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PCAFC Question


Burg

Question

i am 90% schedule and rated 100% IU i was made T&P december of 2016

I have pretty severe ptsd and all of the trimmings, migraines that are deabilitating, nightmares, sleep issues, anger control issues, confusion, short term memory is totally gone...

i have a pretty messed up left knee that i cant bend very far, because of the knee on the left i have prematurely worn my right hip from limping for years so i cont bend that leg very well at the hip

i have 5 bad discs/vertebra in my lower back L1 l2 l3 l4 and s1... one of them pushes against a nerve root which caused all sorts of seemingly unrelated issues and some of them are getting worse... i cannot urinate without being cathed... the last year i am starting to have foot drop issues and have had a few bad falls... one of them led to skinning my good knee (lol) to the fat layer and i ended up with a pretty bad staph infection... one of my problems is i have always self cathed standing... i have never been able to do it sitting... i end up bleeding... since my stability has deteriorated i cannot do the cath while standing so my wife has to do this for me 4 times a day... i cannot get up off the toilet without help... ( i forgot to mention that a fall a few years ago tore up my right shoulder so pulling myself up isnt really pretty either anymore... i cant even take a plate out of the cupboard anymore) i walk with a knee brace, back brace and a long walking stick (a cane hurts my back)

i have not been able to put on my own socks shoes, underwear or pants for 10 to 15 years 

i need help getting into and out of the bed, i cant do showers because its too risky with the falling... i cant get into or out of the tub without help.

i cant wash my lower half, i can wash my face hair and front of my upper body

i cannot do my own meds... last time i "helped" my wife by getting my own meds i accidently took 3 sleeping pills (im supposed to take 1/2 of 1 per day) instead of the 3 Acetaminophen tablets i am supposed to take 3 times a day for pain and swelling... my wife ended up having to call poison control who called the local ER ahead while we were enroute to give them instructions... i did them myself because were were late for church and i was trying to help...

i cannot cook because i forget things like turning the stove off... things of this nature.

we had the phone consultation and it all seemed to go well

we had the video interview and that too went well

2 days later they denied us because "it was not in the best interest of the veteran" "i do not need 6 months of care at this time" its like lady... if it were not for wife helping me with daily living crap i would be dead... im just not sure where to go from here... should i appeal? which way? should i just forget it?

my wife has been doing this stuff for me... dressing me, putting on my braces, handling business, getting me to my appointments, driving, the past couple years she has had to step up even more caths, help walking  etc etc etc for 12 years... lets put it this way after i nearly burned the house down boiling an egg she had to quit her job... she was pennalized by the IRS that year because she didnt have health insurance and was not eligible for the obamacare... thats how long she has had to carry my useless ass!

what should i do? if im not in need of help i would hate to see the person who is!!!

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Burg, Type my name, jamescripps2, into the search box at the top right side of this page to access and read my post here on hadit pertaining to the CPAFC caregiver program. You will find many answers to your questions about the caregiver program from someone that has been through the application and appeal process from stem to stern.

I am also located in TN. My healthcare is provided by VAMC Nashville. You can also listen to archived podcast that are available at exposedvet.com. Those podcast are also also accessible through a link here at hadit, The podcast feature my advice on appeals as related to the caregiver program. Much information is also posted on my website, (listed below), about the CPAFC fiasco.

vatheredneckway.wordpress.com

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17 hours ago, jamescripps2 said:

Burg, Type my name, jamescripps2, into the search box at the top right side of this page to access and read my post here on hadit pertaining to the CPAFC caregiver program. You will find many answers to your questions about the caregiver program from someone that has been through the application and appeal process from stem to stern.

I am also located in TN. My healthcare is provided by VAMC Nashville. You can also listen to archived podcast that are available at exposedvet.com. Those podcast are also also accessible through a link here at hadit, The podcast feature my advice on appeals as related to the caregiver program. Much information is also posted on my website, (listed below), about the CPAFC fiasco.

vatheredneckway.wordpress.com

Thank you so much... this site is a very good resource but its also very complex... and im not the brightest bulb in the string these days...  it took me 10 minutes to find the post i made last night! i tried to find info on it here but everything i ran across seemed to be from before they changed the program... thank you so much!!

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The easiest way to navigate this site is to use the blue navigation bar at the top of the page. It is highlighted in bold blue. Clicking on your content and your activity streams should get you to where you need to be fairy quickly.

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2 hours ago, jamescripps2 said:

The easiest way to navigate this site is to use the blue navigation bar at the top of the page. It is highlighted in bold blue. Clicking on your content and your activity streams should get you to where you need to be fairy quickly.

ok well after reading your story and the fact that we share the same rubber stamping crew (i also use the Nashville hospital as its the closest... and that is a 4 hour round trip for me) i should just skip all of the VHA and get on the waiting list for a bva review and hope... i did the 2 interviews and the very next day after the second one the denial showed up in myhealthyvet notes... i have not received it yet in the mail.

the reasons they gave were (cut and paste)

LOCAL TITLE: CSP DENIAL NOTE
STANDARD TITLE: CAREGIVER CERTIFICATE
DATE OF NOTE: OCT 27, 2022@12:13 ENTRY DATE: OCT 27, 2022@12:13:24
AUTHOR: DAVIS,DANA L EXP COSIGNER:
URGENCY: STATUS: COMPLETED
*** CSP DENIAL NOTE Has ADDENDA ***
Caregiver Support Program Denial Note
Denial date:
10/27/2022
Denied from the Program of Comprehensive Assistance for Family Caregivers.
The person being denied is the Veteran.
Name of Primary Family Caregiver:
Julia Burgess
The reason for denial is the Veteran or service member does not require
personal care services for a minimum of 6 continuous months based on an
inability to perform an ADL and/or a need for supervision, protection or
instruction.
The reason for denial is participation in the Program of Comprehensive
Assistance for Family Caregivers was deemed not in the Veteran's best
interest.
BURGESS, GRANT A CONFIDENTIAL Page 4 of 24

 

brother... i cannot get in or out of a bath, i cant use the catheters myself, i cannot get on or off the toilet alone and i cant dress myself... i cant cook i cant drive, i fall constantly and cant get back up, i have ended up in the local ER with poison control on the line because i took the wrong meds... im a serious mess...  without my wife's help i have no idea what would become of me... here is the REAL problem... they didnt even look at my problems!! i was shifted to permanent and total in 2016... they didnt even look at my records... they didn't look at my xrays or mri's of my back, they didnt look back to where my diagnoses were found... they started looking about the time i stopped going to the VA for care... when covid hit the scene they would not allow my wife and little boy both to accompany me... i cant get there and get through my appointments without my wife... i moved here because my doctors at the VA up north said i would greatly benefit from living in a milder climate (we are from near buffalo ny) we don't have family here and i have ptsd and dont get around very well so its not like i have hobbled around town making friends here!!!! im NOT leaving my child with anyone... its 2022 and i have seen what happens to kids in the care of others xxxx that!! i have gone without care on many things because of their policy... i have a tooth that hurts so bad i cant close my mouth all the way... i started going back this summer when they would allow my little boy to come in with a mask on... now he cant come again because they are back to the 1 "guest" thing again... she isnt my guest he is... she is my lifeline and i cant be there without her literally!!!  dont know what to do... should i do a bva review or just give up?!?!! the other thing is they dont look at ANY of the records i have sumbitted from my local doctor, the local ER or any of the choice program doctors i see... 

 

 

EVIDENCE CONSIDERED TO MAKE THE DECISION
We based this decision on the following records:
Veteran Intake, dated 10/02/2022.
Veteran Assessment, dated 10/06/2022.
Veteran Functional Assessment, dated 10/26/2022.
Caregiver Assessment, dated 10/06/2022.
Primary Care Collaboration, dated 10/17/2022.
VA Medical Records, dated 07/18/2019-10/26/2022
 
 
 
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At this time it seems that the attitude of the PCAFC caregiver program is to see what they can do to deny the veteran when the attitude should be to see what they can do to get the veteran enrolled into the program.

You never give up! If you appeal using the HLR or the supplemental claims, the very same people, the VHA, are going to deny you again. I suggest that you take your claim straight to the BVA. The BVA has nothing to do with the VHA but rather, they come under the VBA, and that is where you will find justice.

I don't know the particulars of your service but evidently you are not a legacy veteran in the program. If you are indeed not a legacy participant, you would file on a VA form 10182 Decision Revue Request.

True, the Board has a backlog, but if your medical records contain all that you claim, it will be the quickest path to a granted decision. The Board generally does not fool around and they do consider the evidence of record to make an equitable decision. You can look up my decision by going to the BVA decision search site https://search.usa.gov/search?affiliate=bvadecisions&_ga=2.77268117.1265507262.1648799257-1511624019.1640929699  Then enter the Citation Nr: A22011682.

Citation Nr: A22011682
Decision Date: 06/22/22	Archive Date: 06/22/22
DOCKET NO. 210903-192826

In the meantime you might consider filing on loss of use of a foot if you do have drop foot and you wear an afo brace. Also, you might consider filing for A&A

 

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10 hours ago, jamescripps2 said:

At this time it seems that the attitude of the PCAFC caregiver program is to see what they can do to deny the veteran when the attitude should be to see what they can do to get the veteran enrolled into the program.

You never give up! If you appeal using the HLR or the supplemental claims, the very same people, the VHA, are going to deny you again. I suggest that you take your claim straight to the BVA. The BVA has nothing to do with the VHA but rather, they come under the VBA, and that is where you will find justice.

I don't know the particulars of your service but evidently you are not a legacy veteran in the program. If you are indeed not a legacy participant, you would file on a VA form 10182 Decision Revue Request.

True, the Board has a backlog, but if your medical records contain all that you claim, it will be the quickest path to a granted decision. The Board generally does not fool around and they do consider the evidence of record to make an equitable decision. You can look up my decision by going to the BVA decision search site https://search.usa.gov/search?affiliate=bvadecisions&_ga=2.77268117.1265507262.1648799257-1511624019.1640929699  Then enter the Citation Nr: A22011682.

Citation Nr: A22011682
Decision Date: 06/22/22	Archive Date: 06/22/22
DOCKET NO. 210903-192826

In the meantime you might consider filing on loss of use of a foot if you do have drop foot and you wear an afo brace. Also, you might consider filing for A&A

im not sure what a legacy veteran is to be honest... im a desert shield/ desert storm era veteran the program just opened up to my group 1 oct... my wife and i have been waiting for this for a decade... and now that its here its still out of reach lol. its pathetic you fight an enemy for your country and you think you made it... but then the real fight begins... fighting pencil pushing bureaucrats and political crap for whats owed to you...

 

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A legacy participant is a post 9/11 veteran who was in the program on or before October 1 , 2020. Legacy veterans are required to appeal using a different method and a different VA form.

My wife/caregiver and I had to wait a decade for the program eligibility requirements to include us. We applied when I was on my death bed. In July, 2020, I had been given a 4% chance to survive a service connected operation and then a 12% chance to survive the next ninety days. I was sent home after thirty days in ICU with 150 opiate pills and a hospital bed. I was told by pain management that I could have all of the opiate pain killer pills that I wanted. I was sent home to die.

I was admitted into the PCAFC caregiver program at the lowest level, level 1 benefits. There were three medical professionals (RNs) coming to my house three days every week. I had leg braces that I could not get on or off by myself and I had a colostomy that I could not even see, much less care for. I could barely raise my head off of a pillow. The CEAT team conceded that I needed help with five of the seven ADLs but still refused to grant level 2 benefits. That arbitrary decision was not in accordance with PCAFC guidelines and contrary to the regulations.

I went through the appeal and deny, another appeal and deny, I requested recertification, appeal and deny, another appeal and deny. I took it up to the BVA and I was granted level 2 benefits using the exact same evidence that was used by the VHA to deny over and over so many times before.

The VHA social workers and, so called expert, CEAT teams, put me through so much hell for more than two years that I cringe to even think about it. Don't ask me what I think about those people because there are just not enough words. I told them that they were wrong, and in the end, I proved it.

Bad thing is, they are doing the exact same thing hundreds if not thousands of other veterans. The fiasco is, on its own, creating an unbelievable backlog at the BVA. You can go to the BVA search prior decisions website that I gave in the post above and type PCAFC caregiver in the search box to see for yourself. All of the cases have been remanded except my case and one more. That other case was granted, only to be vacated and reversed three days later. The reason for vacating and reversing the decision being that the caregiver did not complete caregiver training, and that lack of training had been overlooked in the initial BVA decision.

All of those remands, and my case, being the only granted case, is going to stuff that old hamster wheel so tight that it will cease to function. The cost to the taxpayer is going to be tremendous and unbearably ridiculous. Nobody is going to be held accountable for squandering VA resources. Nobody is going to get disciplined or fired. Nobody is going to miss a paycheck with the exception of THE DESERVING CAREGIVERS AND THEIR SERIOUSLY DISABLED HEROES.

When the going gets tough, the tough get going!

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