DIC Appeal - Advanced age

[Dave119]

Hi everyone, what a great forum. Quick question. I see the timelines for direct appeals can take a few years. My mom is in her mid 80s and filed a direct appeal a few months ago. From what I know, she was advanced on the docket due to her old age. Does that typically make much of a difference in the time it takes to make it to a judge? Dad passed away a long time ago and I am her only kid, so helping her as much as possible. But, a decision in her favor could help her with assisted living or other arrangements down the line. I know there are a ton of factors, but at her age, 1-2 years vs 5 years is a lot. Just wondering if anyone had a similar experience? Thanks so much!!

[Lemuel]

I applied for SMC for my wife just before she passed away.  Should get it back to one year before her death.  If we would have had it earlier or if CHAMPVA would have provided the in home visits like Medicare, she would probably be still alive today.

Definitely apply for everything she is eligible for.

You did not say yet if this is a PACACT claim?  Much easier and faster if it is.  At least my PACACT claim for bladder cancer went very fast.

Edited Monday at 01:57 PM by Lemuel

[Dave119]

3 hours ago, broncovet said:

Dont "think" about these things, apply for them.   The later you apply the later your effective date. There is no downside to applying now vs waiting.  However, there is plenty of downside to waiting.  It is a no brainer, apply sooner rather than later, for both champva and aid and attendance.  That's just my advice, unless you have more than enough money.  Then you dont need to apply at all if you are a billionaire.  

lol, I wish we had that kind of cash. The ChampVA is something we are going to apply for. The Aid and Attendance has been complicated because my moms Primary Care is not sure she meets the requirements under the activities. I help her a lot, but she is able to still go to the bathroom and shower and stuff by her self. 

[broncovet]

Whoa, Hoss!!

   It costs exactly $0.00 (zero) to apply for VA benefits!!  You dont have to have money to apply for either Champva or aid and attendance or other VA benefits.  If somone is charging you money to apply, they are almost certainly ripping you off.  

   Indeed, if you dont have 55 cents for postage, you can apply electronically, or get a VSO who will pay for the postage!  

   As explained above, no excueses apply now.  If you wait until the end of this month, it will cost you another months retro.  

For aid and attendance that means it will cost you around $700 or so, that is, you will get $700 less retro for waiing.  The envelope has to be received by the end of this month, not mailed!!!  Dont delay and throw away $700.  

    

Quote

§ 3.352 Criteria for determining need for aid and attendance and “permanently bedridden.”

(a) Basic criteria for regular aid and attendance and permanently bedridden. The following will be accorded consideration in determining the need for regular aid and attendance (§ 3.351(c)(3): inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. “Bedridden” will be a proper basis for the determination. For the purpose of this paragraph “bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others.

Especially, take note of this:

Quote

c) Attendance by relative. The performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance.

In other words a family member can provide aid and attendance and still get paid for it.  

Edited Monday at 05:32 PM by broncovet

[Dave119]

1 hour ago, broncovet said:

Whoa, Hoss!!

   It costs exactly $0.00 (zero) to apply for VA benefits!!  You dont have to have money to apply for either Champva or aid and attendance or other VA benefits.  If somone is charging you money to apply, they are almost certainly ripping you off.  

   Indeed, if you dont have 55 cents for postage, you can apply electronically, or get a VSO who will pay for the postage!  

   As explained above, no excueses apply now.  If you wait until the end of this month, it will cost you another months retro.  

For aid and attendance that means it will cost you around $700 or so, that is, you will get $700 less retro for waiing.  The envelope has to be received by the end of this month, not mailed!!!  Dont delay and throw away $700.  

    

Especially, take note of this:

In other words a family member can provide aid and attendance and still get paid for it.  

 

For the aid and attendance, don't we need a sign off from her doctor that she cant perform the above tasks? I help her out in her routine, but her primary care doctor does not believe she meets the aid and attendance requirements at this time. Are you reccomending we apply without any confirmation from her doctor? I assumed we needed his sign off. 

 

 

Edited Monday at 07:19 PM by Dave119

[Lemuel]

Is your mom a veteran?  I was under the understanding she is applying as a spouse.

Either get a second opinion or apply for extra-schedular and explain what she does need help with.  What is the root of her condition?  Minor stoke?  Falls?  Heart?  Breathing?  What causes you concern enough to put her in an assisted living or nursing home?  Why do you feel she needs constant watching.

My application is for safety concerns.  I cannot cook anything that cannot be cooked in an appliance that has a "time off" timer.  Like a microwave or a toaster oven because I forget what I was doing if I get any kind of momentary distraction.

Also I have to have assistance remembering to take my seizure medication.

I was having falls, but those have subsided.

What are you observing that concerns you?  Put your own statement in and apply for extra-schedular if the PC is not concerned enough to sign off on her.

Start washing her back if she will let you.  Detail what you do.  If you are helping her keep her meds straight detail that. Take your statement back to the PC and see if he will change his.

Edited Monday at 07:50 PM by Lemuel
add info

[broncovet]

I posted the criteria for Aid and Attendance above.  Yes, the form applying for Aid and attendance is basically also a c and p exam form, where the Va would provide a c and p exam to determine whether or not she needs A and A.  I have no idea.  YOU indicated "you are helping her as much as possible".  IDK whether the help you provide is "assistance with daily living" like bathing feeding, cooking, etc, etc. etc as it suggests in the criteria or not.  

You probably know that more than I do.  If you think she meets the criteria apply.  If you think she could live on her own without your assistance, then she probably does not qualify.