VETERAN Discussion Rating increase R1 to R2

Status
Not open for further replies.

MVFinVA

Distinguished member
Joined
Sep 5, 2017
Messages
116
Reason
Lost a loved one
Diagnosis
05/2017
Country
US
State
VA
We stopped going to a civilian ALS Clinic and go to the VA ALS Clinic exclusively now. All the providers were professional and kind. We found we could get everything we needed almost immediately without any paperwork hassles. The ALS Clinic Coordinator and neurologist know what to do with the paperwork and increases have occurred twice with the money arriving before we even knew the paperwork had been submitted! The first time I called our PVA rep to find out why there was more money!

We have also been able to receive all needed medical equipment, supplies, formula, medicines etc. with no hassles or $$. They are prescribed/ordered and are delivered by UPS or Fed Ex. I can go online and ask for refills when we need more.

When my PALS had some new issues pop up the respiratory therapist saw us within a couple of days and the neurologist stopped in to consult while we were there. The Clinic Coordinator has been able to trouble shoot any problems with refill delays for us.

I can't say enough about how well my PALS has been treated by the VA and how my administrative/caregiver path has been eased by the way they have handled everything.

Now the SAH grant/construction was a whole other issue!!

Mary
 

Atsugi

Legendary member
Joined
Jan 11, 2011
Messages
5,187
Reason
Lost a loved one
Diagnosis
12/2010
Country
US
State
FL
I like to go directly to the source to read exactly what is required to quality for R1 and R2 levels of Special Monthly Compensation.

Veterans law is at Title 38 of the USC section 1114, which is formally written as "38 USC § 1114"

Here are paragraphs r (1) and r(2).

(r) Subject to section 5503(c) of this title, if any veteran, otherwise entitled to compensation authorized under subsection (o) of this section, at the maximum rate authorized under subsection (p) of this section, or at the intermediate rate authorized between the rates authorized under subsections (n) and (o) of this section and at the rate authorized under subsection (k) of this section, is in need of regular aid and attendance, then, in addition to such compensation—


(1) the veteran shall be paid a monthly aid and attendance allowance at the rate of $2,002; or

(2) if the veteran, in addition to such need for regular aid and attendance, is in need of a higher level of care, such veteran shall be paid a monthly aid and attendance allowance at the rate of $2,983, in lieu of the allowance authorized in clause (1) of this subsection, if the Secretary finds that the veteran, in the absence of the provision of such care, would require hospitalization, nursing home care, or other residential institutional care.

For the purposes of clause (2) of this subsection, need for a higher level of care shall be considered to be need for personal health-care services provided on a daily basis in the veteran’s home by a person who is licensed to provide such services or who provides such services under the regular supervision of a licensed health-care professional. The existence of the need for such care shall be determined by a physician employed by the Department or, in areas where no such physician is available, by a physician carrying out such function under contract or fee arrangement based on an examination by such physician. For the purposes of section 1134 of this title, such allowance shall be considered as additional compensation payable for disability.
 

Jhettinger

Forum Supporter
Active member
Joined
Sep 22, 2016
Messages
96
Reason
PALS
Diagnosis
4/2016
Country
US
State
GA
I am pushing for an automatic award of R2 once the VA diagnosis ALS. Instead of all this struggling with ratings. Rules never held me back.

Let's use this Veteran Focused part of the forum and launch a letter writing campaign, or just sit around and ***** about it.

https://www.whitehouse.gov/contact/ will get you started SUBJECT: ALS VETERANS RECEIVE AUTOMATIC RATING OF R2 DISABILITY PAYMENTS
 

MVFinVA

Distinguished member
Joined
Sep 5, 2017
Messages
116
Reason
Lost a loved one
Diagnosis
05/2017
Country
US
State
VA
I disagree with getting an automatic award of R2 on a diagnosis of ALS. Upon diagnosis the vet is already entitled to 100% disability, the SAH grant, the HISA grant, life insurance, mortgage life insurance if the SAH grant has been used, a grant for a vehicle, free medical care, free medical equipment and supplies, etc. While ALS can be fast moving, it isn't always. I propose a streamlined/expedited application process for increases with LOTS of help from the VA in navigating the process, particularly for those receiving their care from a civilian facility.

For the record both my husband and I are vets. I am extremely grateful for the help we've received from the VA and PVA. The process isn't always easy and can definitely be improved (particularly the SAH process) but I don't think that we should max out all the benefits immediately on diagnosis!
 

Atsugi

Legendary member
Joined
Jan 11, 2011
Messages
5,187
Reason
Lost a loved one
Diagnosis
12/2010
Country
US
State
FL
On the other hand, my PALS died 9 months after diagnosis, 11 months after first symptom. In our case, we were really well plugged into the VA, we both worked for the VA. So we had it easy, by comparison.



But if an average vet were diagnosed with a super-rapid decline, they might not see much compensation at all by the time they figured it out and started all the processes.


In general, a lot of vets--like me--don't claim stuff because they want to leave some money in the VA coffers to use on other vets who need it more.


But there is another view. Every bennie, whether it's a paycheck or a piece of hardware, is the equivalent of money coming into the family. The family might benefit from that money for years after the vet has passed. That, to me, is a pretty strong case for maximizing bennies as soon as possible after diagnosis.
 

MVFinVA

Distinguished member
Joined
Sep 5, 2017
Messages
116
Reason
Lost a loved one
Diagnosis
05/2017
Country
US
State
VA
That's a very strong argument Mike! My PALS has FTD in addition to ALS so we haven't talked about it. I'm the one doing all the claims. Our children are grown, so I'm the only one to benefit from the money when he passes. My PALS planned well to take care of me, and we are technically seniors, although my PALS won't be 60 for a month more. That probably strongly colors my view of this issue. Thank you for pointing out the benefit to the family! Right now my PALS is at R! and we don't really need all that is coming in. I'm just stashing it in the bank in the eventuality we will need it. I guess I have feelings of guilt for possibly benefiting from this while my PALS is the one with the ugly disease.
 

Jhettinger

Forum Supporter
Active member
Joined
Sep 22, 2016
Messages
96
Reason
PALS
Diagnosis
4/2016
Country
US
State
GA
Thanks for the valuable input on my idea. So each vet has their own specific condition and economic situation.

This dx means I am going to die younger and without my expected revenue for 9 years. When I die, the mil retire and disability go to zero. The company I had gross is now 1k a month, was 7k a month. My wifes company income is dropping due to her taking care of me. I cannot walk a block with a rollator. Our house upkeep is about $500 a month. To the dbl vet couple if you are both getting retired pay, if one dies, you still have a check.

I think Mike and mvfinva have it dead on. I would like to leave something behind. I would love to relieve the pressure on my wife.
 

GillG

Active member
Joined
Feb 15, 2018
Messages
48
Reason
PALS
Diagnosis
11/2015
Country
US
State
TX
I don't know if I agree with maxing out upon diagnosis but certainly with streamlining the process without the struggles of having to figure out how and when to go to the next level. Reading the requirements for each SMC is dizzying and the progression and symptoms of ALS are not neat and tidy like the rules for SMC. We all know the outcome of this disease. Where I see a huge issue is in the rating process. Once our application goes through to be rated, the person making the final decision is not an ALS specialized neurologist. So they are basically looking for particular wording in the file that fits within a sort of template. And we have to hope that our files reflect the info needed. That can be difficult if the provider and patient are not privy to what they are looking for. An example, I am rated up to M 1/2 for loss of use of hands. I have leg weakness and severe spacticity which makes it almost impossible to walk more than around the house to and from rooms. I need loss of use to get my next increase. So what constitutes loss of use? There is a definition that goes with it but that can be subjective depending on what doctor sees you especially if they send you out for C and P exam.

As far as the notion of not wanting to make claims for benefits to leave money for other vets , this is just my opinion after speaking to my SAH agent who has been doing this a long time. The VA has a huge budget. I believe it's one of the biggest of all government entities. If vets do not make claims to leave money in the coffers so to speak. We run the risk of the powers that be seeing an excess in funding and deciding to divert the funds elsewhere and shrink the funding. Now would that happen? Who knows. Am I saying we should all just go on a claim binge? No. I am just offering a different perspective.

I am not trying to contradict anyone here. Just wanted to weigh in with some things that are floating around in the noggin.
 

Atsugi

Legendary member
Joined
Jan 11, 2011
Messages
5,187
Reason
Lost a loved one
Diagnosis
12/2010
Country
US
State
FL
Good discussion. Good points, all.


Random thought: VA policy is that if the evidence is 50/50, the tie goes to the veteran.


Also, there is no need for "total" loss of use. If your leg can't reliably walk or hold you up, it's totally toast.


When I worked at VA, I listened to each vet's story and almost always found myself thinking, "My God, we have to help this man. The system is far too complex, and the clerks are way undertrained--the supervisors have "big picture" views, but SOMEONE has got to get the benefits to the veteran! I got myself in a lot of trouble--a LOT of trouble, quite often because I kept finding errors in our work, and finding inefficiencies in the system. No one had the training or the time to actually help the vets get the proper benefits when they needed them!,

The doctors are just doctors, they don't know squat about benefits (even if they think they do).
The C&P guy is just a guy, he's not a doctor. He just writes down what you tell him has been written by a doc.

I told my doctors exactly what wording to use. Write down what the regulation says. No need to be original. I wrote it out with references to the appropriate regulation paragraph, so that the rater did not need to know a damn thing. They just had to look at the reg that I pointed them to, and they would see the rules in black and white.

Kinda like: Patient suffers loss of use of both hands and both feet. These conditions are more likely than not to originate from work as a combat basketball collector in Idaho during his naval service during the period xx to xx. The patient has complete paralysis of both legs below the hip, accompanied by characteristic organic changes including trophic concomitants confirmatory of complete paralysis. There is no effective function remaining for balance or propulsion. The patient is unable to walk to the bathroom, to dress or undress, or get in or out of a wheelchair or bed without the regular aid and attendance of another person. IAW 38 USC Section 1114, Special Monthly Compensation is warranted at the R2 level beginning date xx. Medical records attached.
 

GillG

Active member
Joined
Feb 15, 2018
Messages
48
Reason
PALS
Diagnosis
11/2015
Country
US
State
TX
Great example! That is what I have been learning. We as the patient have to basically coach the provider what to write in the notes. It shouldn't have to be that way. Most of us would not be able to walk in off the street and know to rattle off the paragraph that you wrote. I also agree that the docs usually have no idea about the rating side nor most other VA employees. So who do we ask? Luckily there are those like you Atsugi who have knowledge and experience to share. I try to share my experience as well but it is so frustrating that so many vets are in the dark and left to their own devices trying to figure this stuff out.
 

MVFinVA

Distinguished member
Joined
Sep 5, 2017
Messages
116
Reason
Lost a loved one
Diagnosis
05/2017
Country
US
State
VA
We have the benefit of the VA ALS clinic's experience in doing this so the doc and social worker know what needs to go in the claim. If there could be some sort of liaison to help civilian providers navigate what is needed it would help.

I have a CALS friend from support group whose PALS vet was receiving care at a renowned ALS clinic. I mentioned to her that her PALS should be getting a lot more money based on what she had told me about his condition. She contacted the VA ALS clinic social worker and worked with him to find out what was needed from their neurologist. They quickly got an increase. This could be set up as a program at all VA ALS clinics. I'm not sure where we could go to suggest this. All of us PALS and CALS are pretty busy!
 

Nuts

Forum Supporter
Extremely helpful member
Joined
Feb 23, 2014
Messages
2,524
Reason
Lost a loved one
Diagnosis
01/2014
Country
US
State
NC
I'd like to pitch the PVA here. If you don't have a doctor or social worker who knows the VA system, get a PVA rep who does. It's unfortunate that who to call varies from one location to another---not even this is standardized with this damn disease.
 

chally

Very helpful member
Joined
Apr 23, 2015
Messages
1,255
Reason
PALS
Diagnosis
02/2015
Country
US
State
wv.
Great talk !
PVA helped us
Right to highest rate
All vets with als get your claims in asap
Good luck
 

Atsugi

Legendary member
Joined
Jan 11, 2011
Messages
5,187
Reason
Lost a loved one
Diagnosis
12/2010
Country
US
State
FL
Yep. PVA been vedy, vedy good to me.


When our PVA guy rotated out, a newby took his place. Great attitude but needed backup on the knowledge side, so I called national and they happily gave advice on the phone, then they pointed the local newby to the right answers.


Only one thing went wrong. PVA Newby sat us down in his office, helped us fill out a form, then faxed it off. It was an application for $10,000 life insurance. FIVE YEARS LATER, I began to wonder, what ever happened to that? I visited newby in his office, he made some calls, and we discovered that the VA fax machine never received the PVA transmission. So I lost $10,000 because I didn't follow up to be sure.


My life is just a series of lessons for other people to learn from.
 
Status
Not open for further replies.
Top