Never give up when you are right, and you know you are right, and you have some fight left in you!

[jamescripps2]

In October 2020, after more than ten years of exclusion and being fenced out from participation in the program for pre 911 veterans, the Program of Comprehensive Assistance for Family caregivers (PCAFC) under the new eligibility regulations in accordance with the provisions, and as defined by the Mission act, was expanded to include Vietnam era veterans. I applied for caregivers benefits on October 7, 2002.

Due to the flood of new applications the decision took about six months. Although, according to the new regulations, my caregiver and I clearly met the eligibility requirements for level 2 benefits we were awarded level 1 benefits.  I immediately appealed. I was denied with no reason or basis given. I again appealed. I was then told that two appeals was the end of the line for me in the appeal process. I then asked for a chance for recertification, as it had been a year since my original application submission. My request for recertification was approved by VISN 9 but I was warned that recertification could bring about severance from the program for myself and my caregiver altogether.

The recertification process produced a continued award of level 1 benefits. I again immediately appealed and was once again denied. I immediately appealed again and was denied the very next day, in less than twenty four hours, by the CEAT team in VISN 8. After six wrongfully denied appeals for level 2 caregiver benefits before the Veterans Health Administration, (the VHA), I was still being denied with no reason or basis for the denial which was certainly not in accordance with the laws and regulations governing the CPAFC program. I spent many hours upon hours preparing for each appeal.

During the prosecution of my claim and as due to a Court of Veterans Appeals case, the law was changed to allow more than just two VHA appeals. Now we were not limited to just two VHA appeals, we could also appeal to the Veterans Benefits Administration. (VBA). Now we could ask for a higher level review or a supplemental claims appeal which are useless as they are both adjudicated by the same folks, the VHA, who have already shown their ineptness in rendering fair and impartial decisions. The Court rendered a decision that we could also ask for a review by the Board of Veterans Appeals, and even to the Court if need be.

In compliance with the order of the Court, I was notified by the VHA that I could ask for a higher level review, a supplemental claim, or ask the Board to review my case. At the same time, I was warned by the VHA, in what I took to be a threatening way, that if I chose a Board review and the Board denied my claim, that would be the final and the end of it for me.

I asked for the HLR, and my case was quickly closed, no decision, just closed. Immediately I asked for a review by the BVA, and that my case be advanced on the docket as due to my being a R-2 vet. The Board agreed to advance my case on the docket as the evidence of record supported the advancement of my case on the docket.. 

On June 22,2022, the Board granted my level 2 CPAFC benefits using the exact same evidence of record as was used by the VHA to deny me so many times. The BVA furnished a full explanation of reasons and basis for its decision to grant the benefit. I will be looking for my retro back to October 2020, which is well deserved by my faithful caregiver's free labor of many years.

Let me say this in closing and you can draw your own conclusions as to whether or not I should or should not have prevailed and what your own chances are if the system isn't fixed. My VA providers and my outside providers, do and have always supported my claim for level 2 benefits with letters and record entries. I have three 100% P&T awards and many, many lesser awards for both physical and mental disabilities. I have fourteen large painful service connected and rated scars. I run on a battery. My body has been completely reconstructed from my knees to above my navel as due to service connected circumstances. More than a few doctors and providers have stated in the record that I cannot sustain in my home or community without a caregiver. No veteran of any era or branch of service has ever been awarded a higher disability rating than I carry, and no veteran of any era or branch of service draws more monthly compensation than I do. VISN 8 CEAT team conceded in February 2021 that I needed help with five of the seven listed ADLs but they ruled that I still did not need assistance so as to require level 2 benefits. Considering all that has been said here, for what reason was was I and my caregiver put through so much grief and agony to the point of loosing what little self respect that we had left ????????????

Edited July 4, 2022 by jamescripps2

[jamescripps2]

I am almost sure that this is the very first PCAFC case to be heard before the BVA.

 

[Phury & Rhage]

I am so happy that you finally prevailed, but I'm so sorry that it took so long for no good reason. 

I have never had a claim against VHA so I don't have any personal knowledge of its claim process.  It is my opinion (as one of the 1st people hired with my job title at a new DROC and over 3 years as a claims processor there) that giving Vets an early and direct route to BVA has been a HUGE success for Veterans.  The primary reason for my opinion is that Vets seem to get more favorable decisions on their claims once that claim gets to CAVC.  To get to CAVC, you have to get through the BVA. 

I have worked many BVA remands that were remanded from CAVC back to BVA and then back to VA to actually do the remand work.  CAVC gets it wrong sometimes too (in my opinion) but your chances of getting a favorable decision move up to at least 50% based on my experiences (my perspective and opinion ONLY).  Hopefully, this trend will hold true so that Vets can skip the early, long torture so many have experienced that has drug on for years in many cases.

Again, I am so happy for your well-deserved win!

Phury

[pacmanx1]

Congratulations.