Vet's wife asks for help with disability claim

Dear Sgt. Shaft,

My husband is service connected for stage 4 colon cancer, and he is rated 100%. He also is a quadriplegic as the result of a fall that occurred when he fell from a ladder while trying to climb through a window in our home after he had locked himself out. At the time of the fall he was on heavy medications for his service connected conditions and his doctors have stated that the medications that he was taking more than likely contributed to the fall.

I understand that the VA is now requesting an independent medical opinion to support the statements that they have received from his VA doctors. I am doing my best to care for my husband, and I cannot work and take care of him. Is there anything you can do to encourage the VA to process this case as a hardship? I believe that they already have enough medical information to grant the claim. My husband is Walter Womack CSS 252 21 0660.

Thank you for your help.

Mrs. W
Via the internet

Dear Mrs. W,

I understand from the powers that be at the Department of Veteran Affairs that a Decision has been made which granted service connection for loss of use of both hands due to incomplete C3-C5 spinal cord injury (residuals of fall) with a 100 percent evaluation; service connection for loss of use of both feet due to incomplete C3-C5 spinal cord injury (residuals of fall) with a 100 percent evaluation and service connection for respiratory insufficiency on ventilator due to spinal cord injury with sleep apnea with a 100 percent evaluation. Entitlement to special monthly compensation, aid and attendance, specially adaptive housing and automobile and adaptive equipment has been granted. The effective date has been established as November 15, 2013, the date they believe the claim was initiated. I will follow up with that issue and get back to you shortly.

Shaft Notes

U.S. Senators Patty Murray (D-WA) and Kirsten Gillibrand (D-NY) recently introduced an amendment to the National Defense Authorization Act (NDAA) which would ensure that military families' health plans provide adequate coverage for children and loved ones with disabilities. The amendment requires TRICARE, the Department of Defense health program for members of the military and their families, to provide coverage for behavioral health treatments, including applied behavior analysis (ABA).

Under current TRICARE policies, many children are denied coverage for ABA and critical behavioral health treatments, and those children who do receive care often receive less than the prescribed treatment. That places TRICARE behind the curve of thirty-four states and the District of Columbia, which require private insurers to cover ABA as a medically necessary service for most children with a developmental disability. The U.S. Office of Personnel Management also categorizes ABA as a "medical therapy” and covers ABA for federal employees’ dependents.

"Every parent of a child with a disability wants to do everything they can to provide the best care, but for military parents dealing with overseas deployments and frequent moves from state to state, the challenge to access quality care is even greater," said Senator Murray. "The least we can do for our service men and women is provide quality health care for their loved ones, and this amendment ensures that promise extends to children with disabilities, too."

"It is alarming that our military families who have sacrificed so much are denied essential services for their children suffering from autism and other developmental disabilities," said Senator Gillibrand. "This legislation will help ensure that our military families have access to the critical services, care and support they desperately need and deserve."

Behavioral health treatments for children with developmental disabilities are widely recognized as effective therapies that can help children learn the skills to be successful in school, live independently, and find meaningful employment. However, despite the widely-recognized benefits of these treatments, they are not always available for families who receive their health care through TRICARE. The American Academy of Pediatrics and the National Institute of Mental Health support behavioral health parity so that evidence based therapies can be accessed by children and youth with developmental disabilities. This includes systematic application of ABA for children with autism spectrum disorder and other developmental disabilities.

Organizations supporting the Murray-Gillibrand amendment include:

Military Officers Association of America, National Military Family Association, Commissioned Officers Association of the U.S. Public Health Service, VetsFirst, Paralyzed Veterans of America, Autism Speaks, Easter Seals, Association of University Centers on Disabilities, The Arc, Autism National Committee, National Down Syndrome Society, ACCSES, ADHD Aware, American Dance Therapy Association, American Association on Intellectual and Developmental Disabilities, American Association on Health and Disability, Brain Injury Association of America, Epilepsy Foundation, Family Voices, Health & Disability Advocates, Lutheran Services in America Disability Network, Mental Health America, National Association of Councils on Developmental Disabilities, National Association of State Directors of Special Education, National Organization on Disability, National Council on Independent Living, Physician-Parent Caregivers, and School Social Work Association of America.

• The Subcommittee on Disability Assistance and Memorial Affairs recently held a hearing examining the Department of Veterans Affairs’ ability to process complex disability benefits compensation claims.

While VA has made progress reducing its disability compensation claims backlog over the last several months, concerns remain regarding the department’s ability to process complex claims, which can involve multiple medical issues as well as traumatic brain injury, post-traumatic stress, military sexual trauma and special monthly compensation, with consistent quality and efficiency.

Recent VA Inspector General Reports highlight concerns regarding VA’s ability to process complex claims. In the past four years, at least 19 VA regional offices have been inspected by the IG on a second instance. Of those, more than half saw a decrease in processing accuracy of traumatic brain injury claims. When the IG looked at post traumatic stress claims, half of the offices it inspected could not process 50 percent of PTS claims correctly upon second inspection.

Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, D.C. 20035-5900; fax 301/622-3330, call 202/257-5446 or email sgtshaft@bavf.org.