Caregiver Appeal Process

Hello. A little background on the situation. My husband is 100% P&T for PTSD, I am 70% disabled. We recently applied for the Caregiver Program and were denied citing that my husband does not meet the qualifications to require daily assistance with supervision, protection, or instruction. He does not have any issues with ADL but he does not drive, and cannot communicate effectively with his doctors at the VA. This has resulted in his inability to receive medication or treatment from the VA. I have reached out to Patient Advocate over a dozen times and cannot make contact, let alone get any progress made. I believe that if I had the ability to speak to his doctors that we could move forward with a treatment plan. His doctors are firm in their beliefs that he is a "difficult patient" who "thinks he knows what is best for him, regardless of doctor recommendation". My care providers are very helpful and I think that if I could get him linked up with my care team, that maybe things would be different. I am frustrated and disappointed in the process. My husband has significant impulse control deficiencies as well as anger management issues. We are not in harms way, by any means but I lack certain resources to be able to get him the care that he needs. Also, in his discussions with his doctors and the caregiver interviews he does not disclose the issues that he has. Particularly his sleep issues (he only sleeps once every 4 days) and his lack of care for his mental health issues has pushed him from 30% to 100% in just under 3 years.
I have contact information for patient advocate to request an appeal, but how do I, as the spouse, divulge the proper information- not "around his back" but perhaps offering a different insight into his care needs.
Does anyone have any advice?
 
Yes he needs treatment this seems to have nothing to do with the caregiver claim. Showing worsening symptoms because of poor, inconsistent or neglected treatment is not grounds for caregiver status it pretty much exclusively revolves around ADL's which you admitted he has no trouble with. Because of widespread fraud the caregiver program got very strict and they go by the book now you just trying to explain things otherwise will fall on deaf ears I recommend finding a way to schedule timely treatment appointments with a counselor to make sure your husband leads a steady life.
 
I applied for Caregiver program and was denied. My husband is 100% service for 15 yrs. had many disabilities including severe PTSD and can't take care of his daily living needs. I have make all his food, help him dress, shave him and help shower, make & drive him all va apts, fill his medicine pack &give him his medication. Last September he tried commit suicide & almost succeeded. Went into full cardiac arrest. Left a note that Vietnam killed him. This was a shock and gave no clue. So now I don't trust leaving him alone not only because of his personal needs but this too. His doctors are in agreement I should have help through caregiver. I submitted an appeal and waiting decision. Has anyone won appeal and if they deny again do I gave any recourse? Thanks.
 
I applied for Caregiver program and was denied. My husband is 100% service for 15 yrs. had many disabilities including severe PTSD and can't take care of his daily living needs. I have make all his food, help him dress, shave him and help shower, make & drive him all va apts, fill his medicine pack &give him his medication. Last September he tried commit suicide & almost succeeded. Went into full cardiac arrest. Left a note that Vietnam killed him. This was a shock and gave no clue. So now I don't trust leaving him alone not only because of his personal needs but this too. His doctors are in agreement I should have help through caregiver. I submitted an appeal and waiting decision. Has anyone won appeal and if they deny again do I gave any recourse? Thanks.
My appeal for denial was overturned.
 
Hello. A little background on the situation. My husband is 100% P&T for PTSD, I am 70% disabled. We recently applied for the Caregiver Program and were denied citing that my husband does not meet the qualifications to require daily assistance with supervision, protection, or instruction. He does not have any issues with ADL but he does not drive, and cannot communicate effectively with his doctors at the VA. This has resulted in his inability to receive medication or treatment from the VA. I have reached out to Patient Advocate over a dozen times and cannot make contact, let alone get any progress made. I believe that if I had the ability to speak to his doctors that we could move forward with a treatment plan. His doctors are firm in their beliefs that he is a "difficult patient" who "thinks he knows what is best for him, regardless of doctor recommendation". My care providers are very helpful and I think that if I could get him linked up with my care team, that maybe things would be different. I am frustrated and disappointed in the process. My husband has significant impulse control deficiencies as well as anger management issues. We are not in harms way, by any means but I lack certain resources to be able to get him the care that he needs. Also, in his discussions with his doctors and the caregiver interviews he does not disclose the issues that he has. Particularly his sleep issues (he only sleeps once every 4 days) and his lack of care for his mental health issues has pushed him from 30% to 100% in just under 3 years.
I have contact information for patient advocate to request an appeal, but how do I, as the spouse, divulge the proper information- not "around his back" but perhaps offering a different insight into his care needs.
Does anyone have any advice?
I recommend you talk to the social worker at the VA facility where you husband receives care.
 
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