on a good day i often am slow learner

[robert51]

i have been 70% IU PT  over 13 years but during that time I keep getting help seeing a psychiatrist for 10 of the years  out of pocket  My reasons for out of pocket is often I need more then the allotted 45 min... This doctor writes a 10 plus page report every year and it says without  help I can not function , My help has been wife and nurse daughter and sometimes outsiders of which I pay .. If I get 100% what would be my next step to try to get some of my out of pocket covered for care .. I hear terms like caregiver .. housebound etc .. I have the doctors reports so that is probably a big step and 10 years worth to me seems like a very solid evidence so any advise if I get to 100% scheduler??  my disability is PTSD  I have others but because I am also IU and pt I never wanted to clog up the system for others..

 

 

Edited July 4, 2019 by robert51

[broncovet]

Have you applied for an increase?  If you get an increase, you could get housebound automatically, if awarded.  (If you have 100 percent, plus an additional 60 percent seperate and distinct, you should get statuatory housebound.)

You can also apply for Aid and Attendance, which is known as SMC L, if you have to have "help".  

Generally, the "choice" program "should" pay your medical bills if the VA does not offer that service.  But you have to ask them.  Do you have a VAMC prime care doc?  Did you ask him if you are eligible for "choice", because you cant get help with VA as you need more time?  Start there.  

You probably need a representative to help you obtain more benefits.  

[vetquest]

I agree with broncovet, you will never get more benefits unless you ask.  File for increased disability under PTSD and anything else that makes you need aid and attendance.  You really have to spell it out for them though.

Edited July 4, 2019 by vetquest

[Oceanbound]

Time to file an opinion from your doc for an increase with your private medical file. If they tell you, you need a C&P exam after requesting an increase, file a writ of mandamus the next day and tell them to go pound sand. Literally.

Also I wrote it out for you since its more likely than not you're going to need it.

 

Writ.pdf

[Phury & Rhage]

21 hours ago, Oceanbound said:

Time to file an opinion from your doc for an increase with your private medical file. If they tell you, you need a C&P exam after requesting an increase, file a writ of mandamus the next day and tell them to go pound sand. Literally.

Also I wrote it out for you since its more likely than not you're going to need it.

 

Writ.pdf 16.74 kB · 11 downloads

You aren't wrong, however, I'd like to point something out.  The writ process takes time.  It might be faster to take the exam.  If you get your private provider to fill out the DBQ, and they do so thoroughly, then the evidence is probably adequate to rate an increase.  BUT, development VSRs are trained from the get-go to order exams for increases.  While the manual states that an exam is only warranted where the evidence of record is not adequate, in practice, we (dev VSRs) don't make the call on exam adequacy - raters do.  And it's a big, fat error (something we get graded on) to make that claim ready for decision without ordering necessary exams.

If you feel strongly that your private DBQ is thoroughly complete, you could probably refuse an exam and send in the form that says to rate the claim without further evidence.  If my private physician described my current state in terms that are helpful to my claim, I might also try to make the VA rely solely on that exam for increased severity.  In practice though, I see tons of private DBQs with blocks left blank.  I don't closely look to see if those blocks are necessary because, again, I don't make the call on exam adequacy. 

You suggested a viable option, but there are some considerations in exercising it.  Thanks for the cool example

Phury