Has Anyone Successfully Appealed a Reduction in Caregiver Tier Level?

ThisGuyIsThisGuy

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My husband was recently reduced from tier 3 to tier 1. I believe he still meets the requirements to be tier 3. His ADL and Supervision/Protection ratings should easily qualify him tier 3. The social worker who lowered him to tier 1 cherry-picked through his records citing single sentences as evidence of his improvement while ignoring everything else. My initial appeal to my local VA was denied; not unexpected. I am in the process of appeal to the VISN but am curious if anyone else has had success? Please share your stories Thank you.
 

RGZWS6

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We're in a simular situation and were just denied all together. We haven't started the appeal process...still a bit in shock. Were you provided any guidance or direction or a template on how to appeal the descisions?
 

ThisGuyIsThisGuy

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Absolutely no guidience given whatsoever. If you pull up your medical records you should be able to find the notes from the social worker detailing the reasons for you being dropped. My plan is it pick apart their reasons line by line and refute it up with medical records. In our case, the social worker went through the records and only used the pieces that fit their narrative while ignoring the other 99%. In a just system an appeal should be easy, unfortunately this is the VA. Best of luck to you.
 

Rater81

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Please go on Facebook and join the group Veteran Warriors. They have excellent examples on caregiver appeals. They really know their stuff and are a wonderful asset.
 

oddpedestrian

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Appealing is really a waste of time maybe someone prevailed here or there but the numbers across the board are WAY down and still falling, I was involved in this when the Caregiver Program first started its tailspin in 2017 the social worker wrote incredibly malicious lies about me in my notes that I had attempted to remove all the way up to the OGC all denied. @ThisGuyIsThisGuy Make no mistake those notes are now a part of his clinical file if he came up on a review or exam it could be used as evidence to support a reduction. When you read the notes see if his primary care team concurred with the social worker's findings this is how they win and keep you off the program, if you cant get his docs to support it your appeal is DOA. @RGZWS6 Same goes to you make sure you read his clinical notes via bluebutton you will see what was said to deny but also its probably worded that hes perfectly fine these notes can be used later to ambush a claim or support a reduction.

They have been making their own rules since 2017 when they wanted to get everyone off of the program its referenced in the article below released a few weeks ago, I sat in forums I read their public comments they have an issue with two adults not working one is enough they believe its unethical for the VA to support two especially parents that's the bottom line.

 

chaplaincharlie

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If you appeal you have a chance. If you give up, then you are accepting the VA's decision. The caregiver program is in flux. Talk with your VA PCM.
 

RGZWS6

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@RGZWS6 Same goes to you make sure you read his clinical notes via bluebutton you will see what was said to deny but also its probably worded that hes perfectly fine these notes can be used later to ambush a claim or support a reduction.
Not to hijack this thread, but I've attached what was in the Blue Button; just simple Yes and No. No detail AT ALL! Also of note, its interesting how they manipulated these 7 questions ever so slightly to avoid the specifics that VHA Directive 1152 states for eligibility. They used a Q and A called the Functional Independence Measure to "score" the disability. According to the Social worker, the scores weren't "severe" enough to be clinically accepted, but they did reflect the mid-tier requirement for support.

We are going to appeal and attach the letter to the medical record if only to dispute this if/when a benefits review is ever done at the BVA. I'm supposed to be receiving a template appeal letter from the CG office, so I'll attach that here as well.
 

Attachments

  • VHA Directive 1152(1) Caregiver Support Progra.pdf
    355.4 KB · Views: 12
  • Blue Button.docx
    12.4 KB · Views: 6

RonG

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If you appeal you have a chance. If you give up, then you are accepting the VA's decision. The caregiver program is in flux. Talk with your VA PCM.
I like this.

Even if there was only a 1% chance of success, that is a possibility ...

Ron
 

ThisGuyIsThisGuy

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Appealing is really a waste of time maybe someone prevailed here or there but the numbers across the board are WAY down and still falling, I was involved in this when the Caregiver Program first started its tailspin in 2017 the social worker wrote incredibly malicious lies about me in my notes that I had attempted to remove all the way up to the OGC all denied. @ThisGuyIsThisGuy Make no mistake those notes are now a part of his clinical file if he came up on a review or exam it could be used as evidence to support a reduction. When you read the notes see if his primary care team concurred with the social worker's findings this is how they win and keep you off the program, if you cant get his docs to support it your appeal is DOA. @RGZWS6 Same goes to you make sure you read his clinical notes via bluebutton you will see what was said to deny but also its probably worded that hes perfectly fine these notes can be used later to ambush a claim or support a reduction.

They have been making their own rules since 2017 when they wanted to get everyone off of the program its referenced in the article below released a few weeks ago, I sat in forums I read their public comments they have an issue with two adults not working one is enough they believe its unethical for the VA to support two especially parents that's the bottom line.

Luckily we’re not dealing with his drs conspiring with the social worker; both his PCM and psychiatrist have written addendums in his caregiver notes stating that tier 1 is too low and he should be higher. The social worker simply went through his records and took everything out of context in order to justify her findings. For example, she cites 4 C&P evaluations he has back in 2014 for TBI, PTSD, migraines, and hearing loss. Rather than explain what she found in each, she grouped them together and quoted one line, “no ADLs are affected”. When I looked through those exams, you know what I found? The doctor who did his hearing exam was the one who wrote that but the whole sentence read, “no ADLs are affected due to conductive hearing loss”. That’s just one example of what she did.
 

ThisGuyIsThisGuy

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Not to hijack this thread, but I've attached what was in the Blue Button; just simple Yes and No. No detail AT ALL! Also of note, its interesting how they manipulated these 7 questions ever so slightly to avoid the specifics that VHA Directive 1152 states for eligibility. They used a Q and A called the Functional Independence Measure to "score" the disability. According to the Social worker, the scores weren't "severe" enough to be clinically accepted, but they did reflect the mid-tier requirement for support.

We are going to appeal and attach the letter to the medical record if only to dispute this if/when a benefits review is ever done at the BVA. I'm supposed to be receiving a template appeal letter from the CG office, so I'll attach that here as well.
That’s pretty crazy they didn’t include any write or notes as to why. You should ask for it.
 

ThisGuyIsThisGuy

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Appealing is really a waste of time maybe someone prevailed here or there but the numbers across the board are WAY down and still falling, I was involved in this when the Caregiver Program first started its tailspin in 2017 the social worker wrote incredibly malicious lies about me in my notes that I had attempted to remove all the way up to the OGC all denied. @ThisGuyIsThisGuy Make no mistake those notes are now a part of his clinical file if he came up on a review or exam it could be used as evidence to support a reduction. When you read the notes see if his primary care team concurred with the social worker's findings this is how they win and keep you off the program, if you cant get his docs to support it your appeal is DOA. @RGZWS6 Same goes to you make sure you read his clinical notes via bluebutton you will see what was said to deny but also its probably worded that hes perfectly fine these notes can be used later to ambush a claim or support a reduction.

They have been making their own rules since 2017 when they wanted to get everyone off of the program its referenced in the article below released a few weeks ago, I sat in forums I read their public comments they have an issue with two adults not working one is enough they believe its unethical for the VA to support two especially parents that's the bottom line.
I would also suggest you request a new PCM or find one outside the VA.
 

RGZWS6

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As promised, here is the appeal template letter I received in the mail yesterday. Each VISN has separate mailing addy, that can be found here: VA.gov | Veterans Affairs

I removed the area I'm in to avoid any confusion.
 

Attachments

  • Appeal Template Redacted.pdf
    87.4 KB · Views: 28

ThisGuyIsThisGuy

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That’s awesome! Thanks for sharing. Keep us up to date on how it goes for you. I’ll be submitting our in the next week or so and will keep you guys updated.
 
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