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Program of Comprehensive Assistance for Family Caregivers (PCAFC)

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hurryupnwait

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Has anyone in Oregon received a decision letter about acceptance into the PCAFC caregiver program?  We filed an application on October 26, 2020 and have gone through all the assessment interviews, which concluded on December 2, 2020.  Now, we are in Hurry up and Wait mode. 

This is for the pre 1975 vets that became eligible for the program on Oct 1, 2020.

Edited by hurryupnwait
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https://www.moaa.org/content/publications-and-media/news-articles/2020-news-articles/advocacy/long-awaited-va-caregiver-program-launches/

I only found one contact # here:

https://www.caregiver.va.gov/Care_Caregivers.asp

Can you scan and attach here the reason for their denial?

 

Cover veterans, name address and C file # prior to scanning it.

 

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03/10/2022

I am a Vietnam era 100% service connected disabled veteran. I have been awarded the maximum special monthly compensation at the “O” rating. I also have been granted Aid and Attendance at the R-2 level. No veteran of any era has ever been awarded a higher disability rating than I have been awarded. There are very few R-2 rated veterans worldwide.

In October, 2020 the Program of Comprehensive Assistance for Family Caregivers (PCAFC) program became available for application by pre 9/11, older era veterans. I read the eligibility requirements and applied for the program. According to the clearly written regulations, my caregiver and myself clearly qualify for maximum level 2 caregiver benefits, We were assigned minimum level 1 benefits instead.

I exhausted my appeal rights by appealing the maximum of twice to the VHA, I was denied both times. I then asked, and was granted a recertification. Once again, I was awarded the minimum level 1 benefits. Again, by filing the maximum of two appeals, I exhausted my appeal rights before the VHA a second time.

Please note that on the last VHA appeal adjudicated by VISN 8, the “fair and impartial” review by an expert team included a review of my appeal, a review my medical records, and a review of my prior appeals. The entire process only took less than two days, The appeal was submitted on Feb 16, 2021 and a decision to deny was rendered on the 18th of Feb, 2021, with no decision reason or basis offered.

Given no other choice, I next filed a Higher Level Review. ( HLR) That appeal was filed on March 1, 2022 and according to E benefits, it was closed on Feb, 14, 2022. And yes, there is no typo here, it was closed before it was even received. The VHA is also the assigned to adjudicate in the HLR process.

It is evident and obvious that regulations governing PCAFC are disregarded. The decisions are arbitrary. The inept general attitude of the program seems to be” What can we do to deny this veteran”. The adjudication process of the program is conducted by the VHA, and is not a “non adversarial” process.

I am sure that Congress, in the passing of the “Mission Act” never envisioned the extent of the shenanigans that are being executed by PCAFC in order to separate the most seriously ill and disabled veterans from their benefits. It is a dis respectful, unlawful, unacceptable and disgraceful practice.

Upon learning that my HLR claim had been prematurely closed with no decision whatsoever, on March 10/ 2022, for whatever it is worth, I filed a Supplemental Claim.

If the Supplemental claim is denied, I will next seek a review at the Board Of Veterans Appeals. A Board review is exactly where the VISN adjudicators want to see our claims end up. I know, and they know, that the Secretary Of The Department OF Veterans Affairs has ordered the Board not to hear PCAFC claims at this time. Those claims will be filed in a dark place, not to be opened for many years to come.

The Board, at this time, is backlogged at 200,000 cases, and are working on cases filed in 2018. That relates to a death sentence for me and many others of the most severely disabled population.

I expect that anyone prying into the unlawful PCAFC decisions to meet fierce opposition as those people have a smug way of defending the decisions that have been arbitrarily rendered. As I have discovered,  they defend one another. They have no intention of complying with regulations as laid out by Congress.

Thank you for your interest,

 

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Here is what you are going to be up against when making application for the caregiver program which was expanded due to the passage of the Mission Act.(PCAFC)

When you compare the plainly written regulations with the evidence as presented, decide for yourself if the claim should have been granted, or if the decision was arbitrary denied and therefore cannot be defended by the VHA. The VHA adjudicates PCAFC claims, not the VBA, so there is no consideration of the benefit of the doubt, nor is a non adversarial process. The attitude of the VHA seems to be, lets see what we can do to separate this disabled veteran from his benefits.

As a last resort you can appeal to the BVA, but that is a life sentence to us older and severally disabled vets. The Board is working 200,000 claims behind and they are working 2018 claims at this time despite being given their requested extra funding. 

The real kicker is the fact that the Secretary has instructed the Board to not hear those kind of cases at this time. So, the veteran is being placed between the hammer and the anvil. That is called legal abuse

If you have ample proof and have been denied PCAFC, please post your case. Just solid cases please, no whiners please.

Don't like it! Contact the Secretary, your Congressmen, and your Senators.

Edited by jamescripps2
can't get the attached files linked
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 Cut and paste the link into your browser. This is just a minimal evidence sample. I have many more doctors saying the same thing. I can post more if this is not convincing.

file:///C:/Users/james%20cripps/Desktop/Three%20page%20evidence.pdf

Edited by jamescripps2
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     Thanks for the info James.  I applied for the program 2 months ago and was also denied.  I'm sure I qualify as the rules are written.  I'm going to appeal but I have no idea what route is the best use of my time and also the best use of the VA's time.  They give 3 choices but there is no real reason why I would appeal in one way versus another so maybe I would waste a lot of time.  

     If anyone has advice on which choice to use for appeal please let us know. Thanks for your time.

 

   

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Those who are experienced and knowledgeable already know that the Veterans Health Administration (VHA) has demonstrated that it does not play by the rules and regulations that govern the PCAFC program and have no intentions of doing so, no matter what the evidence shows. That being said, If you elect a fair and impartial VHA appeal, you can expect a rubber stamped denial with no reason or basis for the arbitrary decision.

If you elect to do the Higher Level Revue (HLR), that decision is also in the hands of the VHA who has already denied you once. Expect to be rubber stamped again by the same fair and impartial  entity who denied you before.

If you elect appeal using the Supplemental Claims route, guess what? The VHA gets another shot at denying you once again using the rubber stamped fair and impartial arbitrary denial process.

Understanding all of the above, the VHA would rather that you appeal to the Board of Veterans Appeals (BVA) That is exactly where the VHA would like to see your claim go, but it is a a dilemma, because the Secretary of the Department of Veterans Affairs has ordered that the board not hear those kind of cases at this time! The BVA works for the Secretary so again, guess what? The Board is obliged to follow the orders of the Secretary and the veteran is placed between the hammer and the anvil. To date, there has never been a PCAFC case heard by the Board.

In my own case, after six VHA appeals my claim is at the Board. Although the Board, as stated above, does work for the Secretary, the Board falls under the Veterans Benefits Administration (VBA), not the Veterans Health Administration (VHA).

The Board does follow the rules and regulations. With much experience, I can say that in the end, if the Board hears your case, the chances of you getting a fair and impartial revue are pretty good. At least at the Board you can expect a reason and basis for the grant or denial.

I am confident that my PCAFC case will be granted at the Board, hands down, because the evidence is solid and indisputable. I just don't know if I can outlive the process of getting the case to the Board to be adjudicated. 

I can't recommend what appeal route to take but I will say that if you elect to follow the VHA, HLR, Supplemental claims route your denials will come rapidly. I went through six appeals inside three months with the last appeal being submitted on Feb 16, only to be denied on Feb 18 with no reason given for the arbitrary denial.

As part of the mission act reform of the PCAFC the process was to become more consistent and transparent. If it was indeed transparent we would have access to who the CEAT members were along with their qualifications.

Edited by jamescripps2
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