make mistakes no matter how large or small...this one is just a small mistake  and really no problem, you outline the SMC (t) very well  just getting a little to far into it with two separate SMC's .

I think we all knew it as Eli mention the criteria as separate with being permanent and not Temporary.

I appreciate Eli taking the time to research all this about the Appropriate SMC and just how the TBI is look at with the VA.

 Alex I never ever doubt your expertise  & God Forbid if I ever file a claim  rather EED or my condition gets worse and I am in need of some of these higher Tier of SMC's  I certainly want you as my Rep..so if &  when this time comes  you be ready...

Great job Great information by you both.

 

[jfrei]

Thank you both for posting all this information I’m sure it will take me awhile to read it throughly instead of scanning it as I did the letter from the BVA.