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Author Topic: Denied A&A Benefits - appeal or another process?  (Read 524 times)
newpen
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« on: May 13, 2012, 01:15:02 PM »

I have read through many of the topics and postings on this website.  Thank you so much for all of your efforts.  This site is invaluable.

My father is a WWII vet.  He is 90 and my mother is 89.  Both have been living in Independent Living at a Continuing Care Facility for over 10 years.  My mother has dementia and other health issues.  My Dad can function in IL as long as his meals are provided and the nursing staff in the building is there to help on occasion.  My mother has needed increasing amounts of care from the Assisted Living arm of the facility and they pay extra monthly fees for all care provided by them.  We applied for the A&A benefit for both of them and were denied due to my Dad's monthly pension income exceeding monthly expenses.  The monthly fees for IL were not eligible to deduct.  If it were not for my father, my mother would have to be in AL.  As it is, she receives assistance with bathing and dressing.  Recently, we added daily medication administration for her from the folks in AL.  Regarding the decline in benefits as it relates to my mother, the letter we received states "If your wife has an in-home attendant and/or is residing in an ALF and you want the cost of her expenses to be utilized, you must provide a statement from her doctor that states that she needs to be in a protective environment".  I am sure her doctor will provide such a letter.  My question is will the VA take into account the cost of her meals, residence fees, etc. even though she is in IL with my father?  Should we continue through an appeal process?  I have seen other posts where the response was NOT to appeal.  If no, how should we proceed?  Sorry for the long post but I want to make sure all of the pertinent info is here.  Thanks again for all of your work on behalf of these veterans.
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vetadmin
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« Reply #1 on: May 14, 2012, 10:19:32 PM »

Not an easy answer for you.  IL properties are hard to get approved due to the exploitation by them regarding this pension for folks who were still "independent"  The VA has pushed back on IL properties to the point of being unfair.

NO, you never appeal.  You submit a VA 21-4138 Statement in Support of Claim with additional information for the VA to consider.  That can be a change in diagnosis or the Dr's letter stating they need to be in a protected enviornment.

The VA will not allow for the costs of meals, only allowable medical expenses.

If Mom's monthly expenses completely depletes their combine monthly income, he can file as a veteran with an ill spouse, but think you should try and submitt information for them to reconsider given that Dad and Mom both have needs.
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newpen
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« Reply #2 on: May 15, 2012, 05:55:09 PM »

Thanks for the quick reply.  I will try the avenue you suggest and let you know what happens.
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