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WomanMarine

How to appeal a HISA Grant denial

Question

In January of this year I was approved for the ILP through Voc Rehab. I had an Industrial Psychologist come to my home and visit with me for three hours. He developed a report that was then submitted to my VR counselor. My VR counselor then created several 'Request for Medical Services' Chpt 31 that were delivered, by me to my Primary.

They stalled for several months of getting me the supplies which ranged from long handle grabber, electric scooter and HISA Grant for outside work which included drive-way.  The only thing that was delivered was a set of grab rails and a shower chair. The issue I believe was with the Prosthetic dept; as I suspect I caught them in a lie. They stated that they had ordered the items and they had to give them out to other veterans. 

These folks would not follow-up with VR and because of this VR cancelled my ILP.

I recently applied for a HISA Grant and was denied. They stated that my prescription was for hand rails and a ramp. In no place on the ILP plan does it request that.

How does one appeal a HISA Grant?

HISA recommendation.pdf

Edited by WomanMarine
Added HISA recommendation

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I assume that you would appeal the the Board of Veterans Appeals (BVA).   I went here:

https://www.index.va.gov/search/va/bva.jsp      and typed in "HISP" under "Find these words" and came up with quite a few cases that were appealed to the BVA some were granted some were not.   Good luck

Edited by toddt
misspelling

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5 hours ago, WomanMarine said:

I recently applied for a HISA Grant and was denied. They stated that my prescription was for hand rails and a ramp. In no place on the ILP plan does it request that.

How does one appeal a HISA Grant?

HISA grants are controlled by the VA Medical Center Prosthetic Clinic .  There is usually someone assigned as the HISA Coordinator. You can appeal the Denial using what is called a Clinic appeal.   The appeal goes directly to the Prosthetic Department Director at the local hospital.   Your best option is to go to your Primary care doctor at the va and  explain to the doctor what you need, he will either refer you to someone to evaluate you for the need, or will write a prescription for what you need. But  you do need a prescription from a VA doctor.

I am attaching the handbook that explains the HISA Program, a flyer that gives some information on the program and the clinical appeals instruction. 

It would actually be quicker to see the doctor than to appeal the decision.

 

I wish you the best of luck

 

 

Handbook 1173-14 HiSA 18Apr2008.pdf VA Clinic Appeals.pdf SAHFactsheet.pdf

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You appeal a denial of HISA the same way you appeal a denial of other benefits:  You begin by filing a NOD on the applicable form.  

You need to make some decisions:

1.  Hearing or no hearing?  I have no idea if you want a hearing, go for it.  Hearings take longer.  

2.  HLR or SCL.  Choose SCL (Supplemental Claim lane) even if you "may" have to submit new evidence; HLR precludes submitting new evidence.  

3.  Or, I think you can appeal it directly to the BVA, and skip the HLR or SCL. 

 

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2 hours ago, broncovet said:

You appeal a denial of HISA the same way you appeal a denial of other benefits:  You begin by filing a NOD on the applicable form.  

You need to make some decisions:

1.  Hearing or no hearing?  I have no idea if you want a hearing, go for it.  Hearings take longer.  

2.  HLR or SCL.  Choose SCL (Supplemental Claim lane) even if you "may" have to submit new evidence; HLR precludes submitting new evidence.  

3.  Or, I think you can appeal it directly to the BVA, and skip the HLR or SCL. 

 

Dare I say 

WomanMarine,

I think  you  should read the handbook I listed for clinic appeals.... there is no hearing with this appeal, and there is no supplemental claim lane for this...  and no you cannot appeal directly to the BVA...

I have been through the process and I know exactly what I am talking about... 

All it takes is a letter to the director of the Prosthetic department and tell  him/her  what and why you are appealing, there is no special format for this type of appeal nor is there a special form.

If they deny the appeal, it then goes outside the Hospital thru  normal appeal  channels  and eventually it might get to the BVA and then the COVA as my  denial did.. and by the way I won my issue at the

COVA..

As I said before,  it would be much easier and quicker just to see a va doctor and get a prescription for what you need. The Prosthetic representatives  are very liberal in granting HISA if you have the

necessary prescription.  Appeals take too long no matter what system you use. 

Any denial  that involves A VA Medical Center,  goes thru this process... auto adaptive equipment denials,  medical treatment denials, wheelchair denials, brace denials  and yes  HISA denials.. they are the

approving authority for these issues,  and they are who you appeal too.

 

 

 

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7 hours ago, Richard1954 said:

Dare I say 

WomanMarine,

I think  you  should read the handbook I listed for clinic appeals.... there is no hearing with this appeal, and there is no supplemental claim lane for this...  and no you cannot appeal directly to the BVA...

...

As I said before,  it would be much easier and quicker just to see a va doctor and get a prescription for what you need. The Prosthetic representatives  are very liberal in granting HISA if you have the

necessary prescription.  Appeals take too long no matter what system you use. 

Any denial  that involves A VA Medical Center,  goes thru this process... auto adaptive equipment denials,  medical treatment denials, wheelchair denials, brace denials  and yes  HISA denials.. they are the

approving authority for these issues,  and they are who you appeal too.

 

 

 

Thank you Richard 1954, I read your documentation and believe you are correct. 

I have also recently switched Primary's and have put in a request for a new prescription. 

I am not sure how it is going to float as VR actually cancelled my ILP because my previous Primary would not correspond ...

I am going to try to reopen now that I have new Primary.

VR ILP Cancellation.png

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      My reply:
       
      Dear Mr. Hess,
      Thank you for your recent reply. Again, my questions have not been answered. Again, I cite the regulation for the authorization for a second semester. I m fully aware of what the regulations say, because I cited it for you and I will again. This was why I wanted an administrative review. I want the second semester put in my IEEP and Ii have supplied the justification for it. Again, your office has failed to cite a regulation that counters this regulation. Also, your last correspondence failed to address the subsistence allowance that I am eligible for because I AM IN AN IEEP! These two things should have been in my plan and need to be added.  It was these two missing items from my IEEP that give justification for an administrative review that I asked for weeks ago.
      I would like to have this semester reimbursed since I am still in an IEEP. As long as it is not for academic feasibility, which my grades have more than proven that I am not, then I am allowed to have the second semester while still in the IEEP.  Per M28R, Part IV, Section C, Chapter 3, states “… however, one additional academic term may be approved if the reason for the additional term is not solely for the purpose of determining academic potential. When considering if an additional academic term is appropriate, the VRC must:
       
            • Determine that additional diagnostic and/or evaluative services are needed
                        The panel has recommended more diagnostic testing, the psychiatric neurological meets this requirement
      • Ensure that the second academic term is authorized in conjunction with these additional diagnostic and/or evaluative services
                  This speaks for itself.
      • Address all feasibility concerns during the second academic term
                  Has not been done.
      • Submit written documentation regarding the need for additional services that specifies how the additional services will assist in the determination of feasibility
                  This is your offices job.
      • Obtain concurrence from the VR&E Officer
                  This is your offices job.
      I have more than met this requirement. I would also request my monthly subsistence be restored, with back pay, since I am still in an IEEP, I should still be receiving my monthly subsistence and I am still in school full time.
      Per 38 CFR 21.266, a Veteran participating in an extended evaluation program can receive a subsistence allowance. The allowance is paid in accordance with 38 CFR 21.260.
      A Veteran in a program of extended evaluation or an Independent Living (IL) program may be paid a subsistence allowance for full, three-quarter, or half-time participation at the rate specified for institutional training in accordance with 38 CFR 21.260. The procedures for processing an original or amended award found in M28R.V.B.8 should be followed when processing subsistence allowance for Veterans participating in an extended evaluation or IL program.
      I am asking for this to be reviewed and answered for. I cannot ask in a more direct way than this, so there is no ambiguity or reason for it to not be addressed or understood. I have met the requirements for these two items. If not, please advise why and cite your source so I can find the corresponding regulations. I do not believe there is a counter to these regulations.
      Sincerely,
    • By thatguyVLAD
      I graduate soon and want to teach english overseas in either Japan or S. Korea but my GPA is too low for the requirements of the teaching credential program.  Is there a possibility that the VocRehab program would let me retake classes in order to raise my gpa?
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      The VA DRO denied my claim for an earlier effective date for my sleep apnea. They originally denied it in 2008 but granted it in Nov 2019 secondary to my GERD. I was rated for GERD in 2001. So I had it in 2008. I have attached the 2008 denial, 2018 approval, and the NOD SOC. All of my medical files and the medical articles and VA Citations referenced were in existence in or before Jan 2008. The only new items were the NEXUS letter from Dr Bash and a few extra buddy letters. The original denial states that my medical records show no diagnosis or treatment and only isolated complaints of symptoms. The denial does not even list my wife's or my lay statements as evidence reviewed. I have symptoms listed numerous times in my SMRs:

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