VA always prolongs the inevitable

[FormerMember]

Remember §4.14 (pyramiding). You cannot be compensated for two neurological/mental disorders. VA classifies TBI and PTSD or any MDD as a mental disorder. Hence, you get paid for one regardless if you have both. In order to ever qualify for the higher levels of SMC (i.e. R1-R2) you have to be severely F-'d up. Here's the criteria and it's a steep hill to climb. 38 CFR §3.352(b)

(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.

(5) The provisions of paragraph (b) of this section are to be strictly construed. The higher level aid-and-attendance allowance is to be granted only when the veteran's need is clearly established and the amount of services required by the veteran on a daily basis is substantial.

Think of having LOU of your upper extremities and trying to inserted a catheter 4-6 times a day. Or being a paraplegic lying in bed and needing to be flipped every 4 hours due to your bedsores. I mentioned the SMC O to R1 path as it is one way to get there but again, you need some mega-issues-i.e. two (2) SMC Ls and one has to be A&A.

I'm doing a radio show this PM w/ Jerrell Cook and John. I'll be discussing SMC in all likelihood as I have 3 right now who I'm repping who are all terminal in that regard. One passed away 7/1/18 but the appeal will still go forward.

Bon chance.

Edited August 30, 2018 by asknod

[eli]

Remember that Smc T was set up specifically for TBI vets special needs.

See page 49 of the pdf I attached in how R2 and T differ:

Comparing SMC(r-2) to SMC(t) 
 No req that vet require assistance of or supervision by health care prof.  
 
 Vet simply needs evid, preferably a statement from a doctor or health care prof, that in  absence of daily in-home care  vet would require instit’l care.

[broncovet]

I will try to say what Alex said in English:   

The higher levels of A and A are for people who need "NURSING" care, that is, care by a NURSE.  

Its about money.  The VA can save money, sometimes, by supervising your care with a nurse, instead of paying to put you in a full time nursing home.  

A nursing home can cost 20,000 or more per month, while a nurse can supervise and visit your home (sometimes) for much less.  

[FormerMember]

1 hour ago, eli said:

Remember that Smc T was set up specifically for TBI vets special needs.

See page 49 of the pdf I attached in how R2 and T differ:

Comparing SMC(r-2) to SMC(t) 
 No req that vet require assistance of or supervision by health care prof.  
 
 Vet simply needs evid, preferably a statement from a doctor or health care prof, that in  absence of daily in-home care  vet would require instit’l care.

Nice try, Eli. Try reading how to get to R-anything first (see below). Sorry but you don't get to R 1-2 with a note from the doctor. You get there because you are entitled, at a minimum, to SMC O. If, and only if, you have a SMC L for A&A, in addition to another L for some other disability, do you qualify, at a minimum, for R1. Please do not disseminate incorrect information here as it makes it immeasurably more difficult for others to know the correct interpretation.  SMC R2 pays $8,676.60. You will never see that on a SMC T check.  Besides, the VHA issues the check directly to the caregiver. They do not include it in the Vet's monthly compensation check. 

§3.350(e)

(e)Ratings under 38 U.S.C. 1114 (o).

(1) The special monthly compensation provided by 38 U.S.C. 1114(o) is payable for any of the following conditions:

(i) Anatomical loss of both arms so near the shoulder as to prevent use of a prosthetic appliance;

(ii) Conditions entitling to two or more of the rates (no condition being considered twice) provided in 38 U.S.C. 1114(l) through (n);

(iii) Bilateral deafness rated at 60 percent or more disabling (and the hearing impairment in either one or both ears is service connected) in combination with service-connected blindness with bilateral visual acuity 20/200 or less.

(iv) Service-connected total deafness in one ear or bilateral deafness rated at 40 percent or more disabling (and the hearing impairment in either one of both ears is service-connected) in combination with service-connected blindness of both eyes having only light perception or less.

(2)Paraplegia. Paralysis of both lower extremities together with loss of anal and bladder sphincter control will entitle to the maximum rate under 38 U.S.C. 1114(o), through the combination of loss of use of both legs and helplessness. The requirement of loss of anal and bladder sphincter control is met even though incontinence has been overcome under a strict regimen of rehabilitation of bowel and bladder training and other auxiliary measures.

(3)Combinations. Determinations must be based upon separate and distinct disabilities. This requires, for example, that where a veteran who had suffered the loss or loss of use of two extremities is being considered for the maximum rate on account of helplessness requiring regular aid and attendance, the latter must be based on need resulting from pathology other than that of the extremities. If the loss or loss of use of two extremities or being permanently bedridden leaves the person helpless, increase is not in order on account of this helplessness. Under no circumstances will the combination of “being permanently bedridden” and “being so helpless as to require regular aid and attendance” without separate and distinct anatomical loss, or loss of use, of two extremities, or blindness, be taken as entitling to the maximum benefit. The fact, however, that two separate and distinct entitling disabilities, such as anatomical loss, or loss of use of both hands and both feet, result from a common etiological agent, for example, one injury or rheumatoid arthritis, will not preclude maximum entitlement.

(4)Helplessness. The maximum rate, as a result of including helplessness as one of the entitling multiple disabilities, is intended to cover, in addition to obvious losses and blindness, conditions such as the loss of use of two extremities with absolute deafness and nearly total blindness or with severe multiple injuries producing total disability outside the useless extremities, these conditions being construed as loss of use of two extremities and helplessness.

 

[FormerMember]

1 hour ago, broncovet said:

I will try to say what Alex said in English:   

The higher levels of A and A are for people who need "NURSING" care, that is, care by a NURSE.  

Its about money.  The VA can save money, sometimes, by supervising your care with a nurse, instead of paying to put you in a full time nursing home.  

A nursing home can cost 20,000 or more per month, while a nurse can supervise and visit your home (sometimes) for much less.  

Or by someone under the direct supervision of a nurse, doctor or other similarly situated individual.

[eli]

@Alex I am simply providing the regs as listed by the VA and knowing of vets that receive smc t.

It isn't easy to qualify and as listed in the pdf I linked there are pre-reqs but the difference I was pointing out in my post was quoted from the regs regarding how smc t differs from r2.

No one stated you get r1-2 with a note from the doctor.

Also the caregiver program is the tiered program, not smc T.  These are 2 separate "programs" or payments types, (choose your own verbiage).

And yes I completely agree that erroneous information is not beneficial, I encourage everyone to do their due diligence and research these issues themselves.

The VA covers many issues, health, law, etc and no one should blindly accept information on a blog.

(j) Special aid and attendance benefit for residuals of traumatic brain injury (38 U.S.C. 1114(t)). The special monthly compensation provided by 38 U.S.C. 1114(t) is payable to a veteran who, as the result of service-connected disability, is in need of regular aid and attendance for the residuals of traumatic brain injury, is not eligible for compensation under 38 U.S.C. 1114(r)(2), and in the absence of such regular aid and attendance would require hospitalization, nursing home care, or other residential institutional care. Determination of this need is subject to the criteria of Sec.  3.352.

(1) A veteran described in this paragraph (j) shall be entitled to the amount equal to the compensation authorized under 38 U.S.C. 1114(o) or the maximum rate authorized under 38 U.S.C. 1114(p) and, in addition to such compensation, a monthly allowance equal to the rate described in 38 U.S.C. 1114(r)(2) during periods he or she is not hospitalized at United States Government expense. (See Sec.  3.552(b)(2) as to continuance following admission for hospitalization.)

(2) An allowance authorized under 38 U.S.C. 1114(t) shall be paid in lieu of any allowance authorized by 38 U.S.C. 1114(r)(1).   (Authority: 38 U.S.C. 501, 38 U.S.C. 1114(t))

            [26 FR 1587, Feb. 24, 1961, as amended at 27 FR 4739, May 18, 1962; 28 FR 1587, Feb. 20, 1963; 28 FR 5671, June 11, 1963; 40 FR 54245, Nov. 21, 1975; 45 FR 25392, Apr. 15, 1980; 46 FR 47541, Sept. 29, 1981; 48 FR 41161, Sept. 14, 1983; 49 FR 47003, Nov. 30 1984; 54 FR 34981, Aug. 23, 1989; 60 FR 12886, Mar. 9, 1995; 67 FR 6873, Feb. 14, 2002; 68 FR 55467, Sept. 26, 2003; 74 FR 11483, Mar. 18, 2009; 83 FR 20736, May 8, 2018]