CAREGIVER APPEAL.....PLEASE HELP!!

[james1969]

My husband is a vet with numerous physical and mental issues. I was approved for the caregiver program about a year an half ago level 3. Three weeks ago we received a letter from the VA stating that we were being taking off the program, stated that my husband was rehabilitated (don't get this)..and it was not a permanent benefit, other than that they were not very specific about the reasons behind. My husband receives most of his physical care with private doctors, simply because the appointment scheduling and medical care at the VA were awful, in some cases a simply appointment for his back took 6 months for it to be scheduled, therefore his care is mostly done by outside providers. The mental part is done mainly at the VA clinic where he is scheduled for teleconferences with psychiatrist and has one on one with social worker.

In the last three weeks my husband had a procedure done in his back, for which I had to be off work, but obviously this was not done at the VA, so I do wonder if the fact that we don't get our care mainly at the VA had an impact on the decision. I have talked to the Veteran state representative at the VA clinic for the appeal and I was told to get the medical records or appointment tracking for the last 3 weeks, but obviously the assistance I got was limited and not that good.

I don't know what else to do, or who to talk too or how to write an appeal. Any ideas or suggestions for appeal would be greatly appreciated.

 

[Jason Perry]

Baseline point, you must immediately disagree and request a hearing for the reduction in benefits if you want to protect your rights.

 

[Combat Eng]

What are the hours needed for care at level 3? Do they know your actually working? My thought was that they re-evaluate each year and base their decision off an evaluation, didn't know they based off medical records become vets don't solely use VAMC for medical care, but if I was you everytime you see a private doc always have then forward the notes to his primary care at the VA

 

[Warrior644]

My husband is a vet with numerous physical and mental issues. I was approved for the caregiver program about a year an half ago level 3. Three weeks ago we received a letter from the VA stating that we were being taking off the program, stated that my husband was rehabilitated (don't get this)..and it was not a permanent benefit, other than that they were not very specific about the reasons behind. My husband receives most of his physical care with private doctors, simply because the appointment scheduling and medical care at the VA were awful, in some cases a simply appointment for his back took 6 months for it to be scheduled, therefore his care is mostly done by outside providers. The mental part is done mainly at the VA clinic where he is scheduled for teleconferences with psychiatrist and has one on one with social worker.

In the last three weeks my husband had a procedure done in his back, for which I had to be off work, but obviously this was not done at the VA, so I do wonder if the fact that we don't get our care mainly at the VA had an impact on the decision. I have talked to the Veteran state representative at the VA clinic for the appeal and I was told to get the medical records or appointment tracking for the last 3 weeks, but obviously the assistance I got was limited and not that good.

I don't know what else to do, or who to talk too or how to write an appeal. Any ideas or suggestions for appeal would be greatly appreciated.

Welcome to the PEB Forum!

Hmm, it seems that the VA Caregiver Support Program at your local VAMC is under the impression that your husband now meets its basic criteria and...

1. No longer require at least six months of continuous supervision or assistance with performing basic functions of everyday life due to a serious injury or mental disorder (including psychological trauma or other mental disorder) incurred or aggravated in the line of duty on or after September 11, 2001.

2. No longer needs help since he is capable to perform one or more activities of daily living on his own OR no longer needs supervision or protection because of his injuries.

3. Can now perform things like: Dressing, Grooming, Bathing, and Feeding

4. No longer has Seizures, Difficulty with Planning or Organizing, Being at Risk for Wandering or Getting Lost.

5. No longer have a Danger of Falling, Sleep Problems, Delusions, Hallucinations, and Memory Problems.

6. No longer needs Help Regulating Mood or Keeping Mood Stable.

With that all said and in my opinion, I would strongly suggest that you include a concentrated effort within your VA Caregiver appeal on answering the basic criteria in which shows/validates (via physical & mental healthcare records) that your husband still require continuous supervision or assistance with performing basic functions of everyday life.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!

 

[spcnasworthy]

I have a question... does the Vet have to fit into all 6 catagories? The caregiver coordinator told me that the only disability that falls under the caregiver program is my ptsd which is at 70%, my TBI is 40%, each of my ankles, knees are at 10% each, my back is 10% and ringing in the ears is 10%.

On good days I can dress myself, bath myself but on the bad days I cant even get out of the bed. My migraines and 24/7 headaches keep me in bed for days. My moods can go from 0-110 in seconds, from depression to explosive anger... without my wife by my side I would probably be in jail. I have sleep problems (400mg of trazadone, hydrozine, clozapam) and I still dont sleep at night. I have paranoia, halluciations, memory problems and am at a constant risk of falling. I stumble.. steps are my enemy.... I dont get lost but planning and remembering what I need to do or the plan I made is impossible. My wife has to do my medications daily, weekly, remind me to take them and refills, doctor's appoint.

 

[Warrior644]

I have a question... does the Vet have to fit into all 6 catagories? The caregiver coordinator told me that the only disability that falls under the caregiver program is my ptsd which is at 70%, my TBI is 40%, each of my ankles, knees are at 10% each, my back is 10% and ringing in the ears is 10%.

On good days I can dress myself, bath myself but on the bad days I cant even get out of the bed. My migraines and 24/7 headaches keep me in bed for days. My moods can go from 0-110 in seconds, from depression to explosive anger... without my wife by my side I would probably be in jail. I have sleep problems (400mg of trazadone, hydrozine, clozapam) and I still dont sleep at night. I have paranoia, halluciations, memory problems and am at a constant risk of falling. I stumble.. steps are my enemy.... I dont get lost but planning and remembering what I need to do or the plan I made is impossible. My wife has to do my medications daily, weekly, remind me to take them and refills, doctor's appoint.

Indeed, no! The aforementioned categories are not inclusive since additional questions are needed then combined to generate a basic score to determine the total number of hours per week to be paid to the VA Caregiver (e.g. Tier 1 = 10 hours, Tier 2 = 25 hours, Tier 3 = 40 hours).

Exactly, the criteria states that an applicant needs to have been seriously injured (physically *OR* mentally, including PTSD and TBI) in the line of duty since 11 September 2001 albeit it doesn’t have to include injuries sustained in combat.

Moreover, the self explanation about your current level of functioning seems to be a good outline to use for your VA Caregiver appeal in my opinion. Never default acceptance to injustices; continue to fight until the desired expectations are achieved supportable by medical evidence/medical documentation. Take care and enjoy life!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!

 

[Pikinika]

Please help!! I finish the caregiver stages the doctor told me I was in tier 2 got the paperwork today and the letter state that I am in tier 1 now.. I want to Appeal the tier does anyone know how ??

 

[Warrior644]

Please help!! I finish the caregiver stages the doctor told me I was in tier 2 got the paperwork today and the letter state that I am in tier 1 now.. I want to Appeal the tier does anyone know how ??

Welcome to the PEB Forum!

Indeed, you can either contact the VA Patient Advocate for assistance or directly contact the Caregiver Support Coordinator assigned to your particular case. Take care!


Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!

 

[Jessjo06]

I had to resign from my job to take care of my wife, she is an OIF Vet, she has PTSD, she has an explosive temper, especially when something triggers her PTSD, she also has extreme depression, gets lost, is afraid of crowds, freeks out while I'm driving and big trucks drives by because she thinks it going to blow up, there is more but to much for me to list...... I was Approved for the VA caregiver program a couple of years ago, at tier 3, then last year we were re evaluated and was told that she no longer requires assistance from me, because she is not seeing a counselor at the VA hospital, she does see someone at the Vet center, and at the CBOC, and both say that she needs a caregiver, so I applied again, and again they say that she does not qualify, what do I need to do to appeal their decision? any advise will help.

Thanks

 

[Warrior644]

I had to resign from my job to take care of my wife, she is an OIF Vet, she has PTSD, she has an explosive temper, especially when something triggers her PTSD, she also has extreme depression, gets lost, is afraid of crowds, freeks out while I'm driving and big trucks drives by because she thinks it going to blow up, there is more but to much for me to list...... I was Approved for the VA caregiver program a couple of years ago, at tier 3, then last year we were re evaluated and was told that she no longer requires assistance from me, because she is not seeing a counselor at the VA hospital, she does see someone at the Vet center, and at the CBOC, and both say that she needs a caregiver, so I applied again, and again they say that she does not qualify, what do I need to do to appeal their decision? any advise will help.

Thanks

Welcome to the PEB Forum!

Unfortunately, the DoVA Family Caregiver Program is a temporary recovery program for military veterans in need of personal care services. Hmm, indeed, I can totally comprehend your current issue.

In my opinion, it seems to be a trend for the DoVA VHA to terminate the enrollment of military veterans in the DoVA Family Caregiver Program after either being on the program for one year and/or a couple of years. Why? Trying to get the program rescinded in my opinion...they simply don't want the additional duties and its requirements.

At this point, you need to submit an appeal to the Director of your VAMC via the Caregiver Support Office. If the VAMC Director upholds the Caregiver Support Office's decision then you would need to file an appeal with the Veterans Integrated Service Network (VISN) Director of your particular area/region of the VA. If no success with the VISN Director, you might want to submit an U.S. Congressional Inquiry with your local congressman/women/person for any potential assistance.

Also, you may want to consider having your wife apply for "Permanent Need for Regular Aid and Attendance" compensation via VA Form 21-2680 (EXAMINATION FOR HOUSEBOUND STATUS OR PERMANENT NEED FOR REGULAR AID AND ATTENDANCE). Have your wife's VA PCP complete the aforementioned form then send it to your local VA Regional Office. Take care and I pray for high success!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!

 

[Kaitsan94]

I am new to this forum...Until May of this year my husband has been on the CG Program for over three years with his 70 year old mother as his CG as tier 3. He is 100% permanent and total disabled. Last year we told the CG Support Coordinator we wanted to switch his CG to myself. She threatened with saying he could be dropped to a tier 2. This May we applied to switch to myself. I was approved but they dropped his tier to tier 2. There has been no improved in his health, mentally or physically. I appealed their decision and was told I needed more evidence to prove my case. I sent a 40 page letter with medical documentation proving my husband and I need this program. This summer we moved out of state and became part of a different states program. We had the in home assessment when we moved, and the worker saw how injured my husband mentally and physically is and suggested he even stay in the mental hospital.

Fast forward to two days ago, I received a call from a worker with our CG Team saying my husband is no longer eligible for the program and we’re being dropped. I haven’t received the letter stating the reason for this yet, but I can’t even think of why they would do this. I’ve printed out the eligibility requirements for the program and my husband exceeds all of them. I plan to appeal this when I recieve the letter.

The betrayal from the VA Hospitals is ridiculous. They are suppose to care for our nations veterans and all they do is make it worse. I feel for all the families and veterans this is happening to. I hope to resolve these issues for everyone suffering.

 

[oddpedestrian]

I am new to this forum...Until May of this year my husband has been on the CG Program for over three years with his 70 year old mother as his CG as tier 3. He is 100% permanent and total disabled. Last year we told the CG Support Coordinator we wanted to switch his CG to myself. She threatened with saying he could be dropped to a tier 2. This May we applied to switch to myself. I was approved but they dropped his tier to tier 2. There has been no improved in his health, mentally or physically. I appealed their decision and was told I needed more evidence to prove my case. I sent a 40 page letter with medical documentation proving my husband and I need this program. This summer we moved out of state and became part of a different states program. We had the in home assessment when we moved, and the worker saw how injured my husband mentally and physically is and suggested he even stay in the mental hospital.

Fast forward to two days ago, I received a call from a worker with our CG Team saying my husband is no longer eligible for the program and we’re being dropped. I haven’t received the letter stating the reason for this yet, but I can’t even think of why they would do this. I’ve printed out the eligibility requirements for the program and my husband exceeds all of them. I plan to appeal this when I recieve the letter.

The betrayal from the VA Hospitals is ridiculous. They are suppose to care for our nations veterans and all they do is make it worse. I feel for all the families and veterans this is happening to. I hope to resolve these issues for everyone suffering.

Go to ebenefits or myhealthvet and print out the current medical records you will see the CG clinical notes on how they were able to drop him usually they get his PCM and MH team to concur with the findings. The CG program is very volatile and the Social Workers who run it are blatant liars who think too many people are using it for welfare purposes (I know this because I read their opinions on the proposed changes that had public comments on the law and the Directors new regs). You should have taken the CG's threat seriously from the beginning they pull a lot of weight and the OGC will not overturn their decision.

 

[Kaitsan94]

Go to ebenefits or myhealthvet and print out the current medical records you will see the CG clinical notes on how they were able to drop him usually they get his PCM and MH team to concur with the findings. The CG program is very volatile and the Social Workers who run it are blatant liars who think too many people are using it for welfare purposes (I know this because I read their opinions on the proposed changes that had public comments on the law and the Directors new regs). You should have taken the CG's threat seriously from the beginning they pull a lot of weight and the OGC will not overturn their decision.

They haven’t posted in his records yet why they have dropped him. I read his records over and over every day. I’m very familiar with how the CG teams lie and blackmail veterans and there families. But it’s still crazy for them to drop my husband from the program when I know he is more than eligible. We took the threat serious but switching his caregiver from his mother to myself was something we had to do.

 

[Rater81]

Join the Facebook group: Veteran Warriors They have detailed info on how to appeal.

 

[desertcamel357]

Welcome to the PEB Forum!

Hmm, it seems that the VA Caregiver Support Program at your local VAMC is under the impression that your husband now meets its basic criteria and...

1. No longer require at least six months of continuous supervision or assistance with performing basic functions of everyday life due to a serious injury or mental disorder (including psychological trauma or other mental disorder) incurred or aggravated in the line of duty on or after September 11, 2001.

2. No longer needs help since he is capable to perform one or more activities of daily living on his own OR no longer needs supervision or protection because of his injuries.

3. Can now perform things like: Dressing, Grooming, Bathing, and Feeding

4. No longer has Seizures, Difficulty with Planning or Organizing, Being at Risk for Wandering or Getting Lost.

5. No longer have a Danger of Falling, Sleep Problems, Delusions, Hallucinations, and Memory Problems.

6. No longer needs Help Regulating Mood or Keeping Mood Stable.

With that all said and in my opinion, I would strongly suggest that you include a concentrated effort within your VA Caregiver appeal on answering the basic criteria in which shows/validates (via physical & mental healthcare records) that your husband still require continuous supervision or assistance with performing basic functions of everyday life.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!

Greetings,
Do you have how to do an appeal for caretaker?

 

[desertcamel357]

They haven’t posted in his records yet why they have dropped him. I read his records over and over every day. I’m very familiar with how the CG teams lie and blackmail veterans and there families. But it’s still crazy for them to drop my husband from the program when I know he is more than eligible. We took the threat serious but switching his caregiver from his mother to myself was something we had to do.

The system is broken. Fact Check the social workers are not friendly.. The money when they block veterans CG is raises tea partys for Fact check. Fight hard