Caregiver denial

[andrewdc]

I was denied for the caregiver program. I am rated r1. Should I appeal to the bva?

[broncovet]

Assuming you got a written decision, that you dispute, yes, file a nod and try to refute their reasons and bases for decision.  

Source:  I dont have a caregiver, so Im relying upon more general benefit informaiton, when ILP is denied, you can appeal that, and you can appeal other unfavorable decisions, not just comp and pension. 

If someone is in the caregiver program, and have appealed it, then they should speak up.  They know more than I do.   

 

[jamescripps2]

Thanks for the invite Broncovet!

I already know that there was no proper "Statement Of The Case" included in the written decision from the Vetrans Health Administration, (VHA) informing you of the reasons and basis of the decision and a viable reason that you did not qualify. The VHA, unlike the DVA, is not required to give you a Statement Of The Case.

I am a R-2 rated veteran and was denied level 2 PCAFC caregiver benefits through six appeals. You have options on your appeals process that were not available to me at the time. You can climb up the appeal steps, one at a time in any order that you choose, Or you can skip some, or all, and go straight to the top. Your choice. Your options are as follows.

#1 appeal the VHA decision through the VAMC Patient Advocate. You get two appeals that will be adjudicated before the same VHA people who just denied you and you can expect to be denied on both of those appeals.

#2 you can file a VA form 20-0996 for a Higher Level Revue (HLR) appeal. In submitting a HLR, you cannot submit additional evidence and once again, the decision is up to the VHA, the same people who have already tossed you under the bus.

#3 You can file a VA form 20-0995, Decision Revue Request, Supplimental Claim. You can submit additional evidence but once again, the same VHA people who have been denying you get to shoot you down again.

#4 file a VA form 10182 Decision Revue Request and ask the BVA to revue your claim. If you are in fact an R-1 rated veteran it will be a slam dunk at the Board. Filing the VA form 10182 will remove your case from the eyes of the VHA and place it in the more capable hands of the Veterans Benefits Administration (VBA). There you will find justice according to the regulations that govern the PCAFC caregiver program.

I would suggest that you avoid all of the VHA denials and go straight to the Board by filing a 10182. At the same time ask the Board to advance your case on the docket based upon the reason that you are an R-1 rated veteran.

When my dog was first in the fight i did not have the right to take a PCAFC case to the BVA. After my final VHA appeal, and thanks to the Beaudette V. Mc Donough CAVC court case, ( FYI)-VA Has Begun Mailing Court-Ordered Notice to Hundreds of Thousands of Veterans and Caregivers as a Result of Beaudette v. McDonough Class Action)      I gained the right to appeal my case to the BVA. On June 22, 2021, I won the very first ever PCAFC caregivers case to ever be heard and granted for level 2 caregiver benefits at the BVA. (BVA docket No. A22011682.

I have written much more on the PCAFC caregiver subject on my web site.

vatheredneckway.wordpress.com

Edited January 18, 2023 by jamescripps2

[broncovet]

You did a great job defining the different methods of appeal.  I agree, to go directily to board, and not mess with HLR or SCL.  

 

The SOC applies to legacy only and is no longer required to appeal to the BVA since 2019.  

And, the SOC is a seperate decision, usually by a higher level review.  

A SOC (or SSOC, that is suplemental statement of case), is a seperate decision, where they essentially deny you again, and allegedly give reasons why.  

A regular VARO decision does not have a "Statement  of case", but is supposed to include "reasons and bases for decision".  

"Reasons and bases for decision" is not the same as a SOC.  

YOU NO LONGER NEED A SOC to appeal to the Board, under AMA.  

If "the board" does not give an adequate reasons and base for decision, the CAVC will usually remand it for an adequate reasons and bases.