VA Caregiver Appeal help

[flemdawg]

Hello all, We were just recently notified that we are going to be kicked off the program. backgroud 100 PT, housebound. 100PTSD, 2 purple hearts. 50%tbi among other smaller percentages. We've been on the program for a few years and are fairly informed on it. We know how to handle the assessments and what to expect with visits, etc. The decision does not align with my injuries and disabilities much less align with my medical records. It seems like the decision was already determined and the CEAT cherrypicked through things to go along with their decision. There are several things that the CEAT ignored from my records and from VA, nurses, doctors, caregiver team etc. that go towards our enrollment in the program such as "unable to self-preservation", "veteran is at risk of self neglect", "someone always needs to be with the veteran to observe, provide supervision, decision and judgement making when home or away from home" They ignore these statements from my records and care team. Instead for their determination they told me that "the Veteran drives, is involved in parenting his minor children and assist when some chores". These statements are taken way out of context as it is noted by everyone in my VA records that my spouse drives at all time. (i sometimes drive my son to the top of the hill in our neighborhood approx 1/4 mile other than that I don't drive for safety reasons) I told the VA that I try to help my kids with homework. I do try to help with some chores but honestly they are far and few between. How should we appeal the decision. How can i make them not ignore my records. Should we use a VSO? should we do this ourselves. We are confident that according to the regs and my injuries that we do qualify. They said that I do not have 6months of care as i sit here bandaged up and need multiple ADL care from my spouse from a surgery by the VA that according to them has a 12 month recovery. They ignore my risk of falls, history of falls, ignore their own records with my safety and Falls. Sorry to vent it just truly seems that the decision was made first then the reasoning was made second. any and all help would be appreciated. I can give more details if necessary. Oh and i'm a "legacy" participant if that makes any difference.

 

[Maat10]

Hello flemdawg,
You may already have answers, which would be good news, but I will tell you up front that when you see a VA provider, they hear "all the good things" going well for you. It may sound wrong, but when you go to the VA, you are there to report the bad and all you cannot do--so that only your needs are heard. Mention the ways you need care -- not what you are trying to do. You tell them what you need, that you want to see a specialist -- whatever it is. It is not civilian care to be sure. If you can see a civilian doctor, perhaps for a second opinion, to listen to your challenges, that documentation will be helpful.
This is how the VA system is built. Many providers may also completely ignore important statements about your needs. Be consistent with your appointments so that only your needs are heard. Once you have the documentation that appropriately reflects your conditions, you appeal. All the way to the Federal level if need be, but don't do it alone. I definitely suggest a Veteran's advocate or an attorney to help you with your caretaker appeal. Also, you may want to talk to an experienced tax representative -- if you have ever had a non-relative help care for you, there are tax deductions to assist.
I do not know enough about the Legacy system to help there. My particular case is rare, or at least that is my hope. The VA is a frustrating process. Keep up with your care and documentation, and don't back down from the challenge. Hope that helps a bit.