VA benefits Rating
- Thread starter butlertl
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Atsugi
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SMCs are given automatically; you do not need to apply. You simply need to inform VBA of the condition with a letter and some documentation.
SMC R2 is the highest level of compensation for the most disabled veterans.
First, you must qualify under SMC O, or under SMC N-1/2 plus K together, AND require the help of another person (Aid and Attendance) every day to perform most of the following ADLs (Activities of Daily Living): dressing, cleaning, feeding, restroom, adjusting prosthetics.
Another person does not need to be with the veteran at all times for him to qualify. He just has to be unable to perform the majority of the above activities without help every day.
A veteran can also qualify if he is required to always be in bed, and requires the aid of another person.
Level R is only given to vets if there are at home, not in an institution.
The difference between R1 and R2 is this:
R1 is if you need Aid and Attendance daily to perform the ADLs. Typically a spouse.
R2 is if the person helping the vet must be a licensed medical professional. Also, the VA must determine that the veteran, without this care, would need to be institutionalized.
The total compensation for R2 in year 2017 is $8506 monthly.
See What is Special Monthly Compensation? Do you qualify?
For instance, on the day my wife became bedridden, I wrote a detailed letter to St Pete, and they moved us from R1 to R2.
SMC R2 is the highest level of compensation for the most disabled veterans.
First, you must qualify under SMC O, or under SMC N-1/2 plus K together, AND require the help of another person (Aid and Attendance) every day to perform most of the following ADLs (Activities of Daily Living): dressing, cleaning, feeding, restroom, adjusting prosthetics.
Another person does not need to be with the veteran at all times for him to qualify. He just has to be unable to perform the majority of the above activities without help every day.
A veteran can also qualify if he is required to always be in bed, and requires the aid of another person.
Level R is only given to vets if there are at home, not in an institution.
The difference between R1 and R2 is this:
R1 is if you need Aid and Attendance daily to perform the ADLs. Typically a spouse.
R2 is if the person helping the vet must be a licensed medical professional. Also, the VA must determine that the veteran, without this care, would need to be institutionalized.
The total compensation for R2 in year 2017 is $8506 monthly.
See What is Special Monthly Compensation? Do you qualify?
For instance, on the day my wife became bedridden, I wrote a detailed letter to St Pete, and they moved us from R1 to R2.
gooseberry
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If you are going monthly or eery couple of months for appointments Tampa will update you automatically. Otherwise, if you have a change, email your main doc and ask for a review.
butlertl
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Thanks gooseberry. We are going to Tampa tomorrow.
Was hoping to try the new drug but Medicare is slow to approve.
And I would need a Nero to approve a script.
Two small issues.
Terry
Was hoping to try the new drug but Medicare is slow to approve.
And I would need a Nero to approve a script.
Two small issues.
Terry
maryhahnward
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Terry,
Ask your neurologist at the VA. The VA policy on the usage of Edaravone:
2017
Edaravone (Radicava) Criteria for Use July 2017 VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives
The following recommendations are based on medical evidence, clinician input, and expert opinion. The content of the document is dynamic and will be revised as new information becomes available. The purpose of this document is to assist practitioners in clinical decision-making, to standardize and improve the quality of patient care, and to promote cost-effective drug prescribing. THE CLINICIAN SHOULD UTILIZE THIS GUIDANCE AND INTERPRET IT IN THE CLINICAL CONTEXT OF THE INDIVIDUAL PATIENT. INDIVIDUAL CASES THAT ARE EXCEPTIONS TO THE EXCLUSION AND INCLUSION CRITERIA SHOULD BE ADJUDICATED AT THE LOCAL FACILITY ACCORDING TO THE POLICY AND PROCEDURES OF ITS P&T COMMITTEE AND PHARMACY SERVICES.
Inclusion Criteria The answers to one of the following must be fulfilled in order to meet criteria.
“Definite” or “probable” ALS according to El Escorial revised Airlie House diagnostic criteria (http://www.alsa.org/assets/pdfs/fyi/criteria_for_diagnosis.pdf)
AND preserved ability to self-feed or walk
Monitoring
Patients should be monitored for respiratory function and ALSFRS-R scores ALS Functional Rating Scale at baseline and every 6 months.
Changes in ALSFRS-R scores should be evaluated for continued therapy with edaravone.
Discontinuation Criteria
Patient becomes dependent on ventilator support during the day and at night (Items 10, 11, 12 on ALSFR-R with score <1)
Patient becomes wheelchair bound (if patient initially met CFU with ability to walk) ( Item 8 on ALSFR-R with score <1)
Patient requires full assist with eating (if patient initially met CFU with ability to feed) (Item 5a on ALSFR-R with score <1)
Additionally, a discussion with the patient/caregiver/family regarding realistic treatment expectations and discontinuation of therapy should be documented in the patient’s EMR.
Exclusion Criteria If the answer to ANY item below is met, then the patient should NOT receive edaravone
□ Notably decreased respiratory function and dyspnea (a score of ≤3 points on ALSFRS-R items for dyspnea, orthopnea, or respiratory insufficiency[ the sum of questions 10,11 and 12 on the ALSFRS])
□ Bilevel positive airway pressure (BiPAP ) dependent (use 24 hrs per day)
□ Complications that might influence evaluation of efficacy (e.g., Parkinson’s disease, schizophrenia, significant dementia, other major medical morbidity)
□ Other possible causes for current symptoms not ruled out (e.g., cervical spondylosis or multifocal motor neuropathy)
Ask your neurologist at the VA. The VA policy on the usage of Edaravone:
2017
Edaravone (Radicava) Criteria for Use July 2017 VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives
The following recommendations are based on medical evidence, clinician input, and expert opinion. The content of the document is dynamic and will be revised as new information becomes available. The purpose of this document is to assist practitioners in clinical decision-making, to standardize and improve the quality of patient care, and to promote cost-effective drug prescribing. THE CLINICIAN SHOULD UTILIZE THIS GUIDANCE AND INTERPRET IT IN THE CLINICAL CONTEXT OF THE INDIVIDUAL PATIENT. INDIVIDUAL CASES THAT ARE EXCEPTIONS TO THE EXCLUSION AND INCLUSION CRITERIA SHOULD BE ADJUDICATED AT THE LOCAL FACILITY ACCORDING TO THE POLICY AND PROCEDURES OF ITS P&T COMMITTEE AND PHARMACY SERVICES.
Inclusion Criteria The answers to one of the following must be fulfilled in order to meet criteria.
“Definite” or “probable” ALS according to El Escorial revised Airlie House diagnostic criteria (http://www.alsa.org/assets/pdfs/fyi/criteria_for_diagnosis.pdf)
AND preserved ability to self-feed or walk
Monitoring
Patients should be monitored for respiratory function and ALSFRS-R scores ALS Functional Rating Scale at baseline and every 6 months.
Changes in ALSFRS-R scores should be evaluated for continued therapy with edaravone.
Discontinuation Criteria
Patient becomes dependent on ventilator support during the day and at night (Items 10, 11, 12 on ALSFR-R with score <1)
Patient becomes wheelchair bound (if patient initially met CFU with ability to walk) ( Item 8 on ALSFR-R with score <1)
Patient requires full assist with eating (if patient initially met CFU with ability to feed) (Item 5a on ALSFR-R with score <1)
Additionally, a discussion with the patient/caregiver/family regarding realistic treatment expectations and discontinuation of therapy should be documented in the patient’s EMR.
Exclusion Criteria If the answer to ANY item below is met, then the patient should NOT receive edaravone
□ Notably decreased respiratory function and dyspnea (a score of ≤3 points on ALSFRS-R items for dyspnea, orthopnea, or respiratory insufficiency[ the sum of questions 10,11 and 12 on the ALSFRS])
□ Bilevel positive airway pressure (BiPAP ) dependent (use 24 hrs per day)
□ Complications that might influence evaluation of efficacy (e.g., Parkinson’s disease, schizophrenia, significant dementia, other major medical morbidity)
□ Other possible causes for current symptoms not ruled out (e.g., cervical spondylosis or multifocal motor neuropathy)
gooseberry
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Most likely you will have an r2 rating now. Did you see Dr. E? He is very good about this kind of thing
gooseberry
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Between Dr. Wilson and Dr. Elamin they were really good about the rating upgrade. Dr. R not so kuch. She reviewed things but never saw steve directly.
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