ptsd Smc

[rigo]

Dear Berta and friends, in Jan30, 2007 had a C/P for my SMC at the Temple VA in Texas, to my surprice the staff was efficient and courteous. The doctor came into the waiting room call my name and we were off, in his desk were all my medical records, it look like a mountain of paper, he asked me why was the reason I was requesting SMC, I proceeded to tell him why, and at the same time I gave him a letter written by my mother in support of my SMC. He did examing me and after the examination he stated that I was in need of aid and attendance of another for my service connected PTSD.

feb 24, 2007 received the white enveloped with the rating decision:

We granted entitlement to special monthly compensation based on need for aid and attendance criteria being met effective June 21, 2000

This constitutes a total grant for special monthly compensation based on aid and attendance.

Your overall or combined rating is 100%. We do not add the individual percentage of each condition to determine your combine rating. We use a combined rating table that considers the effect from the most serious to the least serious conditions.

REASONS FOR THE DECISION (This may help somebody)

Entitlement to special monthly compensation is warranted in this case because the criteria regarding aid and attendance have been met.

Letters from you received August 21, 2006, October 27, 2006, November 7, 2006, and January19, 2007, indicate you continue to disagree with VA decision regarding your claim. Information received from Texas Department of Aging and Disability Services dated March 28, 2006, to September 8, 2006, reveal that you have received services for the aid and attendance. Invoices and Time Sheets fro Auxi Helth Care from May 1, 2006 to September 30, 2006 indicate you receive service to help you with bathing, dressing, feeding, grooming, hair/skin care, transfer/ambulation; cleaning, laundry; meal preparation; shopping and assistance with self-administered medication. VA Examination, VA Medical Center, Temple, TX, dated January 30, 2007, show you require the regular assistance. You currently have posttraumatic stress disorder evaluated as 100 percent. Your posttraumatic stress disorder is severe disabling. You live with your mother who takes care of you with the help of other family members, outside help from nursing and home health providers. Your postraumatic stress disorder manifest with frequent episodes od rage, anxiety, panic, terror which includes aggressive, violent behavior and suicidal homicidal gestures. Your require medical surveillance/precautions. Medications are kept locked up due to prior suicidal overdosage attempts. You do not go out of the house socially only for medical appointments. You become essentially helpless for hours to days after episodes of violence, rage and terror/panic. The other condition which is not service connected is postphlebitic syndrome in both lower extremities which affects your independence to a much lesser degree. You do not go anywhere by yourself, do not drive and demonstrate anxiety and social ambivalence and avoidance. You are able to ambulate independently. You have psychological hindrances to coping with the stress and relationships of life. You are not physically hindered from the outside or from the environment but mentally and emotionally you are debilitated. You are capable of handling your VA benefits. The examiner diagnoses posttraumatic stress disorder severe and disabling. The examiners opines that this is the predominant condition causing you to need aid and attendance because you are emotionally unstable and unpredictable and sometimes become helpless in a histrionic fashion. The secondary diagnosis of postphlebitic and chronic pain syndrome of both lower extremities. Treatment Reports, Central Texas Health Care System (VAMC Waco, Temple and Austin Outpatient Clinic), dated September 16, 2006, show you reported for Kinesiotherapy.

The findings indicate you are in need of aid and attendance due to your service-connected postraumatic stress disorder; therefore, entitlement is established from June 21, 2000, the date of claim.

Even though my claim for SMC was granted, some important evidence is missing, some of the explanations given on my behalf makes no sence. I`m going to recuest the c/p.

Sorry this was long but I think is important for veteran`s to learn about the VA and their rating decisions.

What level of SMC do I qualify under, thanks Rigo

[Dorothy Kansas]

Do you require skilled care from a licensed provider or family member trained under the supervision of a physician? If so you would qualify for R2. I believe you will most likely get the L rate.

[Rich T]

Since they don't use the words "special" or "higher level" I would assume they are granting "Regular" or L. The Special is R1 and Higher level is R2.

[sixthscents]

Yep to my understanding yoou would qualify for R1... it kinda goes like this

In a nursing home there are skilled beds (requiring an RN and other specialized care) and non skilled bed (which require a LPN care, or even just an orderly or CNA)

the ratings R1 and R2 equate to the same requirements for a "skilled" or non-"skilled" position except in a home health eviroment. If the care necessitated by the decription given is accurate then I would suspect - and you can easily check me by speaking with a home health rep, or the ADON of a nuring home facility or DON...(Assis Dir of Nursing) ...(Dir of Nursing) to establish what level of care you would need if you were placed in their facility i.e. skilled or non-skilled - that you would probably need non-skilled care...

PLEASE CHECK ME ON THIS WITH YOUR LOCAL NURSING HOME OR HOME HEALTH PROVIDER...

SMC IS terribly unclear and it is only through quite a bit of research that I discovered WHY the ratings R1 and R2 even existed

I know why the smc logic is what it is, but there may be facets of your case that I am unaware of that were NOT mentioned in the decision which would qualify you for R2, if actually considered.

You CAN have family members perform the care however they MUST be equally trained and certified to perform the care as any professional brought into the home. So if in your situation you need an LPN around the clock, they would have to have a current LPN license, the same goes for CNA, RN etc...

Even with just R1 though its quite a chunk of money, but if you actually have to pay it to a home health company... well you can get their rates etc... I dont want to discourage you. Suffice it to say, they avoid overpaying. Anyway congratualtions on your decison.

SMC is such a HARD area, unless you have a lot of experience with it.

[sixthscents]

Oh and I think R1 because of the following statements.......

indicate you receive service to help you with bathing, dressing, feeding, grooming, hair/skin care, transfer/ambulation; cleaning, laundry; meal preparation; shopping and assistance with self-administered medication. VA Examination, VA Medical Center, Temple, TX, dated January 30, 2007, show you require the regular assistance.

this shows need in day to day activities, and is actually admitted to by the rater

Your require medical surveillance/precautions. Medications are kept locked up due to prior suicidal overdosage attempts

this is a BIGGIE... its shows the need for someone to administer, track and control your medication (LPN at least)

You do not go out of the house socially only for medical appointments. You become essentially helpless for hours to days after episodes of violence, rage and terror/panic.

again the rater is open admitting that 24 hour care is necessary, and by their prior statements it'll be LPN or Med Tech level .... R1.... I'd be VERY suprised if it was any less

[windy city]

Do you require skilled care from a licensed provider or family member trained under the supervision of a physician? If so you would qualify for R2. I believe you will most likely get the L rate.

Dorothy,

You syated that a person requiering the skilled care from a licensed provider or a person under the supervision of a professional you can get a higher aid and attendance. Don't you have to meet certain criterias like recieaving the o or p rate under smc or do they waive those criterias if indeed you need the services of a licensed skilled provider. I just need claryfication is that I am confuse when it comes to getting a higher rate of aid and attendance.

[sixthscents]

You CAN have family members perform the care however they MUST be equally trained and certified to perform the care as any professional brought into the home. So if in your situation you need an LPN around the clock, they would have to have a current LPN license, the same goes for CNA, RN etc...

see my post below... I can look up the reference if youd like... but its somewhere in 3.350 or around there....