PCAFC Question

[Burg]

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!!!

[jamescripps2]

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!