More Health Issues - question about claim

[toomnyhats]

My original decision is attached.  I posted later regarding the lack of connection for my neurogenic bowel (ileostomy with colectomy).  My VSO advised me not to rock the boat since my STRs didn't have any neck documentation.  That was dealt with in the IMO I submitted and was successful in getting the neck connected and the cascade with it.  My health has been up and down and I have not gotten around to filing for the neurogenic bowel. We're in the process of the Specially Adapted Housing grant right now...long process to get bid from contractor but not complaining at all!! Feel blessed to have it.  However, I talked to my VSO once again, about my concerns of my neurogenic bowel not being rated and I was told not to worry because if I had a bowel obstruction, rupture and died from sepsis, the Death Certificate would link it to the spinal cord injury.  I think that was a crock but...now I have other issues and am ready to take them on.  

 Issues I would like to file for are:

1. Neurogenic bowel requiring ileostomy and subsequent colectomy due to disuse syndrome.
2. Gastroparesis.  This has been brewing for awhile along with my GERD but it is to the point now where I'm losing weight too quickly and sometimes can't get anymore than 600 calories in a day even using high calorie supplements recommended by the dietician.  I feel as if I've eaten a Thanksgiving dinner all the time.  A few weeks ago, it resulted in a hospitalization and my small intestine had ileus for a couple of days where nothing moved.  Not sure if Gastroparesis is a ratable and connectable condition to my SCI.
3. I'm scheduled for a suprapubic catheter to be placed on November 14 because I leak around my foley. I can no longer Cath intermittently because my hand is getting to weak to manipulate clothing and I don't have 24 hour help.  Am I correct that a suprapubic is ratable at 100% especially since I already have a 60% Neurogenic bladder rating (not related to my neck issues)
4. Is is worth it to file.  My husband is 60 and taking care of me is becoming very taxing.  The VA covers some home care/homemaker through the standard care but not near enough.  So I don't know if these issues, if granted would bump me higher than an M w/K.  
5. Also does anybody know if Loss of use of both bowel and bladder sphincter control plus paralysis requires the paralysis to be complete (as in ASIA A) or does it also apply to incomplete. I'm listed as a C1 ASIA C SCI. It is not clear in the regs which state,  "(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." 

Any advice or thoughts would be greatly appreciated.

Blessings,

toomnyhats

toomnyhatsRedacted.pdf

[vetquest]

VSO's will almost always tell you to not rock the boat, unless they are county VSO's.  Remember that they are paid by the VA. 

Your condition is not going to improve so I cannot see the VA reducing your benefits if you apply for more but we never know what the VA will do.  You are P&T for your currently received benefits so that is a plus.  With my limited knowledge I would believe that the conditions you wish to apply for are related or secondary to your disabilities.  I would apply for aid and attendance if you are having problems with daily activities, especially if you can no longer cath independently.  Your situation seems intense and my best wishes for you.

There will be others who will give you advice that are much more eloquent than me.

[toomnyhats]

Thanks vetquest!  I am rated an M for SMC - is aid and attendance a separate thing?  I definitely need it.  I am receiving some help from the standard medical package (Homehealth/Homemaker) but it is not near enough.  I need help with my morning routine and my nightly routine along with additional things like PROM, FES hook up, and the homemaking.  My husband is definitely becoming over taxed (he is 60).  We would consider him retiring early but don't have enough trust in the VA to do that.

[Buck52]

I AGREE WITH VETQUEST

YOU CAN SEND IN WHAT MEDICAL RECORDS YOU HAVE AND GET YOUR DR TO STATE YOU CAN'T DO GENERAL THINGS IN LIFE  LIKE COOK OR DRESS YOURSELF AND THAT YOU DO NEED THE AID OF ANOTHER PERSON TO HELP YOU MEET THE GENERAL DAILY THINGS OF LIFE TO HELP MAKE YOUR LIFE  A BETTER LIFE  ECT,,ECT,,

you can write out your lay statment and let them know just how big struggle you have   I mean tell them everything that happens with you on your bad days.

but the main thing is a letter in detail from your Dr opine telling why you need the Aid.

[toomnyhats]

Thanks Buck52 but I'm somewhat confused.  I thought aid & attendance was the SMC I receive...I am classified as SMC M.  I may be misunderstanding terminology??

Is aid and attendance something entirely different.  I also don't understand why I wasn't assigned an SMC of O (paralysis with loss of both sphincter control) or do they only look at paralysis if you are a complete versus incomplete SCI patient?  And how would the 100% for suprapubic and 100% for neurogenic bowel w/ileostomy & colectomy play into things if granted. (I believe those are both rated at 100% from the regs I looked at).

Just when I think I have it figured out...I realize I only know a tiny speck of the big picture!

[Buck52]

toomanyhats

They are 25 Years experinced VSO that do not fully understand how the SMC are  met.SMC is very complicated for even the Best Claims adjudicators.

 

''There are different levels of Special Monthly Compensation. First there are basic levels, ranging from (k) to (s) that are the building blocks to the higher levels, ranging from (l) to (o). One must first establish entitlement to basic Special Monthly Compensation before being considered for higher rates of SMC.

Some of the basic levels of SMC are loss or loss of use of a creative organ, loss or loss of use of a hand or a foot, blindness of one eye, deafness of both ears, loss of voice, housebound, or aid and attendance.

There is a difference between the loss of use and the loss of the body part itself, as explained here.

The different level of SMC that a veteran is entitled to corresponds to a different level of compensation well above the 100% rating. For example, a single veteran rated at 100% receives $2,906.83 per month, but at the highest level of SMC benefits for aid and attendance, the compensation would be $8,179.89 per month.

The VA has a duty to maximize a veteran’s benefits; they are supposed to render a decision that grants every benefit to which the veteran is entitled to.

It is generally presumed that when filing a claim for disability, the veteran is seeking the maximum benefit allowed by law that corresponds to their disability.

Therefore , SMC is not something a veteran has to formally request of the VA. It is inferred when a claim for disability is submitted.

The VA is supposed to consider it when making a decision on the claim, whether the veteran is entitled to SMC benefits if the evidence in the claims file indicates that they are.

The VA often fails to do this though, so you will want to know when you are entitled to these benefits so you make sure the VA is not paying you less than you deserve.

If a veteran is erroneously denied SMC benefits or not granted the full amount of SMC benefits they are entitled to, they could be entitled to retroactive benefits or even make a claim for clear and unmistakable error.

Aid and attendance is a type of SMC that provides additional compensation for veterans who need assistance in tending to their daily needs due to their service connected disability.

SMC can then be awarded, depending on the level of care the veteran needs, in order to alleviate the need for a caretaker. The caretaker does not have to be a medical professional, but can even be a member of the family helping with everyday tasks.

Some of the factors the VA considers as everyday tasks that would qualify the veteran for additional compensation are the inability to dress or undress, bathe, take care of one’s personal hygiene, feed oneself, or being unable to avoid injuring oneself with everyday tasks.

Housebound status is another example of a type of SMC that entitles a veteran to additional compensation when they are substantially confined to their home because of their service connected disability, and it is reasonably certain that the disability will continue throughout their lifetime.

Each of these types of SMC’s also have different levels that qualify veterans for different amounts of compensation.''

 

:Source Hill & Ponton Disability Attorneys

 

 

 

Edited October 27, 2018 by Buck52

[toomnyhats]

Thanks for the clarification Buck52.  It sounds like I was low balled on SMC.  I require assistance to dress/undress, bathing/showering, Passive ROM, preparing meals which I must eat 6-8 small meals a day due to slow stomach emptying (I'm told by my doctor this is related to SCI).  I have an ileostomy that came off recently at night and I was covered with muck.  My husband was working nights and I had to wait 2 hours for him to get home to clean me up.  I eat independently but require special utensils because of my hand weakness. My medications (way too many in my book) are set up by a home health nurse every three weeks and she will also eventually be coming every 2 weeks to change my suprapubic catheter since I don't have the dexterity to do it.  I have a van with zero effort controls adapted to me but I have since worsened and can't leave home unless my husband drives me places.

Next year we plan to use the Automobile grant to go totally high tech if I pass the driver's training at the VA.  Our current van, we purchased before my decision came through so we had to pay for all the adaptive equipment except the ramp.  I have Dragon for my computer so basically my days consist of being on my computer, interacting with my husband and children/grandchildren when they visit. I am unable to do much physically.  I do still oversee how the household runs and finances since those items just require my brain not my body.  I do have a service dog who helps with things like opening doors and picking up anything out of my reach or that I dropped but his capabilities are limited.  He can tug my socks off but he can't put them on.  Ditto with shirt sleeves.  

So would you recommend first filing for the items that were missed and new ones that have come up (neurogenic bowel w/loss of control-dealt with by ileostomy and colectomy, suprapubic, worsening weakness and definite worsening of pain) or should I just request an increase in SMC?  To me It would seem more logical to get SC for the above mentioned items and then see how the SMC rolls out.  There are times I need someone here with me for long periods and SMC M isn't enough for me to hire someone for that.