Well, let’s qualify that. Everything you’ll need to know about the questions you’ll be asked if you wish to apply for PCAFC. PCAFC stands for Program of Comprehensive Assistance for Family Caregivers. I think they should just call it VHA A&A. Or How about A&A Type II? VA is already an utter miasma of acronyms. To the uninitiated, it could drive you to tears listening to VA litigators discourse using all these terms. I find a new one every day in VBMS trying to decypher VA Rater’s notes.

Anyway, here’s the document that I refer to above. I hope it informs and aids any of you in your pursuit of caregiver benefits.
WorkshopSession3_VA PCAFC Veteran Functional Assessment Instrum

On another note, I recently had a Veteran approach me and ask for advice on their SMC aspirations. I gave him a Padawan’s introduction to SMC using Breniser v. Shinseki. George Breniser’s case is a wonderful stroll down SMC Lane and explains what you need to prevail and proceed to the higher levels of O, R1, R2 and T.

The thrust of Breniser is simple. Pyramiding was the primary argument in the Georgemeister’s appeal. He wanted A&A for his loss of use (LOU) of his legs. He lost because you only get one L, M or N coupon for each “condition”. He legitimately had LOU of the lower extremities and was awarded LOU under §3.350(b)(1). All well so far. The appeal hinged on George’s interpretation of how this SMC gig works. The key phrase is incorporated in §3.350(e)(1)(ii)- i.e., “no condition considered twice”. The Georgester reasoned that because he had a condition (lou), he was thus entitled to a&a because he couldn’t do shit like all the rest of us.

So, where do we get this laundry list of ‘conditions’? Why §3.350(b). SMC L inaugurates a Veteran into the higher levels of SMC. SMC K and S are minor awards in the financial scheme of things. You can’t “build” higher SMCs off of them. The five conditions entitling you to SMC at the L rate are:
1) loss of use of lower extremities (feet)
2) lou of a foot and a hand
3) blindness at 5/200 or 5 degrees or less of concentric field of vision.
4) the need for aid and attendance of another
5) Bedridden

And that’s all she wrote. If you have two of these conditions and they are not related to the same “disability”, then you are in high cotton. If one is for a&a, then you’re really on Bucks Boulevard.

In the case of the gentleman asking me about his entitlement, he had been awarded a&a for his cardiomyopathy which caused him to have shortness of breath and a host of other goodies. VA might call this the index disease-that which is so severe it provoked the need for the a&a of another in and of itself. At 100%, this definitely entitled him to the a&a under §3.350(b)(3) back in 2019.

Fast forward to last month and the LOU of his lower extremities due to service connected DM II peripheral neuropathy. So, the DM II is an endocrinological issue under §4.119 DC 7913. The PN is a neurological side effect of the DM II under §4.124a DC 8520 but it’s not separate and distinct to be truthful. The cardio is under §4.104 under DC 7020. So, two different anatomical different body functions. Get it?

My inquiring Veteran also has a high-powered and well-known law dog who disagrees with him (and me) on whether he has enough of these Breniser conditions. The law dog maintains he was granted a&a for all his disabilities but it doesn’t work that way. The actual decision awarded the a&a strictly for the cardio and, in a rush to disenfranchise him of of any future SMC at the O rate, and the jump up to R1, graciously gave him the “bump” under §3.350(f)(4) to SMC M based on the 100% rating for lou of his feet. Poof. There went the R1. That’s VA FM for you.

The actual 2019 decision granting a&a said the 1/2 step bump was specifically for his other disabilities which were separate and distinct from the heart condition- including… (wait for it) his bilateral 40% ratings for his lower extremities. Note this was declared separate and distinct and attributed to the DM II. So, it had nothing to do with the a&a and the heart issue (read a&a condition).

So, our boy has two awards between L and N, no condition being counted twice. Bingo. SMC O. And, since one of the conditions is a&a, under §3.350(h), he should advance to R1 automatically. Mr. Big JD attorney says no- the loss of use of the feet has been “used up” by the 40% bilateral lower extremity PN disability. Here’s the error in that logic. You can’t award a&a for a loss of use condition. If you have lou, you have loss…of…use. Sound it out like Phonics™. Plain and simple. Sure, the lou may make doing certain everyday things like getting on and off the toilet dang near impossible but getting on and off the toilet is not a loss of use of anything. It’s an inability to do something.

A&A is awarded because you cannot accomplish one or more activities of daily living. It will never have anything to do with lou. Impairment, yes but not lou. If you’re lou, you can’t be given a&a in lieu of it. If the a&a preceded the lou, and the lower extremity PN was separate and distinct and used for the §3.350(f)(3) bump, then you get another L separate and distinct from your a&a L. You have acquired a new condition. Sure in the VA world, they’d probably say “Okay, ya gotta cough up the 1/2 step because your 40% turned into 100% and that would be pyramiding. So we’re gonna give you an M instead of the L 1/2 for the extra 100% for the DC 5110 LOU”. Yeah, but the combo of two Ls takes you way past L 1/2 or M to O so that whole argument becomes moot on its face.

Think conditions. Think no condition counted twice. That’s the whole secret to this. Remember, it’s not the degree of disability but the extent of your functional loss. If you have a heart attack and you’re boobs up, then you need a&a. And if the COPD gets so bad you need oxygen to make it to the shitter, then you need a&a for that, too. Two different conditions. Don’t let anyone ever tell you that a 40% rating for a leg under DC 8520 (or even bilaterally) is “used up” or tantamount to lou under §3.350(b)(1). It isn’t. It’s 40% for DC 8520 which is a far cry from 100% under DC 5110 for lou of the lower extremities (LEs).

SMC is a jungle full of possibilities. How you assemble them is the key to whether you’ll advance. If you’re not careful, a lot of disabilities will be combined that could be exploited individually to reach another a&a award. And because every case is horribly unique, each Veteran will need to be mighty careful in how he or she allows VA to bag ’em and tag ’em. Cheating you out of SMC S is often the worst example. VA will combine everything you have to give you a combined 100% rating when they could grant you one 60% or 70% as a stand alone TDIU and then combine the balance to attain SMC S.

In closing, I’m going to discuss the absolute insanity of seeking advice at a Veterans Help site. It’s akin to buying week-old sushi at a 7-11. Imagine our boy, now with all the ammo for R1, sashays over to VBN-the Peggy-loving pink site and asks for advice on whether his SMC calculations are correct. Hold on to your hats. Considering not a single one of them is accredited or possesses so much as a law degree, virtually every one of the Grand Poobahs pooh-poohed the idea that R1 was for application. Read some of this drivel. “Do you realize the dissent is not what is president [sic] here?” I think he was trying for precedent. “I worked for 30 years for VA and I know this shit.” No, sonny. You let the M 21 figure out your shit for 30 years. Garbage in, garbage out. Seeking good advice for your claims-especially SMC claims- in the absence of a claims file or access to the Vet’s VBMS efolder would be like entrusting your claim to the village idiot. Imagine a hearing for SMC with a VLJ and you saying you know you’re not entitled to SMC _____. The Judge asks you why not. You say because a VA claims expert named Rotor Head told you so…
Here’s another one. These chowderheads almost talked this ol’ boy out of pursuing his R1. Who, in their right minds, would try to help defeat a fellow Veteran? The concept is so alien, it defies the imagination. Worse, they laughed about it.

Considering VA has a 74% documented error rate, a VA employee, former or otherwise, dispensing advice lacks that Je ne sais quoi I’d expect to encounter. Not a single one of these Poohbahs have any legal training. Most haven’t litigated much more than their own claims. Cupcake said the dead giveaway is no one is using his or her real name. So how would you check Cruiser’s bona fides? You can’t. He could say he was a Veterans Law Judge or Winnie the Pooh for 30 years and be equally credible. I noticed a lot of the big guys also put up montages of their medals. I’m surprised there aren’t a lot more MOHs up there with all the bravado.

To be credible in this business you need a name, rank airspeed and tail number. You need truth-not braggadocio. Vets need a curriculum vitae they can use as a measuring stick. We use real world examples here. I offered advice using asknod until I became accredited in 2015. I don’t need to hide behind it any more. I’m now 20-year protected and bulletproof. You can find me on the VA’s OGC accreditation list. Granted, that doesn’t make me smart. It just makes me accountable and trusted to do VA claims.
This is how it’s done. Game. Set. Match. There simply is no mystery to this nor is there any Voodoo involved.
redact r1 12.17.2
redact BVA SMC K win 1.6.22
redactR1 RD 1.4.2022

And that’s all I’m going to say about that.
