Nod Or Not?

[Guest Morgan]

My husband received a rating decision for Special Monthly Compensation (SMC) a couple of months ago. We thought it was rated too low, but we hadn't yet filed an official Notice of Disagreement (NOD).

However, I did talk to our senator's veteran and military representative about several things that are going on with the VA and us, and during the conversation, I mentioned that I thought the SMC was wrong.

We just received a letter from the Congressional Liason saying the VA is working my husband's SMC claim for R1/R2! Obviously, the senator's office must have initiated this, but does his inquiry suffice as an NOD? Or should we make sure we go through the usual procedure for an NOD?

I don't want to do anything that would confuse anyone at the RO, as that is far too easy to do. But I don't want to not follow the routine and find the claim denied for failure to file a timely NOD. The letter said my husband has 60 days to submit additional evidence to support the R rating. We have more evidence, but there was plenty submitted with the claim from the first go around.

Anyone have any advice? Should he go ahead and file an NOD?

Carrie

[jimlane1949]

It sounds like the letter you received is some type of response to your husbands claim by mentioning 60 days, because a representative iniated something you still should file the NOD as it iscoming directly from the veteran himself/herself. Wishing your husband well with his claim.

Jim Lane

[Guest Berta]

Carrie -I would respond to the 60 day thing with anything you have-

did they state some specifics in that letter as to what they want?

I believe the VA will accept anything from a ongressional entity or Senator as a NOD sometimes-

They did that to me year in 2004- I filed a NOD and then sent a gripe letter to the VBA-

which had NOTHING to do with my claim- but I put my c file on letter so they would not think I was nuts.

I mean so they would realise I knew a little of what I was talking about-

The VBA sent it to the VA with a cover letter to accept as an NOD.

(without answering it at all)

Looks like they did this in your case too---

Do you have the criteria for these SMC ratings? 38 USC 1114.

Do you have access to any Veterans Benefit Manual from NVLSP?

They explain conditions that can fall into SMC-

like loss of hands or use of hands-

my husband could not handle tools or grasp coins nor could he use a touch tone telephone too good after a stroke-

just an example but the VBM and others here too can show how they fell into these criteria.

Sounds like you have done an excellent job already though-

I feel that a spouses statements can also support SMC situations too.

Edited October 8, 2005 by Berta

[Guest Morgan]

Carrie -I would respond to the 60 day thing with anything you have-

did they state some specifics in that letter as to what they want?

I believe the VA will accept anything from a ongressional entity or Senator as a NOD sometimes-

They did that to me year in 2004- I filed a NOD and then sent a gripe letter to the VBA-

which had NOTHING to do with my claim- but I put my c file on letter so they would not think I was nuts.

I mean so they would realise I knew a little of what I was talking about-

The VBA sent it to the VA with a cover letter to accept as an NOD.

(without answering it at all)

Looks like they did this in your case too---

Do you have the criteria for these SMC ratings? 38 USC 1114.

Do you have access to any Veterans Benefit Manual from NVLSP?

They explain conditions that can fall into SMC-

like loss of hands or use of hands-

my husband could not handle tools or grasp coins nor could he use a touch tone telephone too good after a stroke-

just an example but the VBM and others here too can show how they fell into these criteria.

Sounds like you have done an excellent job already though-

I feel that a spouses statements can also support SMC situations too.

Berta,

I have studied the SMC ratings until my eyes crossed, but still some of it clogs my brain when I try to apply it to my husband's case. I don't have access to the manual from NVLSP. Is it easier to understand than the online stuff from VA? If so, can I download it from their Web site? One of the attorneys there said she would send me information about how to substantiate the R level, but she didn't.

The RO letter asked for any evidence supporting the need for a higher level of care. I had already submitted two private doctor IMOs saying he has loss of use of all extremeties, but they didn't actually rate him for that. They did grant entitlement to SAH for loss of use of lower extremeties. I learned here that that doesn't really mean anything except we can probably build a home that would give him more independence.

In January, his PCP at the outpatient clinic filled out the A&A form and said he needed a higher level of care. But the rater I talked to said they don't pay attention to that because every A&A form has that marked. (???)

Because of the serious medication blunders at the outpatient clinic, I asked that the VA move him into Home Based Primary Care and they approved it (probably after the Senator called someone.) He will start that program this month. He is now under home health care twice a week, and they will start physical therapy next week.

The VA congressional liason has her attention on the case, so I was afraid if I went into the routine NOD process that it might go back to the "mail room."

The senator's office has been very helpful and a VFW field representative from Washington is helping as well. It is such a shame to know that my husband has gone through such hell because of the VA--and the worst is yet to come. The cardiologist and the pulmonologist from his hospitalization a couple of weeks ago, stated in his discharge record that "no further treatment is offered or available." I am hurt, sad . . . and angry.

I quit my job to care for him, so we couldn't possibly afford all of his care outside the VA. The R level would help us to get the help he needs. We are both weary of the dilema--he, of course, more than I. All of this is well documented in his records, but we just don't have time or energy enough to pursue anything other than making sure his health--what's left of it--is protected.

Carrie

PS Just wanted to add that this newest request for further information for the R is a surprise, because we had already received the final decision about his SMC a couple of months ago. I talked to the rater that handled the claim, but she said they had determined he was not at the R level because that rating was reserved for "Hospice" type cases. I had called the senator's office to ask for help in getting him into a program that could monitor him more closely. He asked for details and it went from there. He asked for a letter from us about the circumstances. He forwarded that letter to the VA, so I guess they would consider that a notice of disagreement.

Edited October 8, 2005 by Morgan

[Guest Berta]

Berta,

I have studied the SMC ratings until my eyes crossed, but still some of it clogs my brain when I try to apply it to my husband's case. I don't have access to the manual from NVLSP. Is it easier to understand than the online stuff from VA? If so, can I download it from their Web site? One of the attorneys there said she would send me information about how to substantiate the R level, but she didn't.

The RO letter asked for any evidence supporting the need for a higher level of care. I had already submitted two private doctor IMOs saying he has loss of use of all extremeties, but they didn't actually rate him for that. They did grant entitlement to SAH for loss of use of lower extremeties. I learned here that that doesn't really mean anything except we can probably build a home that would give him more independence.

In January, his PCP at the outpatient clinic filled out the A&A form and said he needed a higher level of care. But the rater I talked to said they don't pay attention to that because every A&A form has that marked. (???)

Because of the serious medication blunders at the outpatient clinic, I asked that the VA move him into Home Based Primary Care and they approved it (probably after the Senator called someone.) He will start that program this month. He is now under home health care twice a week, and they will start physical therapy next week.

The VA congressional liason has her attention on the case, so I was afraid if I went into the routine NOD process that it might go back to the "mail room."

The senator's office has been very helpful and a VFW field representative from Washington is helping as well. It is such a shame to know that my husband has gone through such hell because of the VA--and the worst is yet to come. The cardiologist and the pulmonologist from his hospitalization a couple of weeks ago, stated in his discharge record that "no further treatment is offered or available." I am hurt, sad . . . and angry.

I quit my job to care for him, so we couldn't possibly afford all of his care outside the VA. The R level would help us to get the help he needs. We are both weary of the dilema--he, of course, more than I. All of this is well documented in his records, but we just don't have time or energy enough to pursue anything other than making sure his health--what's left of it--is protected.

Carrie

PS Just wanted to add that this newest request for further information for the R is a surprise, because we had already received the final decision about his SMC a couple of months ago. I talked to the rater that handled the claim, but she said they had determined he was not at the R level because that rating was reserved for "Hospice" type cases. I had called the senator's office to ask for help in getting him into a program that could monitor him more closely. He asked for details and it went from there. He asked for a letter from us about the circumstances. He forwarded that letter to the VA, so I guess they would consider that a notice of disagreement.

I sure hear ya on the complexity of SMC stuff-

will this help?

http://64.233.161.104/search?q=cache:DC0lK...&hl=en&ie=UTF-8

Maybe a search at the BVA under SMC R would also reveal how the VA determined these awards?

I sure wish we had access to VARO awards- especially SMC awards-

[Guest Morgan]

I sure hear ya on the complexity of SMC stuff-

will this help?

http://64.233.161.104/search?q=cache:DC0lK...&hl=en&ie=UTF-8

Maybe a search at the BVA under SMC R would also reveal how the VA determined these awards?

I sure wish we had access to VARO awards- especially SMC awards-

Thanks, Berta.

It got me one step closer to understanding what the VA needs. Under Skilled Care Provided, this mentions: qualifying skilled services. But it doesn't say what those are??? He is getting a lot of skilled care right now, but I don't know if it's qualifying.

I will search the BVA and see if I can find something. I talked to a VFW SO a few days ago and he said in 19 years he had only seen 3-4 vets get the R rating. But I think it's because no one understands it. Our VARO says it pertains to the Hospice patient. Rich said that is not right, and I agree with him.

Dr. Bash has been keeping up with my husband since last December and he has been right on the nose every time something has happened to him. He is a wonderful person, and a brilliant one. With every crisis, he has been two steps ahead of me before I even get the details out of my mouth. The VA doctors have to do a string of tests, and still they misdiagnose . . . or forget to read the test or lab results.

Weary, but still fighting . . .

Carrie