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!!

[Dave119]

1 hour ago, Lemuel said:

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.

My mom is not the Veteran. My late father served. 

My mom lives with my wife, kids and myself. Our home is a 2 story home. My mom has a very difficult time with stairs. She has a back surgery a few years ago, which helped, but she still struggles. We had stair lifts put in. But, even with the lifts, I worry. She lost all the hearing in one of her ears a few years back due to a virus and now suffers from bad balance issues and has had falls (no major injuries, thankfully). She now walks only with the use of a cain. She has moderate to severe COPD, so she also struggles with that condition. There is no option to use a room on the first floor as a bedroom.  We have kids, so it is a full house. 

The reason we were considering assisted living, is that aside from us selling our current home and buying a new one (something we are considering), the house is not a great set up for her. Single floor living would be much better. Also, although she can still handle many things, I don't think living by herself in a typical apartment would be wise at this point. I don't think she should live alone, so the option of moving her into an apartment of her own by herself isnt a good on in my opinion. In my area, there are places that are kind of in between living by yourself, but not yet a nursing home.  

I have to note, despite this, her doctor thinks she doesn't quite meet the requirements listed in the application. I disagree and feel it is absurd due to her age and balance issues. That is why we haven't applied yet. We are in limbo. A second opinion would probably be good idea. 

 

 

 

 

Edited Monday at 08:49 PM by Dave119

[broncovet]

Aid and attendance is also payable for dependents:  Source:

https://www.va.gov/disability/survivor-dic-rates/

    If YOU think she deserves A and A, then the ONLY chance you have of getting it is to apply.  No application = no award of benefits.  

    Yes, you may need to get an IMO (independent medical opinion) to get it.  Its possible that could even be paid by her medicare/ medicare advantage if she (or you) ask.   (A medicare exam helped me win my benefits.  No I did not ask the medicare examiner, because I did not know about that, I just asked for a copy and submitted it to VA, later).  

On this forum many of us have been through this, and its always the same.  The only way to get benefits is to apply.  Thinking about it never works, until/unless you actually apply.  

I wasted a lot of time considering whether or not I should apply when I could have easily gotten benefits years earlier.  Some day I may figure out just how much that procrastination cost me.  Im sure its tens or thousands of dollars.  More likely it could even be six figures.  

Its actually easier for dependents than for Veterans. Why?  Well, for ME to get a and a, I have to prove I need help with daily needs BECAUSE OF A SERVICE CONNECTED CONDTION.  

Your mother wont have to prove any service connection, its just not necessary.  She need only documentation she needs assistance, not that it was due to her military service, which she apparently does not have.  

Edited Tuesday at 01:34 AM by broncovet

[Lemuel]

@Dave119 In your filings do, not talk about your options.  Talk about your mother, her needs to have someone with her, and what you and your family specifically do for her.  Ignore all options other than assisted living or a nursing home.  Do not say how you could keep taking care of her specifically, only that you would if you could afford to do so on her income.

Tell them of her desire to not go to a nursing home and what you are trying to do but cannot do without additional support.  Financial or in-home care.

The only exception I see is selling your home and moving to a larger home that fits your needs.  If you received SMC from when you started taking care of her (when she first needed your help which is when SMC is supposed to start) (forget that you did not apply when it was first needed, she was probably unaware that it was available), that would enable you to put enough down to keep the payments in your range if she was suddenly gone even with the income she is now contributing to household income.

I am reading into your remarks above that the kids are yours and her grandkids.  Everyone is sacrificing something to take care of your mom, so she does not have to go to a nursing home.  The house is yours to sell and you have some equity if it sells for at least the appraised value.

Are you getting all of the assistance from MEDICARE, that you can.  If she does not want one of you to help her with her bath and make sure she does not fall in the tub or shower (personal care she is denying she needs, but if she is using a cane, does need minimally someone outside the shower or tub, but for qualified personal care you have to wash her back to show your presence or get a CNA through Medicare to do it because she is bashful of having one of the family do it.

I have CNAs three times a week come that also have Medicare and Medicaid patients.  The do light house work chores in addition to washing my back and seeing me in and out of the shower and Japanese hot tub.

I have one regular that is supper efficient.  It let my wife, while she was still alive and able, to hire additional help especially with the yard and garden.

Focus on your desire to keep doing what you are for her and how the extra help her PC could order would help you.  Ask the PC to order her help.  Make sure it includes helping her with a timed medication dispenser filled by a nurse for her pills if she needs it.  I do and I have had to go to an urgent care clinic to get it done. Some pharmacies where you pick up medications will do it, but of course the CHAMPVA mail out will not. 

I make too many mistakes trying to do it myself, and you or a member of your family do not want to make a serious mistake with her medication.  Tell her PC that he knows damn well these mistakes are much less frequent with a Nurse and that is the reason a CNA is not qualified to fill a timed medication dispenser.

You say earlier you are already in appeal.  Part of that appeal evidence can be your physicians listening to your mother's denials instead of you and your fears of someone in the family doing a wrong thin unintendedly.

Focus on the info @broncovet has given you.  You cannot do the best for your mother if you do not do the best for those of you taking care of her.

A good call to make in some cases like yours where you are at wits end, is to the White House Hotline for veterans.  You will need your fathers ID information to do that.  Congressman also help on occasions.  Rattle a few cages.  The squeaky wheel gets the grease.  Get everything that you can that will reduce the stress of taking care of your mother at home. 

Explain to your mother that denials to her doctor are putting a problem on you letting her stay with you and your family.  Ask her to let you or your wife see her doctor with her.

[broncovet]

It may help if you keep a "log".  For example:

Sept. 9/2024 8:02. Woke up mother.  Helped her down stairs to breakfast to prevent another fall, like the one on 9/02/2024 (proviide details of that fall).  

8:15. Cooked and served her breakfast, afteer helping her get dressed and explaining what day today is.  (Now include times and dates of when you assisterd her, and what you did). It was a weekday so I went to work, and left her in the care of my spouse, (Sue Smith, give her name).  She seems to like it when Sue cares for her better than me, except that Sue has more trouble lifting her on or off the bathroom.......

etc, etc. etc.  Use your own example, dont use mine.  Document times you gave her medications, even over the counter, and what those meds are for.  Example:

10:30 AM. Moring meds.  Aspirin (ASA) 2 tablets  (140 mg) for arthritis and joint pain.  Also blood thinner recommend by Dr. Severson.    Tylenol, 1 325 mg also for arthritis pain  

Dpocument even if she takes them on her own, but you put them in pill boxes each day so she remembers.  

Do that for a week or even a month and provide that to your doctor to be put in her medical record...

Edited Tuesday at 11:27 AM by broncovet