December 5, 2024 • 61 mins
John, Ray, and Bethanie break down the complexities of the VA Aid and Attendance benefit and walks through the Disability Benefits Questionnaire (DBQ) process required to qualify for this additional compensation.
• Aid and Attendance benefits are available to veterans and surviving spouses of deceased veterans who were service-connected
• The DBQ requires in-person examination by specific medical professionals (MD, DO, PA, or APRN) and takes about one hour
• Qualifying activities include bathing, dressing, medication management, transferring, and mobility needs
• Cognitive impairments like dementia can qualify for Aid and Attendance, not just physical limitations
• Veterans don't need constant care to qualify – having good and bad days is expected
• Hypoglycemic episodes from diabetes requiring assistance qualify for the benefit
• Home assessments for adaptive equipment like shower chairs or grab bars can be requested from VA providers
• Veterans can receive retroactive Aid and Attendance benefits when appropriate
• Fiduciary arrangements may be needed if veterans cannot manage their financial benefits
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
J Basser (00:00):
Well, I guess they have no interruption.
Ad (00:01):
Don't talk to me.
J Basser (00:05):
It's time for the Exposed Vet Radio Show.
The Exposed Vet Radio Show.
We discuss issues affectingtoday's veteran.
Now here's your host, john andRay.
Welcome, ladies and gentlemen,to the episode of the Exposed
Vet Radio Show.
It's a cold day here inKentucky.
(00:27):
It's a cold day in Tennesseetoo.
How's it in Ohio, betsy?
Is it cold up there?
Bethanie Spangenberg (00:33):
23 degrees currently 23.
J Basser (00:37):
That's 22 here on this December 5th 2024.
Got our co-host, mr Ray Cobb.
How you doing, ray.
Ray Cobb (00:45):
I'm doing great.
A little cold down here.
I actually got on a flannelshirt for a change.
J Basser (00:51):
Really.
I told John Dorsey that helives in Minnesota.
I said you need to quit sendingthe clippers this way.
That's what he's doing.
He's mad at us, but yeah,that's why I'm getting cold.
I think we've got James Crippsin there too.
James, are you with us?
Ray Cobb (01:06):
I don't see him there.
I think that's James there yougo.
Ad (01:11):
I think we've got him.
J Basser (01:31):
There you go.
I guess he's with us.
He's just got some interferenceissues.
Okay, we will discuss today.
It's a topic that a lot ofveterans need to understand and
we we're going to start off thedbq best and go over it.
For, uh, basically it's a smc,l or I guess it's a dependent,
which is the level smc.
(01:52):
I think it'd be right thatisn't f and c.
A lot of people file for it andit depends on what the level is
and things like that.
But that's it's going to goover it and when she gets done
we're going to discuss a lot ofissues on it and try to
everybody explain whatactivities are being led in your
home and things like that.
So, bethany, welcome aboard andgo ahead and get started.
(02:14):
You want to.
Bethanie Spangenberg (02:15):
All right.
Well, this is a very importantDBQ and discussion because I
think a lot of veterans qualifyfor aid and attendance and they
just don't utilize the benefits.
I'm glad we're talking aboutthis today.
To the DBQ itself, it is fourpages long.
It is not the typical DBQ.
(02:38):
The DBQ is embedded within anapplication, so the first couple
pages is actually informationthat's related to the veteran
and the claimant or, you know,whoever is trying to get the
benefit for the aid andattendance.
The DBQ is still found on thesame VA website.
(03:04):
In order to find the form andthey can just go all the way to
the bottom, click on the formfor the aid and attendance and
it's right there.
But to break down, the firstpage, section 1 is the Veterans
Identification Information.
Section 2 is the Cant'sidentification information and
(03:31):
what's interesting about thisparticular type of special
monthly compensation is thatit's available to not only
veterans but their survivingspouses or surviving parents
that may be eligible.
So recently in our local areawe had a Purple Hearts recipient
who passed away and his spouseis in need of care, so she is
(03:52):
eligible to receive benefitsbecause of her husband.
So now that her husband haspassed, the family is able to
collect these benefits for hissurviving spouse who
unfortunately had a stroke andis paralyzed on one side, so
she's in significant need ofassistance with her activities
(04:14):
of daily living for aid andattendance and the criteria that
is required in order for aclaimant to be eligible.
Page two is still part of theveteran or claimant information.
(04:38):
It's asking abouthospitalization.
Is the individual currentlyhospitalized?
Just ask for basic informationthe date that they were admitted
, the name of the hospital andthe address.
Section 5 is the certificationand signature of the claimant.
Again, this DBQ is differentbecause this application of this
(05:01):
set of forms has both theclaimant information and the
medical examiner's assessment inthere.
Page 2, section 6 is actuallywhere the examiner starts and it
notes specifically in this DBQthat the examiner must be a
(05:23):
medical doctor, which is an MD,a doctor of osteopathy, which is
a DO, a physician assistant oran advanced practice registered
nurse, which is your nursepractitioner.
So it's very specific on who isable to fill out this form when
the veteran goes to have thisexamination done.
(05:45):
This is a required in-personexamination.
I do not believe video examsare appropriate because there's
some assessments on here themedical examiner has to do in
order to really capture theinformation pertaining to the
veteran.
This examination takes aboutone hour or more, depending on
(06:07):
the severity of the veteran'scondition.
Any questions so far, before Istart diving deep into the
questions.
Ray Cobb (06:19):
No, I think one thing that, like I told you, every
time you come on I learnsomething.
The lady at the beginning, whenyou were talking about she now
qualifies for it, was herhusband, 100%.
Bethanie Spangenberg (06:32):
He was 100%.
Ray Cobb (06:34):
Okay.
Bethanie Spangenberg (06:36):
Sorry, I interrupted you there, did he?
Ray Cobb (06:38):
have aid and attendance as well.
Bethanie Spangenberg (06:41):
No, he was 100% service connected and the
family, I guess, worked with aservice officer many years ago
and it just so happened that myhusband had an interaction with
him and the son was driving thedad's car and the dad had a
purple heart on his licenseplate and he's like, hey, who's
(07:05):
that purple heart for?
And so he kind of told us thestory and he's like, well, is
your dad receiving benefits?
So what happened is we sat downwith the veteran and his family
and his spouse and we talked toeverybody and we were trying to
help him get the aid andattendance benefits as well as
an increase for his conditionattendance benefits as well as
(07:29):
an increase for his condition.
He was actually a World War IIveteran that had significant
scarring due to shrapnel of theabdomen and the lumbar spine,
and how that man functioned howhe did for so long.
I think, took a lot of mentalpower to overcome his physical
disability.
So when we talked with themthey really didn't understand
that he was also entitled tothese benefits and unfortunately
(07:53):
, a few months after we met withhim he got an infection and
passed away.
So at this point the family istrying to receive the
retroactive benefits on top ofseeking the benefits for the
spouse.
So at the time he passed he was100% service-connected, with an
(08:15):
open application for the SMCaid and attendance.
And then, of course, at thispoint the family's not only
seeking like burial benefits,like they'll do transfer of the
body and some of the burialcosts but, also the retroactive
(08:36):
benefits and the aid andattendance.
So there's a lot moving on forthis particular case that I had
mentioned case that I hadmentioned.
J Basser (08:50):
She needs her crew benefits and she needs her own
agent.
She qualifies for it, she needsit.
Bethanie Spangenberg (08:58):
Yeah, she does, she does, and it was
actually pretty striking becauseshe not only with her stroke
did she have the paralysis, butshe suffered from some dementia.
But she was very.
You know, as people developdementia they tend to fixate on
the past and sometimes the pastbecomes more vivid.
Ad (09:19):
And when.
Bethanie Spangenberg (09:20):
I was talking with her.
You know I am very adamant thatI force the family to be
uncomfortable while anindividual with dementia is
talking, because when a personwho has dementia is talking they
really struggle and I need tobe able to appreciate their
struggles.
A lot of times the family willstep in and try to help them.
(09:41):
You know, complete theirthoughts and I'm very adamant
that no, I need to see thisstruggle.
I need you to just let her youknow, talk about what she wants,
and that was the case with this.
But she was very at that timeshe was very fixated on telling
me about her husband changed,how he had changed after the war
(10:02):
and how difficult it was whenhe had returned.
And you don't always hear thatstory as a family until you're
in a situation like we were in,where we're trying to get
benefits and we're talking abouther husband's disability, you
don't get to hear about whatlife was like back then and the
changes that the family had as awhole, what life was like back
(10:26):
then and the changes that thefamily had as a whole.
So for this particularindividual it was very memorable
to me because that was thefirst time the family had really
heard about the struggles thatthey had when he had returned
from war.
So very impactful story andcase story and case.
(10:50):
All right, any other questionsbefore I dive into the examiner
section no, go ahead.
Okay, all right.
So question believe it or not?
On section six, we're alreadyon Question 18 of the DBQ
section and they're asking whatdisabilities are considered
(11:11):
permanent and totally disabling.
Now, this is based on theclinician's judgment, not
necessarily what the legalrequirements are or what has
been determined from the veteranbecause or determined by the VA
.
Or what has been determinedfrom the veteran or determined
by the VA because the examineris not going to have that
information in front of them.
If the examiner determines thata condition is considered
(11:36):
permanent and total disabling,they are to describe it and how
that it is disabling and why itwon't improve.
That it is disabling and why itwon't improve.
The next section is actual yourbasic vitals, your age, your
height, your weight, your bloodpressure, pulse, respiration
(12:00):
just the basic generalinformation that you would get
at a doctor's office.
There is a section on here thatthe examiner is to describe the
nutrition status.
That is a question that can beasked directly of the veteran,
like if the examiner is tryingto document something about the
(12:20):
nutrition.
They can say well, how do youeat?
What does your typicalnutrition breakfast look like?
Or your meals look like?
Or do you eat a lot of friedfoods?
Do you eat a lot of whole-bakedfoods?
Tell me about it and so you cankind of collect that
information and document itthere.
(12:40):
Document it there.
Or, if you know, you can takeobservations.
If they're too thin for theirbody habitus or if they're obese
, you can document that and justkind of paint the picture of
what the veterans nutritionalstatus is an important section
on here which I find interestingbecause it's the smallest
(13:01):
section that they have is theywant you to describe the
veteran's gait.
The medical examiner issupposed to talk about how the
individual walks and ambulates.
The reason why I find itinteresting is because typically
if there is an individualthat's in need of aid and
attendance because they can't dothe basic activities of daily
living, most of the time theirgait or their ability to walk is
(13:24):
not the greatest.
So they leave a little bit ofspace and I have a previous aid
and attendance exam that I didand I'm going to kind of talk
about it a little bit and justkind of reference it as we go
through some of these.
So for this particular veteranthat I saw, he was
(13:45):
service-connected for his lumbarspine and his cervical spine.
He was in an accident.
A motor vehicle accident whilehe was on active duty Ended up
breaking his leg as well.
So for him we're looking atcervical spine arthritis,
impairment of femur, lumbarspine arthritis.
(14:05):
He had lower extremityradiculopathy, upper extremity
radiculopathy, diabetes, kidneydisease, heart disease, bladder
cancer and arthritis of theknees.
So he's a hot mess.
So for his gait analysis I putthat he walks with a roller
walker, has lower extremityweakness which requires handrail
to transfer.
(14:26):
So not only is the gait ortheir ambulation important, but
how does the individual get upfrom the chair in order to start
ambulating?
So it really needs to besomething that is observed by
the clinician so they candescribe how well they go from
sitting to standing and movingforward.
(14:52):
And then the next page underpage three, the rest of this DBQ
, can actually be completed ifthe veteran has appropriate
information in their statementin supportive claim.
The only reason I bring this upis, let's say that a veteran
(15:14):
goes to have an aid andattendance exam done and they
get the report and they see thereport and they're like well,
they didn't talk about X, y andZ.
Well then you can now argue ifit is in your statement and
supportive claim that you alsorequire these additional things
that the examiner did notdiscuss.
(15:35):
So the next things that I talkabout just keep in mind that all
of these questions can bedocumented by the veteran, by
the veteran's spouse, by thefamily members and submitted in
a statement of support of claimas evidence.
So if you're trying to, or therepresentative is trying to,
argue for the aid and attendance, they can reference not only
(15:58):
the exam but the family'stestimony.
So the next question is question26, and it asks about if the
patient or the individual isconfined to the bed and indicate
the number of hours in bed.
Now, I put an asterisk by thisbecause some individuals don't
(16:21):
sleep in a bed.
If you have heart failure, ifyou have lung issues, if you
have back or arthritis issues,not everybody sleeps in a bed.
Some individuals sleep in arecliner.
That is a common place forveterans to be sleeping because
it allows them to essentiallylay back but keep their their
(16:48):
chest elevated, so breathingisn't so difficult or that the
arthritis isn't.
The back isn't completely flat,in a flat position to where
when you get up it's reallypainful.
The recliner kind of allows forthe back to be somewhat
immobile in a more comfortableposition.
(17:10):
So you still want to documenthow many hours that you're in
the recliner, and it's specificto certain timeframes, so you
can put that in the statement.
The examiner is essentiallyasking the veteran well, how
often of the day are you sittingin your chair or how often of
the day are you in your bed?
(17:31):
And they would just simplydocument that.
Question 27, does the patientrequire assistance with any of
the following activities ofdaily living Bathing, showering,
eating, self-feeding, dressing,ambulating within the home or
their living area, tending tohygiene needs such as brushing
(17:53):
their teeth, combing their hair,transferring in or out of the
bed or a chair, toileting oreven medication management?
Again, all those can be put ina statement.
So the examiner is asking thesequestions what do you need help
with?
The next question is about beinglegally blind.
(18:14):
There is regulations within the38 CFR that discusses blindness
as a qualifier for receivingaid and attendance.
Honestly, I do more aid andattendance related to physical
needs, rather like theirarthritis or diabetes, rather
than anything to do with theirvision.
(18:35):
So the next question is doesthe patient require nursing home
care?
And then the examiner justdiscusses how they would need
nursing home care.
Question 30 is in your judgment, does the patient have the
mental capacity to manage theirbenefit payments or are they
able to direct someone to do so?
(18:56):
This is always a tricky onebecause the examiner again has
to use their clinical skills todecide.
All right, is there evidence ofmemory loss?
clinical skills to decide allright.
Is there evidence of memoryloss?
What kind of things are theydoing throughout the day?
(19:17):
As far as self-care, are theyable to operate a microwave?
Are they able?
To basically do some of thosehigher thought process tasks
where it's like multiple tasksat a time, and this can be
somewhat tricky too, because ifthe clinician says no, then that
(19:39):
opens up a can of worms at theVA and I've had it happen before
Judiciary.
What is it?
J Basser (19:51):
It's called fiduciary.
Bethanie Spangenberg (19:53):
Exactly it's a fiduciary, yes, and so
let me.
I want to kind of talk aboutthat because that was a very
interesting case and it was kindof scary on my part, part of
why I felt there needs to bemore security with compensation
and pension.
But this individual was entitledto a large lump sum and in one
(20:17):
of my assessments this is 10plus years ago now, but in one
of my assessments they wanted meto say whether they are not.
They had the capacity to managetheir benefit payments and I had
to decide if this individual,this veteran who has a history
(20:40):
of cocaine abuse, who admittedto active cocaine use, would be
able to receive a large lump sumand manage it appropriately.
And that was a very difficultsituation because at that time I
did not feel that a veteran whowas an active drug user, who
(21:04):
admitted to be an active user incocaine, receiving a large lump
sum of money was concerning tome.
Who admitted to be on activeuse in cocaine, receiving a
large lump sum of money wasconcerning to me.
And so I had to get otherpeople involved.
So that's how I know it canopen up a can of worms, but they
.
I don't remember what happenedwith that situation, but what I
(21:27):
did was appropriate, by gettingother people involved, because
it wasn't just me, no-transcript, and so it was just a very
(21:56):
challenging scenario.
Ray Cobb (21:59):
So anyway, yeah, bethany, I got one locally here
that I got involved with, or Iwas asked to get involved with,
about a year and a to getinvolved with about a year and a
half, two years ago now,gentleman.
Matter of fact is my age,vietnam veteran, a wheelchair,
as famous as I am, and had nofamily.
(22:22):
Well, he somehow, in some wayway, had met a lady.
He was, I think he was 73 atthe time, and he met a
(22:46):
39-year-old young lady who hemoved in with her and put her on
his checking account and thebank called me, knowing what I
do with veterans around herelocally.
His situation was that she wasgoing in there and, as they've
put it, wearing extremely niceclothes, pulling out large sums
(23:06):
of money each week and then atthe end of the month they were
always four or five checksoverdrawn.
And she indicated to me thathis VA income was over $5,000 a
month and they wanted to know ifI could have it looked into.
(23:29):
They wasn't married they wasn'trelated but that's an example of
how you kind of got to becareful.
Bethanie Spangenberg (23:46):
Yeah, and unfortunately it happens too
often and a lot of it's not seenbecause, you know, as veterans
get older, most of the timetheir family is not always
involved or they're loners orthey're to themselves, and it
actually happens a lot more thanyou anticipate.
I talk a little bit about mytime working in the nursing home
(24:06):
and doing dementia care, but itopened my eyes to a lot and I
was only in dementia care for ayear, dedicated dementia care
for a year inside the nursinghome, and you see a lot because
not only I was there to seeregular patients this wasn't
veteran patients but you see alot of the elderly because of
(24:28):
their conditions, how they gettaken advantage of and, like I
said, I was only there for ayear but it's probably the most
learning and impactful timebecause it took a lot of
resources to handle thosesituations and so you know you
(24:49):
get to appreciate that as youget older or as you develop
disabilities, and I'm notsurprised to hear that about
your veteran.
All right, I'm going to goahead and jump into the next few
questions.
Question 31 is what is theposture and general appearance
of the patient?
(25:09):
This is something that we dofor all of our patients and all
of our care notes, because we'rejust trying to paint a
generalized picture Whetherthey're clean, shaven,
well-dressed, alert, attentive,their thought process.
That's simplistic for theexaminer to document once
they've interacted with thepatient.
(25:30):
32 is describe the restrictionsof the upper extremity, with
particular reference to grip,fine motor movements and ability
to feed themselves, to buttonclothing, shave and attend to
the needs of nature.
They do not give much room forthis.
I always add an additional pageon these exams because you
really can't capture a fullpicture with the little bit of
(25:52):
space that they give you.
And if I reference an examplethat I gave for the same veteran
we were talking about with thearthritis I talked about, the
veteran has limited forwardflexion, internal and external
rotation of the bilateralshoulders with decreased
strength.
He has decreased strength inthe grip of both hands with an
(26:14):
intention trimmer in the righthand.
He has difficulties buttoninghis clothing.
He does not shave.
He has trouble with his balancewhile brushing his teeth due to
lower extremity weakness.
So, that gives a picture of whatthose limitations are as it
relates to the upper extremities.
If we jump to question 33,they're now asking the same
(26:36):
question about the lowerextremities and with particular
reference to the extent oflimitation of motion, atrophy or
muscle, how the muscles shrinkdue to non-use or disease and
contractures or otherinterference of the lower
extremities.
And for my veteran I put he hasweakness in both legs that
(26:57):
limit movements.
For range of motion testingWeakness is worse in the right
leg versus the left.
He's unable to flex his rightfoot.
And then obviously before I hadannotated about his gait and the
limitations with his transfer,so that contributed to the lower
(27:18):
extremity limitations.
34 is describe restriction ofthe spine, trunk and neck.
For my veteran I put there isvery minimal to no movement in
the cervical spine in all planes.
Range of motion in the lumbarspine is unable to be tested due
to lower extremity weakness.
Now for this veteran I did notfeel that he was able to really
assess range of motion in thelumbar spine.
(27:40):
Normally when I assess range ofmotion of the lumbar spine I'll
have the veteran stand on bothfeet with nothing in front of
them, bend over, touch theirtoes, lean back and arch their
back, take their left hand totheir left knee, bend to the
side and then I do right hand tothe right knee, bend to the
side and then I will have themtwist or rotate as if they're
(28:02):
looking over their shoulder fora vehicle if they're driving
this veteran.
Because of the lower extremityweakness he was not safe or
stable to be doing that type ofrange of motion.
So I did not do it with him andjust annotated why I felt he
was not able to be tested.
And that's important to documentbecause again you're
(28:26):
demonstrating that there's asafety concern for this
individual.
If we go to page four this isthe last page it says describe
all other pathology, includingthe loss of bowel or bladder
control or the effects ofadvancing age, such as dizziness
, loss of memory or poor balance, that affects patients' ability
to perform self-care, or ifhospitalized beyond the ward or
(28:47):
clinical area.
So if they're hospitalized,like what limits them as far as
their mentality, memory, balance, things like that?
So question 36 is how often perday or week and under what
circumstances is the patientable to leave the home or
immediate premises?
So for this particular veteranI put, let me see here For him I
(29:19):
can't find it as readily as Iwant to, but he essentially that
he oh, here it is, the veteranwill leave the house one to two
times weekly to go through adrive-thru for a drink.
Oh, here it is, the veteranwill leave the house one to two
times weekly to go through adrive-thru for a drink.
So he would get in the car andhe wanted like a Coke or a Pepsi
or something, and he would havehis wife go through the
drive-thru and he'd be with themand get a drink, and so he
(29:40):
never did the grocery shopping.
The wife did all of that stufffor him.
Thirty-seven are aids, such ascanes, braces, crutches or the
assistance of another personrequired for walking or
ambulation.
And this is just asking youknow what kind of assistive
devices are used and with thatassistive device how far are
they able to ambulate?
(30:01):
One block, five to six blocks,one mile I think that's a
stretch.
For this particular veteran.
I put three feet because he wasnot secure enough on that
roller walker to walk more thanthree feet.
He would have to sit and thenbe pushed or be you know kind of
slat his feet if he could topull himself forward.
So yeah, if somebody's, youknow, really struggling and in
(30:26):
need of aid and attendance, I'mnot sure how many can walk a
mile Anyway.
So the last section for theexaminer is the examiner's
signature and the examiner'sinformation.
And while it's the shortest DBQmaybe hypertension is about the
same, but it is the mosttimeensive considering the
(30:49):
length of the form and the datathat it has to capture.
Any questions about the DBQ.
J Basser (30:58):
Yeah.
I tried doing the back exam,bending over and touching your
toes.
I was on static hypertension.
Ad (31:11):
I'd be on the floor.
J Basser (31:15):
Now I agree with you on the block.
The block is a standard word,but you know, city block or city
block, okay, but some blocksare shorter than others, you
know.
But that's the one block is thelowest level that they've got
over to be here, right?
Bethanie Spangenberg (31:29):
so yeah, I don't think I've ever done an
aid and attendance exam onsomebody that could even walk a
block with, even with theirroller walker or their
assistance.
There's always something that'simpacted, but I do have one
other case that I'd like to talkabout.
This is as it relates todementia, or he was diagnosed
(31:54):
with neurocognitive disorder.
So this particular individualthat I did for aid and
attendance is a little bitdifferent than most.
So most of the time your aidand attendance is physical need.
This one is for mental orcognition.
So this person had a type ofcancer that was Agent Orange
(32:15):
related.
He underwent radiation andchemotherapy and sometimes with
radiation and chemotherapy itcan cause an early, onsetified
neurocognitive disorder, chronicfatigue syndrome.
He had reflux and tinnitus.
So for him there's a couplenotes that I documented for his
(32:49):
aid and attendance.
As far as nutrition goes, theveteran's weight and nutritional
status demonstrated obesity.
The veteran limps duringambulation, his gait is slowed
and his stride is shortened, sohe's just taken real small steps
for stability.
In regards to medicationmanagement, I felt that he
required medication management.
(33:09):
He was not able to do it on hisown and I documented that the
veteran is not aware of whatmedications he is currently
taking.
He knows that he is takingmedications for his stomach, but
not specifically what medicalconditions.
If his wife doesn't remember totell him to take medications,
the veteran commonly does notremember to take them.
He has not taken hismedications as of noon today
(33:30):
when I did the exam when Idescribed his lower extremities
I talked about.
He has arthritis in both knees.
His right hip is limited inrotation.
He has fallen in the past dueto balance troubles.
Ad (33:49):
And.
Bethanie Spangenberg (33:49):
I really on my additional page is when I
really dive into where his needis and in the comments section I
wrote the wife reports thatwhile they were in the Walmart
parking lot the veteran wasdriving.
The veteran forgot where he wasand circled the parking lot.
(34:09):
He had to be reminded by thewife where they were and the
directions back to home.
Approximately four months agofrom the time of this exam, the
veteran drove the vehicle intothe grass median, missing the
entry to the parking lot, anddrove the car onto a facility
sidewalk.
He was assisted by from abystander in order to lift the
vehicle off the facilitysidewalk and back onto level
(34:29):
ground.
The veteran would strugglewithout the assistance of his
wife and children.
The wife assists with memorytroubles and the children assist
with physical troubles.
The wife fears that the veteranwould forget to eat if she was
no longer around.
During examination the veteranwas easily agitated and debated
the reports from his wife.
He denies much of what his wifereports.
(34:51):
The veteran was observedfollowing the wife into another
room if she was gone for toolong.
The veteran would requireresidential institutional care,
nursing home care orhospitalization if he did not
have anyone to assist him.
The veteran's memory andbehavioral outburst is his
greatest limitation forindependence.
His memory troubles limit hisability to recall need of
(35:13):
medications and drivingdirections.
So this particular veteran, youknow, some families may not
consider that dementia may be aqualifier for aid and attendance
, but it absolutely is.
J Basser (35:31):
And I just wanted to point that case out.
Ray Cobb (35:35):
Qualifier for nursing and attendance.
Yeah, but the question that wasasked of me, of course it's
been a while.
They asked if I was able to geton a riding lawnmower and mow
my grass which you know, using awalker.
(35:55):
I don't know how they wouldexpect me to climb on a riding
lawnmower and I walked in with awalker.
I think at that time I had notgotten my first scooter, so I
didn't know if that was still.
Is that a normal question orwas that one the examiner came
(36:17):
up with?
Bethanie Spangenberg (36:18):
That's a normal question as it pertains
to coronary artery disease.
There's a specific METSquestion that asks about the
riding lawnmower.
So that is a standard questionfor coronary artery disease when
they're trying to capture theMETS Not necessarily for an
attendance we'll put a label forthis year on this gasoline.
J Basser (36:41):
Now all these activities may live in the
phrase.
Attendance record is ruled thatit does not have to be a
constant need for care becauseyou know, some vets are going to
have good days and bad days,depending on what the situation
is.
you know the environment, theirlife and how your disability
affects you.
You know on days that you knowsome days your blood pressure is
(37:07):
high and you're not going toget as busy on the days that it
goes low, because if it goes lowit drops really low and you
have issues and so it's notevery day.
But you know, as far as walking, walking blocks and things like
that, you know if you've gotissues with your legs and maybe
some type of vascular disease orneurological issues like foot
(37:30):
drop and things like that, thenwalking a block is not very good
at all.
You know, but again, it's not aconstant need.
Yeah, you know.
And don't be confused withactivities.
You've got your standard 8 to10, you've got your level of
activities of daily living.
Don't confuse those withactivities of daily living when
(37:51):
it comes to the caregiverprogram, because theirs are a
lot more concise and different.
As far as you know, it'sbasically the same but they look
at it a whole lot different.
Bethanie Spangenberg (38:01):
Yes, they do.
Yeah, they're very similar asfar as, like, the questions that
they ask and the needs of theveteran, but they're different
as far as the criteria and theprocess, heals and all that
stuff.
But they're different as far asthe criteria and the process,
heals and all that stuff.
Now I will tell you that for mydementia veteran, he was denied
on both his aid and attendance,his initial application for aid
(38:26):
and attendance, and he was alsodenied on his initial
application, or the wife'sinitial application, for the
caregiver program, and so theyhad to go through and fight that
with an attorney, unfortunately.
J Basser (38:41):
Mm-hmm.
Well, that's sad, but they do.
You know they've got a reasonfor the denial.
I guess you know the VA's gottheir own reasons for doing
stuff and usually it takes ahigher level of you or a
supplemental or usually a BVAdecision.
Sometimes it takes the best ofthe court to fix it.
You know.
Ad (39:01):
Yeah.
J Basser (39:02):
It's crazy.
It is, but you know, forexample, transferring.
Transferring means, say, forexample, if you want to transfer
from the bed to the floor, to awheelchair or to a walker or
whatever you'd help doing that.
You know, getting out of bedand things like that.
You should have that inattendance.
(39:28):
And he's got one of the alarmdesk comm alarm.
But if he's using a device likea feed pap or something that
makes noise or whatever and thevet doesn't hear the alarm go
off, well you got that thingshared with your wife or your
partner excuse me, I don't, youknow and they hear it and they
(39:48):
get up and they help you.
They either get your, you knowget your stuff to bring your
sugar up a little bit.
You know your glucose up andyou know you're up for a while
until it levels off and you cango back to sleep.
But you know that keeps you outof the hospital.
And so that's another issue too, because that will also I think
that will also be part thatshould get somebody
(40:09):
aid-dependent for having to dostuff like that.
Or if you fall a lot, if youwalk and you do things like that
and get around.
I mean there's different thingslike ambulation.
Basically, transfers have got alot to do because even getting
in the shower, you know to atransfer, like from a wheelchair
to a shower chair or somethinglike that, or you have to hold
(40:31):
on.
You know, in a shower, you knowif you bend over to do
something, wash your legs oryour feet.
You know in a shower and youknow, if you bend over to do
something, wash your legs orfeet.
You know you could crash and Iknow it.
I've done it more than oneoccasion.
Bethanie Spangenberg (40:45):
Yeah, I would agree.
If you have the hypoglycemicepisodes and you require the
assistance of another, that isabsolutely criteria.
The assistance of another, thatis absolutely criteria.
And in fact, even on thediabetes DBQ it asks about low
blood sugars.
And so if you've ever had theDBQ done when it comes to the
(41:07):
diabetes and on there it talksabout, you know, low blood sugar
requiring assistance of another, and it says yes, then you
could use that as evidence toargue for aid and attendance.
J Basser (41:19):
That's been good.
Guys, don't get me wrong.
But if you do the CBQ for aidand attendance, you know people
are filing claims for aid andattendance.
I hate to say this, but aid andattendance housebound issues
like SNCF still are a benefit.
If they see the need for it,they should award it.
That's what they need to do.
(41:40):
This form came out for peopleto put in so they could file a
claim for it, so they'll be ableto turn it in.
It's still an ancillary benefit.
If you need it, they shouldhave awarded it in the first
place.
If you need it, they shouldhave awarded it in the first
(42:01):
place.
Ad (42:03):
But they treat everything like a claim, regardless of what
it is.
J Basser (42:06):
Yeah, correct.
So I guess it depends on whereyou're at too, you know.
I mean, I know some folks thathave a lot easier time getting
their stuff done than some folksI know.
Location, location, location, Iguess right.
Ray Cobb (42:23):
Yeah.
J Basser (42:27):
Now, it's hard, but DBQ had a list of ADLs, you know
, like bathing and hygiene andthings like that.
Did you put check marks in theboxes or what did you do?
Bethanie Spangenberg (42:40):
You're supposed to circle it and then
describe which.
Again, they don't leave muchroom to it.
But now what's interesting isthey've actually done a fair job
I still think there's room forimprovement actually done a fair
job.
I still think there's room forimprovement.
But they recently when I sayrecently, February of 2023, they
(43:01):
updated the aid and attendanceform and it's more specific as
far as particular activities.
Before that, they would leave ablank space and you would just
have to talk about ADLs for theveteran.
But this time you actuallycircle what they require
assistance with, and it'sspecifically bathing and
(43:23):
showering, eating orself-feeding, dressing,
ambulating within the home orthe living area, tending to
hygiene needs, transferring inor out of the bed or chair,
toileting, medication,management.
And then it does talk aboutadditional activities.
Now the ones that arereferenced here are actually
(43:45):
considered IADLs, which areIndependent Activity or
Instrumental Activities of DailyLiving.
And that is, the more complexthings, such as shopping and
meal preparation, house cleaningand home maintenance,
transportation, things like that, and so there is a space for
them to talk about thoseinstrumental activities of daily
(44:06):
living as well.
J Basser (44:07):
Right, okay, everybody needs to know this.
Good for doing this?
Yeah, a lot of folks, I think,need that attention.
This Good for doing this?
Yeah, a lot of folks, I think,need that attention, but have no
idea.
Yeah, we'll see how that goes.
Bethanie Spangenberg (44:26):
I think the fact that a lot of times, if
a veteran still has a livingspouse or a live-in, maybe a
child lives with them andthey're doing a lot of the meal
preparation or assisting withlike buttons and medication
management, they don'tnecessarily recognize their need
(44:49):
until that individual is gone.
And so, you know, having thisdiscussion, you know, makes
veterans start to really reflecton you know, the role that
others play in their activitiesof daily living and their
day-to-day lives.
A lot of veterans don't reallyrecognize the significance of
(45:09):
their significant othersignificant other.
J Basser (45:13):
You take sensory neuropathy, diabetic neuropathy
and motor skills in your handsand your fingers and you deal
with medications.
You know you can probably getthe bottles down after you drop
them to as many times as youpick them up.
But when you start puttingpills, you know you start mixing
and putting pills on littlebitty containers.
(45:35):
That becomes an issue becauseusually you wind up with pills
all over the floor.
And that's when you step in andhelp somebody do that.
As far as help, that's one initself, all by itself.
I'm sure Ray's been throughthat, but he's got neuropathy in
his hands too, isn't it, ray?
Ray Cobb (45:54):
Yeah, and another thing is neuropathy in the hands
will affect.
What it affected me is thatwhen I do at the time before Pam
started giving me injectionssometimes giving the injection
right as or right before orwhatever giving the injection
(46:15):
right as or right before orwhatever you kick the needle at
the wrong angle and it actuallybends the needle.
And I had several times that Ibent the needle strictly because
(46:36):
of not being able to properlyhold or control your hands or
fingers.
Really, in that particular case,one time I actually bent the
needle and it was as tall as theskin, because when I pulled it
back the needle actually hadbroken and, you know, fell, and
if I had gotten it in there andthen done it, then I would have
(46:58):
broken the needle off inside me.
And now you've got a wholeother situation.
Ad (47:05):
But you've got to bend it.
Ray Cobb (47:08):
With bad diabetes, you know, you can get to a certain
point where it's not safe foryou to give your injections
Right.
J Basser (47:22):
You know, even with they'll say, been there done
that you know prosthetic devices.
Like you know, braces, evendiabetic pumps and things like
that you know, even your, evenyour deck concepts.
You know, if you've got badshoulders and bad arms and you
have to wear it on the back ofyour arm, you have to.
You know you can't reach themto both your arms.
(47:43):
You got to have to put it onabsolutely Absolutely.
Absolutely.
That's where the caregiver actcomes in, but I don't know.
Ray Cobb (48:05):
That whole thing is going to come to a head here
pretty soon, I think.
J Basser (48:10):
March is next year.
Come to a head.
I don't know what they're doing.
I mean, I think that needs tobe done in an adjudication way.
I think the regional office onthe handle it decides to be a
they can do a form or whateverand help out, but I don't think
they have any businessadjudicating claims, in my
opinion.
Ad (48:27):
Yeah business of getting clean, in my opinion.
J Basser (48:31):
Yeah, my opinion though.
We got to get clean in thespecial case.
Bethanie Spangenberg (48:39):
You know, one thing that kind of triggered
in my memory is some socialworkers will try to fill this
out, Some social workers willtry to fill this out and while
(49:02):
it is evidence, the VA may sendyou for a reexamination by an MD
, DO, PA or nurse practitioner.
I think a lot of times thesocial worker does a better job.
As far as capturing theveterans' need and painting the
picture, but they will notaccept it from a social worker.
Ray Cobb (49:19):
Liveny, that's a good point, because with myself it's
been a few years ago, but thesocial worker was in a form with
Pam and I and then she says nowI'm going to go over this and
have the doctor sign it.
And that's exactly whathappened.
(49:41):
We never met with the doctorwhen we turned the form in and
she went over it and the doctorsigned it.
She went over it and the doctorsigned it.
Then, after the next day orwhatever, she called me and
informed me that she had goneover it with the doctor.
Bethanie Spangenberg (50:01):
The doctor agreed with everything and it's
signed and it's been submitted.
Ray Cobb (50:04):
I think that's appropriate.
It went right straight through.
Bethanie Spangenberg (50:09):
I got it the first time.
That's good.
I'm glad to hear that that'swhat they're doing.
I think, honestly, that's thebest use of your team and your
clinical skills.
I think the social workerthat's essentially what they're
there for is to identify theveteran's needs and put those
resources out for the veteran.
So I'm glad to hear that theydid that.
(50:35):
So the other thing that goesalong with aid and attendance,
that it's not necessarily acompensation or pension benefit,
but it is a benefit through theVA system is if a veteran needs
accommodations, whether it'sfor their home or for like the
(50:57):
shower, for grab bars, for likea handrail, the clinician can
order an occupational therapyconsult inside the home and the
therapist will come out andidentify what needs that the
veteran has in order to assuresafety during activities of
(51:19):
daily living like showering orbathing.
So they may provide a showerchair to the veteran, they may
provide the handrails around theshower.
And that's not again, that'snot a benefit through
compensation of pension, butthat's something that you can go
into the clinic and you can askyour clinician for.
(51:41):
So let's just say you haven'tqualified for in attendance yet
or you haven't received a grantfor that condition.
You can still go into yourprimary care provider and
discuss the needs that you havewithin your home and ask
specifically for someone to comeout and assess the home for
things that you may need toassess with your activities of
(52:02):
daily living.
Ray Cobb (52:05):
You mentioned grant.
They actually came into my homeand that's when they
recommended the HESA grant andredid my shower with a fold-down
shower seat, a roll-in shower,a handicapped sink so that I can
sit on my walker and shave inthe mornings, Things of that
(52:28):
nature.
Bethanie Spangenberg (52:31):
There's a lot of different applications
for those for, like you orveterans that need.
They'll do the home adaptationand then they'll do the vehicle
adaptations and I know you guyshave talked about the vehicle.
I guess you guys have a guru onthose vehicle adaptations.
I heard that podcast.
J Basser (52:52):
Oh yeah, he's a pretty good guest, Of course.
I think Ray dug anotherwoodwork.
Ray Cobb (52:56):
How many?
J Basser (52:57):
has he done for you, Ray?
Ray Cobb (53:00):
I'm on my third vehicle now, so he's done three
different.
You know, I think he's gottenme a couple of scooters, two
lifts, and now I have a vehiclethat is wheelchair accessible,
that the ramp comes out and Ijust roll up into the van and
(53:24):
they fix me a nice seat thatcomes back and I can transfer
right straight from thewheelchair into the seat and
then pull forward like a normalpassenger.
But yeah, he's good at what hedoes.
J Basser (53:42):
You know I'll tell you something else on aid
attendance.
You know it's not like aregular claim.
I mean they can actually goback to the date to condition
rules on that and Bethany wastalking about, like the HISA
grant.
They put in certain things foryou and you know evidence.
That's half of the time they'reusing reason and the basis to
(54:02):
put that in.
But they'll have a diagnosis ofwhat's going on and get that in
there.
That could actually affect youreffectiveness in your age
attendance.
I've seen you go back on oneguy.
I forget how far they went back.
He worked on one for like 10years.
Ray Cobb (54:20):
Oh, wow.
Bethanie Spangenberg (54:24):
That's actually what I'm anticipating
for the Purple Heart recipientthat I was talking about earlier
.
Unfortunately, I can see thepotential, but I don't think the
family sees the potential.
From my understanding, theyhave not made any further
movement since the last time Italked to them on any type of
(54:47):
disability reimbursement claims.
And I've tried to stress but Ithink that's a large burden too
is the family doesn't reallyunderstand and you try to
emphasize it, but without theirhelp you can't receive the
benefit.
J Basser (55:02):
Yeah, you all realize too.
Now, if this benefit'savailable to this veteran and
this veteran without thenecessity of the care that he is
receiving, that he would be ina nursing home.
That would be an R2, wouldn'tit right?
Ray Cobb (55:19):
Yeah, that's.
One of the main criteria isthat you can exist in your home
without any assistance.
But if you have to have anyassistance in that and you would
have to be as they refer to itor the way they refer to mine,
would have to beinstitutionalized, which means a
(55:41):
nursing home or a hospital thenthat is one of the main things
that gets you to that R2.
J Basser (55:50):
Too well.
Ad (56:00):
It is what it is.
J Basser (56:04):
It's kind of hard, but you've got to realize too that
any time you're dealing with aVA, it's their responsibility
because of the adjudication theydon't take, but the VA is their
responsibility to maximize thebenefit and the best of the
favor You're supposed to yeah,they're supposed to do that.
If I say it boils down to it,it should do.
(56:26):
Of course it's anon-adversarial system too, but
that's kind of strange.
You know, I know the CMPexaminers that work for the VA
in town.
They're trained, you know, andthey're told, basically, you
know some of these veterans aremaybe in bad mood and things
like that.
You know to give them respectand be kind and things like that
(56:47):
.
You know, I know I'm seeing alot of examiners in my day, that
are like hey man, I'm youngerthan you.
What are you doing this for?
You know that has nothing to dowith it, right?
Yeah, Because we can't take outthe human factor.
Folks, Humans are going to behuman.
(57:11):
If we don't want this, we couldhave stayed home and went back
to college and done somethingelse, right, Ray could have
played football and played inthe band.
Ray Cobb (57:17):
Yeah, we'd still be rocking.
J Basser (57:27):
That's uncalled for, Ray.
Ray Cobb (57:33):
You don't be saying that Pam and I had a good
conversation.
She picked up a name we had togo to her doctor today
concerning her heart and he toldher how come she gets these
anxiety attacks.
And of course I'm saying she'sworried about me and she, you
(57:53):
know she doesn't agree with thatand I said, well, maybe not,
because when the band wasplaying she would get up and run
around and would fly down thehall and stuff and they actually
named her Fireball because theythought the house was on fire.
Fireball because they thoughtthe house was on fire.
So that stuck with her.
And still every once in a whilewhen I'm teasing her I'll say
(58:15):
slow down, fireball.
It is a lot of work on ourspouses to take care of us and I
know sometimes I stop and thinkand don't appreciate or at
least tell her that I appreciatewhat she does.
(58:36):
She needs to do more of that.
All you veterans out therelistening, you think about that.
You think about little things,not necessarily you couldn't
eventually do, but it makes it awhole lot easier because she
(59:03):
helps you do it every single day.
J Basser (59:05):
Bethany, I want you to give everybody your contact
information in case folks needan item from Valor for Vets.
Bethanie Spangenberg (59:08):
I want to give you your badge.
J Basser (59:10):
All right.
Bethanie Spangenberg (59:10):
You can check us out at wwwvalor4vetcom
or you can give us a call at888-448-1011.
J Basser (59:23):
There you go, and guess what guys?
She kept the show.
She kept her voice during theshow.
She's been a little bit underthe weather, but she got it in.
Bethanie Spangenberg (59:32):
Let's hope I still don't have this illness
the next month.
J Basser (59:35):
You've had it two months in a row.
Now we're going to quit this.
Big change is coming to showfolks.
Oh, by the way, one quick noteVAgov and the VA search engine
has now got the 2025, the summer2024 pay rates in the system
for compensation custom of thecompensation.
So look at it and see what kindof cookie you got, because they
(59:59):
paid us some cookies this yearand not money.
I think I got an Oreo orchocolate chip or something like
that.
Other than that, guys, I'mgoing to shut her down.
Thanks for coming on, bethanyRay.
Thanks for being there for me,buddy.
We appreciate you.
Ray Cobb (01:00:15):
Thank you.
Thank you, thanks for having me.
J Basser (01:00:17):
All right, this is John, on behalf of the Exposed
Vet Radio Show.
Thanks for listening.
You have been listening to theExposed Vet Podcast.
Any opinions expressed on theshow are the opinions of the
guest speakers and notnecessarily the opinions of
Exposed Vet, exposedvetcom orBlogTalkRadio Tune in next week
(01:00:40):
for another episode of theExposed Vet Podcast.
Thanks for listening.
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Don't talk to me.
J Basser (00:05):
It's time for the Exposed Vet Radio Show.
The Exposed Vet Radio Show.
We discuss issues affectingtoday's veteran.
Now here's your host, john andRay.
Welcome, ladies and gentlemen,to the episode of the Exposed
Vet Radio Show.
It's a cold day here inKentucky.
(00:27):
It's a cold day in Tennesseetoo.
How's it in Ohio, betsy?
Is it cold up there?
Bethanie Spangenberg (00:33):
23 degrees currently 23.
J Basser (00:37):
That's 22 here on this December 5th 2024.
Got our co-host, mr Ray Cobb.
How you doing, ray.
Ray Cobb (00:45):
I'm doing great.
A little cold down here.
I actually got on a flannelshirt for a change.
J Basser (00:51):
Really.
I told John Dorsey that helives in Minnesota.
I said you need to quit sendingthe clippers this way.
That's what he's doing.
He's mad at us, but yeah,that's why I'm getting cold.
I think we've got James Crippsin there too.
James, are you with us?
Ray Cobb (01:06):
I don't see him there.
I think that's James there yougo.
Ad (01:11):
I think we've got him.
J Basser (01:31):
There you go.
I guess he's with us.
He's just got some interferenceissues.
Okay, we will discuss today.
It's a topic that a lot ofveterans need to understand and
we we're going to start off thedbq best and go over it.
For, uh, basically it's a smc,l or I guess it's a dependent,
which is the level smc.
(01:52):
I think it'd be right thatisn't f and c.
A lot of people file for it andit depends on what the level is
and things like that.
But that's it's going to goover it and when she gets done
we're going to discuss a lot ofissues on it and try to
everybody explain whatactivities are being led in your
home and things like that.
So, bethany, welcome aboard andgo ahead and get started.
(02:14):
You want to.
Bethanie Spangenberg (02:15):
All right.
Well, this is a very importantDBQ and discussion because I
think a lot of veterans qualifyfor aid and attendance and they
just don't utilize the benefits.
I'm glad we're talking aboutthis today.
To the DBQ itself, it is fourpages long.
It is not the typical DBQ.
(02:38):
The DBQ is embedded within anapplication, so the first couple
pages is actually informationthat's related to the veteran
and the claimant or, you know,whoever is trying to get the
benefit for the aid andattendance.
The DBQ is still found on thesame VA website.
(03:04):
In order to find the form andthey can just go all the way to
the bottom, click on the formfor the aid and attendance and
it's right there.
But to break down, the firstpage, section 1 is the Veterans
Identification Information.
Section 2 is the Cant'sidentification information and
(03:31):
what's interesting about thisparticular type of special
monthly compensation is thatit's available to not only
veterans but their survivingspouses or surviving parents
that may be eligible.
So recently in our local areawe had a Purple Hearts recipient
who passed away and his spouseis in need of care, so she is
(03:52):
eligible to receive benefitsbecause of her husband.
So now that her husband haspassed, the family is able to
collect these benefits for hissurviving spouse who
unfortunately had a stroke andis paralyzed on one side, so
she's in significant need ofassistance with her activities
(04:14):
of daily living for aid andattendance and the criteria that
is required in order for aclaimant to be eligible.
Page two is still part of theveteran or claimant information.
(04:38):
It's asking abouthospitalization.
Is the individual currentlyhospitalized?
Just ask for basic informationthe date that they were admitted
, the name of the hospital andthe address.
Section 5 is the certificationand signature of the claimant.
Again, this DBQ is differentbecause this application of this
(05:01):
set of forms has both theclaimant information and the
medical examiner's assessment inthere.
Page 2, section 6 is actuallywhere the examiner starts and it
notes specifically in this DBQthat the examiner must be a
(05:23):
medical doctor, which is an MD,a doctor of osteopathy, which is
a DO, a physician assistant oran advanced practice registered
nurse, which is your nursepractitioner.
So it's very specific on who isable to fill out this form when
the veteran goes to have thisexamination done.
(05:45):
This is a required in-personexamination.
I do not believe video examsare appropriate because there's
some assessments on here themedical examiner has to do in
order to really capture theinformation pertaining to the
veteran.
This examination takes aboutone hour or more, depending on
(06:07):
the severity of the veteran'scondition.
Any questions so far, before Istart diving deep into the
questions.
Ray Cobb (06:19):
No, I think one thing that, like I told you, every
time you come on I learnsomething.
The lady at the beginning, whenyou were talking about she now
qualifies for it, was herhusband, 100%.
Bethanie Spangenberg (06:32):
He was 100%.
Ray Cobb (06:34):
Okay.
Bethanie Spangenberg (06:36):
Sorry, I interrupted you there, did he?
Ray Cobb (06:38):
have aid and attendance as well.
Bethanie Spangenberg (06:41):
No, he was 100% service connected and the
family, I guess, worked with aservice officer many years ago
and it just so happened that myhusband had an interaction with
him and the son was driving thedad's car and the dad had a
purple heart on his licenseplate and he's like, hey, who's
(07:05):
that purple heart for?
And so he kind of told us thestory and he's like, well, is
your dad receiving benefits?
So what happened is we sat downwith the veteran and his family
and his spouse and we talked toeverybody and we were trying to
help him get the aid andattendance benefits as well as
an increase for his conditionattendance benefits as well as
(07:29):
an increase for his condition.
He was actually a World War IIveteran that had significant
scarring due to shrapnel of theabdomen and the lumbar spine,
and how that man functioned howhe did for so long.
I think, took a lot of mentalpower to overcome his physical
disability.
So when we talked with themthey really didn't understand
that he was also entitled tothese benefits and unfortunately
(07:53):
, a few months after we met withhim he got an infection and
passed away.
So at this point the family istrying to receive the
retroactive benefits on top ofseeking the benefits for the
spouse.
So at the time he passed he was100% service-connected, with an
(08:15):
open application for the SMCaid and attendance.
And then, of course, at thispoint the family's not only
seeking like burial benefits,like they'll do transfer of the
body and some of the burialcosts but, also the retroactive
(08:36):
benefits and the aid andattendance.
So there's a lot moving on forthis particular case that I had
mentioned case that I hadmentioned.
J Basser (08:50):
She needs her crew benefits and she needs her own
agent.
She qualifies for it, she needsit.
Bethanie Spangenberg (08:58):
Yeah, she does, she does, and it was
actually pretty striking becauseshe not only with her stroke
did she have the paralysis, butshe suffered from some dementia.
But she was very.
You know, as people developdementia they tend to fixate on
the past and sometimes the pastbecomes more vivid.
Ad (09:19):
And when.
Bethanie Spangenberg (09:20):
I was talking with her.
You know I am very adamant thatI force the family to be
uncomfortable while anindividual with dementia is
talking, because when a personwho has dementia is talking they
really struggle and I need tobe able to appreciate their
struggles.
A lot of times the family willstep in and try to help them.
(09:41):
You know, complete theirthoughts and I'm very adamant
that no, I need to see thisstruggle.
I need you to just let her youknow, talk about what she wants,
and that was the case with this.
But she was very at that timeshe was very fixated on telling
me about her husband changed,how he had changed after the war
(10:02):
and how difficult it was whenhe had returned.
And you don't always hear thatstory as a family until you're
in a situation like we were in,where we're trying to get
benefits and we're talking abouther husband's disability, you
don't get to hear about whatlife was like back then and the
changes that the family had as awhole, what life was like back
(10:26):
then and the changes that thefamily had as a whole.
So for this particularindividual it was very memorable
to me because that was thefirst time the family had really
heard about the struggles thatthey had when he had returned
from war.
So very impactful story andcase story and case.
(10:50):
All right, any other questionsbefore I dive into the examiner
section no, go ahead.
Okay, all right.
So question believe it or not?
On section six, we're alreadyon Question 18 of the DBQ
section and they're asking whatdisabilities are considered
(11:11):
permanent and totally disabling.
Now, this is based on theclinician's judgment, not
necessarily what the legalrequirements are or what has
been determined from the veteranbecause or determined by the VA
.
Or what has been determinedfrom the veteran or determined
by the VA because the examineris not going to have that
information in front of them.
If the examiner determines thata condition is considered
(11:36):
permanent and total disabling,they are to describe it and how
that it is disabling and why itwon't improve.
That it is disabling and why itwon't improve.
The next section is actual yourbasic vitals, your age, your
height, your weight, your bloodpressure, pulse, respiration
(12:00):
just the basic generalinformation that you would get
at a doctor's office.
There is a section on here thatthe examiner is to describe the
nutrition status.
That is a question that can beasked directly of the veteran,
like if the examiner is tryingto document something about the
(12:20):
nutrition.
They can say well, how do youeat?
What does your typicalnutrition breakfast look like?
Or your meals look like?
Or do you eat a lot of friedfoods?
Do you eat a lot of whole-bakedfoods?
Tell me about it and so you cankind of collect that
information and document itthere.
(12:40):
Document it there.
Or, if you know, you can takeobservations.
If they're too thin for theirbody habitus or if they're obese
, you can document that and justkind of paint the picture of
what the veterans nutritionalstatus is an important section
on here which I find interestingbecause it's the smallest
(13:01):
section that they have is theywant you to describe the
veteran's gait.
The medical examiner issupposed to talk about how the
individual walks and ambulates.
The reason why I find itinteresting is because typically
if there is an individualthat's in need of aid and
attendance because they can't dothe basic activities of daily
living, most of the time theirgait or their ability to walk is
(13:24):
not the greatest.
So they leave a little bit ofspace and I have a previous aid
and attendance exam that I didand I'm going to kind of talk
about it a little bit and justkind of reference it as we go
through some of these.
So for this particular veteranthat I saw, he was
(13:45):
service-connected for his lumbarspine and his cervical spine.
He was in an accident.
A motor vehicle accident whilehe was on active duty Ended up
breaking his leg as well.
So for him we're looking atcervical spine arthritis,
impairment of femur, lumbarspine arthritis.
(14:05):
He had lower extremityradiculopathy, upper extremity
radiculopathy, diabetes, kidneydisease, heart disease, bladder
cancer and arthritis of theknees.
So he's a hot mess.
So for his gait analysis I putthat he walks with a roller
walker, has lower extremityweakness which requires handrail
to transfer.
(14:26):
So not only is the gait ortheir ambulation important, but
how does the individual get upfrom the chair in order to start
ambulating?
So it really needs to besomething that is observed by
the clinician so they candescribe how well they go from
sitting to standing and movingforward.
(14:52):
And then the next page underpage three, the rest of this DBQ
, can actually be completed ifthe veteran has appropriate
information in their statementin supportive claim.
The only reason I bring this upis, let's say that a veteran
(15:14):
goes to have an aid andattendance exam done and they
get the report and they see thereport and they're like well,
they didn't talk about X, y andZ.
Well then you can now argue ifit is in your statement and
supportive claim that you alsorequire these additional things
that the examiner did notdiscuss.
(15:35):
So the next things that I talkabout just keep in mind that all
of these questions can bedocumented by the veteran, by
the veteran's spouse, by thefamily members and submitted in
a statement of support of claimas evidence.
So if you're trying to, or therepresentative is trying to,
argue for the aid and attendance, they can reference not only
(15:58):
the exam but the family'stestimony.
So the next question is question26, and it asks about if the
patient or the individual isconfined to the bed and indicate
the number of hours in bed.
Now, I put an asterisk by thisbecause some individuals don't
(16:21):
sleep in a bed.
If you have heart failure, ifyou have lung issues, if you
have back or arthritis issues,not everybody sleeps in a bed.
Some individuals sleep in arecliner.
That is a common place forveterans to be sleeping because
it allows them to essentiallylay back but keep their their
(16:48):
chest elevated, so breathingisn't so difficult or that the
arthritis isn't.
The back isn't completely flat,in a flat position to where
when you get up it's reallypainful.
The recliner kind of allows forthe back to be somewhat
immobile in a more comfortableposition.
(17:10):
So you still want to documenthow many hours that you're in
the recliner, and it's specificto certain timeframes, so you
can put that in the statement.
The examiner is essentiallyasking the veteran well, how
often of the day are you sittingin your chair or how often of
the day are you in your bed?
(17:31):
And they would just simplydocument that.
Question 27, does the patientrequire assistance with any of
the following activities ofdaily living Bathing, showering,
eating, self-feeding, dressing,ambulating within the home or
their living area, tending tohygiene needs such as brushing
(17:53):
their teeth, combing their hair,transferring in or out of the
bed or a chair, toileting oreven medication management?
Again, all those can be put ina statement.
So the examiner is asking thesequestions what do you need help
with?
The next question is about beinglegally blind.
(18:14):
There is regulations within the38 CFR that discusses blindness
as a qualifier for receivingaid and attendance.
Honestly, I do more aid andattendance related to physical
needs, rather like theirarthritis or diabetes, rather
than anything to do with theirvision.
(18:35):
So the next question is doesthe patient require nursing home
care?
And then the examiner justdiscusses how they would need
nursing home care.
Question 30 is in your judgment, does the patient have the
mental capacity to manage theirbenefit payments or are they
able to direct someone to do so?
(18:56):
This is always a tricky onebecause the examiner again has
to use their clinical skills todecide.
All right, is there evidence ofmemory loss?
clinical skills to decide allright.
Is there evidence of memoryloss?
What kind of things are theydoing throughout the day?
(19:17):
As far as self-care, are theyable to operate a microwave?
Are they able?
To basically do some of thosehigher thought process tasks
where it's like multiple tasksat a time, and this can be
somewhat tricky too, because ifthe clinician says no, then that
(19:39):
opens up a can of worms at theVA and I've had it happen before
Judiciary.
What is it?
J Basser (19:51):
It's called fiduciary.
Bethanie Spangenberg (19:53):
Exactly it's a fiduciary, yes, and so
let me.
I want to kind of talk aboutthat because that was a very
interesting case and it was kindof scary on my part, part of
why I felt there needs to bemore security with compensation
and pension.
But this individual was entitledto a large lump sum and in one
(20:17):
of my assessments this is 10plus years ago now, but in one
of my assessments they wanted meto say whether they are not.
They had the capacity to managetheir benefit payments and I had
to decide if this individual,this veteran who has a history
(20:40):
of cocaine abuse, who admittedto active cocaine use, would be
able to receive a large lump sumand manage it appropriately.
And that was a very difficultsituation because at that time I
did not feel that a veteran whowas an active drug user, who
(21:04):
admitted to be an active user incocaine, receiving a large lump
sum of money was concerning tome.
Who admitted to be on activeuse in cocaine, receiving a
large lump sum of money wasconcerning to me.
And so I had to get otherpeople involved.
So that's how I know it canopen up a can of worms, but they
.
I don't remember what happenedwith that situation, but what I
(21:27):
did was appropriate, by gettingother people involved, because
it wasn't just me, no-transcript, and so it was just a very
(21:56):
challenging scenario.
Ray Cobb (21:59):
So anyway, yeah, bethany, I got one locally here
that I got involved with, or Iwas asked to get involved with,
about a year and a to getinvolved with about a year and a
half, two years ago now,gentleman.
Matter of fact is my age,vietnam veteran, a wheelchair,
as famous as I am, and had nofamily.
(22:22):
Well, he somehow, in some wayway, had met a lady.
He was, I think he was 73 atthe time, and he met a
(22:46):
39-year-old young lady who hemoved in with her and put her on
his checking account and thebank called me, knowing what I
do with veterans around herelocally.
His situation was that she wasgoing in there and, as they've
put it, wearing extremely niceclothes, pulling out large sums
(23:06):
of money each week and then atthe end of the month they were
always four or five checksoverdrawn.
And she indicated to me thathis VA income was over $5,000 a
month and they wanted to know ifI could have it looked into.
(23:29):
They wasn't married they wasn'trelated but that's an example of
how you kind of got to becareful.
Bethanie Spangenberg (23:46):
Yeah, and unfortunately it happens too
often and a lot of it's not seenbecause, you know, as veterans
get older, most of the timetheir family is not always
involved or they're loners orthey're to themselves, and it
actually happens a lot more thanyou anticipate.
I talk a little bit about mytime working in the nursing home
(24:06):
and doing dementia care, but itopened my eyes to a lot and I
was only in dementia care for ayear, dedicated dementia care
for a year inside the nursinghome, and you see a lot because
not only I was there to seeregular patients this wasn't
veteran patients but you see alot of the elderly because of
(24:28):
their conditions, how they gettaken advantage of and, like I
said, I was only there for ayear but it's probably the most
learning and impactful timebecause it took a lot of
resources to handle thosesituations and so you know you
(24:49):
get to appreciate that as youget older or as you develop
disabilities, and I'm notsurprised to hear that about
your veteran.
All right, I'm going to goahead and jump into the next few
questions.
Question 31 is what is theposture and general appearance
of the patient?
(25:09):
This is something that we dofor all of our patients and all
of our care notes, because we'rejust trying to paint a
generalized picture Whetherthey're clean, shaven,
well-dressed, alert, attentive,their thought process.
That's simplistic for theexaminer to document once
they've interacted with thepatient.
(25:30):
32 is describe the restrictionsof the upper extremity, with
particular reference to grip,fine motor movements and ability
to feed themselves, to buttonclothing, shave and attend to
the needs of nature.
They do not give much room forthis.
I always add an additional pageon these exams because you
really can't capture a fullpicture with the little bit of
(25:52):
space that they give you.
And if I reference an examplethat I gave for the same veteran
we were talking about with thearthritis I talked about, the
veteran has limited forwardflexion, internal and external
rotation of the bilateralshoulders with decreased
strength.
He has decreased strength inthe grip of both hands with an
(26:14):
intention trimmer in the righthand.
He has difficulties buttoninghis clothing.
He does not shave.
He has trouble with his balancewhile brushing his teeth due to
lower extremity weakness.
So, that gives a picture of whatthose limitations are as it
relates to the upper extremities.
If we jump to question 33,they're now asking the same
(26:36):
question about the lowerextremities and with particular
reference to the extent oflimitation of motion, atrophy or
muscle, how the muscles shrinkdue to non-use or disease and
contractures or otherinterference of the lower
extremities.
And for my veteran I put he hasweakness in both legs that
(26:57):
limit movements.
For range of motion testingWeakness is worse in the right
leg versus the left.
He's unable to flex his rightfoot.
And then obviously before I hadannotated about his gait and the
limitations with his transfer,so that contributed to the lower
(27:18):
extremity limitations.
34 is describe restriction ofthe spine, trunk and neck.
For my veteran I put there isvery minimal to no movement in
the cervical spine in all planes.
Range of motion in the lumbarspine is unable to be tested due
to lower extremity weakness.
Now for this veteran I did notfeel that he was able to really
assess range of motion in thelumbar spine.
(27:40):
Normally when I assess range ofmotion of the lumbar spine I'll
have the veteran stand on bothfeet with nothing in front of
them, bend over, touch theirtoes, lean back and arch their
back, take their left hand totheir left knee, bend to the
side and then I do right hand tothe right knee, bend to the
side and then I will have themtwist or rotate as if they're
(28:02):
looking over their shoulder fora vehicle if they're driving
this veteran.
Because of the lower extremityweakness he was not safe or
stable to be doing that type ofrange of motion.
So I did not do it with him andjust annotated why I felt he
was not able to be tested.
And that's important to documentbecause again you're
(28:26):
demonstrating that there's asafety concern for this
individual.
If we go to page four this isthe last page it says describe
all other pathology, includingthe loss of bowel or bladder
control or the effects ofadvancing age, such as dizziness
, loss of memory or poor balance, that affects patients' ability
to perform self-care, or ifhospitalized beyond the ward or
(28:47):
clinical area.
So if they're hospitalized,like what limits them as far as
their mentality, memory, balance, things like that?
So question 36 is how often perday or week and under what
circumstances is the patientable to leave the home or
immediate premises?
So for this particular veteranI put, let me see here For him I
(29:19):
can't find it as readily as Iwant to, but he essentially that
he oh, here it is, the veteranwill leave the house one to two
times weekly to go through adrive-thru for a drink.
Oh, here it is, the veteranwill leave the house one to two
times weekly to go through adrive-thru for a drink.
So he would get in the car andhe wanted like a Coke or a Pepsi
or something, and he would havehis wife go through the
drive-thru and he'd be with themand get a drink, and so he
(29:40):
never did the grocery shopping.
The wife did all of that stufffor him.
Thirty-seven are aids, such ascanes, braces, crutches or the
assistance of another personrequired for walking or
ambulation.
And this is just asking youknow what kind of assistive
devices are used and with thatassistive device how far are
they able to ambulate?
(30:01):
One block, five to six blocks,one mile I think that's a
stretch.
For this particular veteran.
I put three feet because he wasnot secure enough on that
roller walker to walk more thanthree feet.
He would have to sit and thenbe pushed or be you know kind of
slat his feet if he could topull himself forward.
So yeah, if somebody's, youknow, really struggling and in
(30:26):
need of aid and attendance, I'mnot sure how many can walk a
mile Anyway.
So the last section for theexaminer is the examiner's
signature and the examiner'sinformation.
And while it's the shortest DBQmaybe hypertension is about the
same, but it is the mosttimeensive considering the
(30:49):
length of the form and the datathat it has to capture.
Any questions about the DBQ.
J Basser (30:58):
Yeah.
I tried doing the back exam,bending over and touching your
toes.
I was on static hypertension.
Ad (31:11):
I'd be on the floor.
J Basser (31:15):
Now I agree with you on the block.
The block is a standard word,but you know, city block or city
block, okay, but some blocksare shorter than others, you
know.
But that's the one block is thelowest level that they've got
over to be here, right?
Bethanie Spangenberg (31:29):
so yeah, I don't think I've ever done an
aid and attendance exam onsomebody that could even walk a
block with, even with theirroller walker or their
assistance.
There's always something that'simpacted, but I do have one
other case that I'd like to talkabout.
This is as it relates todementia, or he was diagnosed
(31:54):
with neurocognitive disorder.
So this particular individualthat I did for aid and
attendance is a little bitdifferent than most.
So most of the time your aidand attendance is physical need.
This one is for mental orcognition.
So this person had a type ofcancer that was Agent Orange
(32:15):
related.
He underwent radiation andchemotherapy and sometimes with
radiation and chemotherapy itcan cause an early, onsetified
neurocognitive disorder, chronicfatigue syndrome.
He had reflux and tinnitus.
So for him there's a couplenotes that I documented for his
(32:49):
aid and attendance.
As far as nutrition goes, theveteran's weight and nutritional
status demonstrated obesity.
The veteran limps duringambulation, his gait is slowed
and his stride is shortened, sohe's just taken real small steps
for stability.
In regards to medicationmanagement, I felt that he
required medication management.
(33:09):
He was not able to do it on hisown and I documented that the
veteran is not aware of whatmedications he is currently
taking.
He knows that he is takingmedications for his stomach, but
not specifically what medicalconditions.
If his wife doesn't remember totell him to take medications,
the veteran commonly does notremember to take them.
He has not taken hismedications as of noon today
(33:30):
when I did the exam when Idescribed his lower extremities
I talked about.
He has arthritis in both knees.
His right hip is limited inrotation.
He has fallen in the past dueto balance troubles.
Ad (33:49):
And.
Bethanie Spangenberg (33:49):
I really on my additional page is when I
really dive into where his needis and in the comments section I
wrote the wife reports thatwhile they were in the Walmart
parking lot the veteran wasdriving.
The veteran forgot where he wasand circled the parking lot.
(34:09):
He had to be reminded by thewife where they were and the
directions back to home.
Approximately four months agofrom the time of this exam, the
veteran drove the vehicle intothe grass median, missing the
entry to the parking lot, anddrove the car onto a facility
sidewalk.
He was assisted by from abystander in order to lift the
vehicle off the facilitysidewalk and back onto level
(34:29):
ground.
The veteran would strugglewithout the assistance of his
wife and children.
The wife assists with memorytroubles and the children assist
with physical troubles.
The wife fears that the veteranwould forget to eat if she was
no longer around.
During examination the veteranwas easily agitated and debated
the reports from his wife.
He denies much of what his wifereports.
(34:51):
The veteran was observedfollowing the wife into another
room if she was gone for toolong.
The veteran would requireresidential institutional care,
nursing home care orhospitalization if he did not
have anyone to assist him.
The veteran's memory andbehavioral outburst is his
greatest limitation forindependence.
His memory troubles limit hisability to recall need of
(35:13):
medications and drivingdirections.
So this particular veteran, youknow, some families may not
consider that dementia may be aqualifier for aid and attendance
, but it absolutely is.
J Basser (35:31):
And I just wanted to point that case out.
Ray Cobb (35:35):
Qualifier for nursing and attendance.
Yeah, but the question that wasasked of me, of course it's
been a while.
They asked if I was able to geton a riding lawnmower and mow
my grass which you know, using awalker.
(35:55):
I don't know how they wouldexpect me to climb on a riding
lawnmower and I walked in with awalker.
I think at that time I had notgotten my first scooter, so I
didn't know if that was still.
Is that a normal question orwas that one the examiner came
(36:17):
up with?
Bethanie Spangenberg (36:18):
That's a normal question as it pertains
to coronary artery disease.
There's a specific METSquestion that asks about the
riding lawnmower.
So that is a standard questionfor coronary artery disease when
they're trying to capture theMETS Not necessarily for an
attendance we'll put a label forthis year on this gasoline.
J Basser (36:41):
Now all these activities may live in the
phrase.
Attendance record is ruled thatit does not have to be a
constant need for care becauseyou know, some vets are going to
have good days and bad days,depending on what the situation
is.
you know the environment, theirlife and how your disability
affects you.
You know on days that you knowsome days your blood pressure is
(37:07):
high and you're not going toget as busy on the days that it
goes low, because if it goes lowit drops really low and you
have issues and so it's notevery day.
But you know, as far as walking, walking blocks and things like
that, you know if you've gotissues with your legs and maybe
some type of vascular disease orneurological issues like foot
(37:30):
drop and things like that, thenwalking a block is not very good
at all.
You know, but again, it's not aconstant need.
Yeah, you know.
And don't be confused withactivities.
You've got your standard 8 to10, you've got your level of
activities of daily living.
Don't confuse those withactivities of daily living when
(37:51):
it comes to the caregiverprogram, because theirs are a
lot more concise and different.
As far as you know, it'sbasically the same but they look
at it a whole lot different.
Bethanie Spangenberg (38:01):
Yes, they do.
Yeah, they're very similar asfar as, like, the questions that
they ask and the needs of theveteran, but they're different
as far as the criteria and theprocess, heals and all that
stuff.
But they're different as far asthe criteria and the process,
heals and all that stuff.
Now I will tell you that for mydementia veteran, he was denied
on both his aid and attendance,his initial application for aid
(38:26):
and attendance, and he was alsodenied on his initial
application, or the wife'sinitial application, for the
caregiver program, and so theyhad to go through and fight that
with an attorney, unfortunately.
J Basser (38:41):
Mm-hmm.
Well, that's sad, but they do.
You know they've got a reasonfor the denial.
I guess you know the VA's gottheir own reasons for doing
stuff and usually it takes ahigher level of you or a
supplemental or usually a BVAdecision.
Sometimes it takes the best ofthe court to fix it.
You know.
Ad (39:01):
Yeah.
J Basser (39:02):
It's crazy.
It is, but you know, forexample, transferring.
Transferring means, say, forexample, if you want to transfer
from the bed to the floor, to awheelchair or to a walker or
whatever you'd help doing that.
You know, getting out of bedand things like that.
You should have that inattendance.
(39:28):
And he's got one of the alarmdesk comm alarm.
But if he's using a device likea feed pap or something that
makes noise or whatever and thevet doesn't hear the alarm go
off, well you got that thingshared with your wife or your
partner excuse me, I don't, youknow and they hear it and they
(39:48):
get up and they help you.
They either get your, you knowget your stuff to bring your
sugar up a little bit.
You know your glucose up andyou know you're up for a while
until it levels off and you cango back to sleep.
But you know that keeps you outof the hospital.
And so that's another issue too, because that will also I think
that will also be part thatshould get somebody
(40:09):
aid-dependent for having to dostuff like that.
Or if you fall a lot, if youwalk and you do things like that
and get around.
I mean there's different thingslike ambulation.
Basically, transfers have got alot to do because even getting
in the shower, you know to atransfer, like from a wheelchair
to a shower chair or somethinglike that, or you have to hold
(40:31):
on.
You know, in a shower, you knowif you bend over to do
something, wash your legs oryour feet.
You know in a shower and youknow, if you bend over to do
something, wash your legs orfeet.
You know you could crash and Iknow it.
I've done it more than oneoccasion.
Bethanie Spangenberg (40:45):
Yeah, I would agree.
If you have the hypoglycemicepisodes and you require the
assistance of another, that isabsolutely criteria.
The assistance of another, thatis absolutely criteria.
And in fact, even on thediabetes DBQ it asks about low
blood sugars.
And so if you've ever had theDBQ done when it comes to the
(41:07):
diabetes and on there it talksabout, you know, low blood sugar
requiring assistance of another, and it says yes, then you
could use that as evidence toargue for aid and attendance.
J Basser (41:19):
That's been good.
Guys, don't get me wrong.
But if you do the CBQ for aidand attendance, you know people
are filing claims for aid andattendance.
I hate to say this, but aid andattendance housebound issues
like SNCF still are a benefit.
If they see the need for it,they should award it.
That's what they need to do.
(41:40):
This form came out for peopleto put in so they could file a
claim for it, so they'll be ableto turn it in.
It's still an ancillary benefit.
If you need it, they shouldhave awarded it in the first
place.
If you need it, they shouldhave awarded it in the first
(42:01):
place.
Ad (42:03):
But they treat everything like a claim, regardless of what
it is.
J Basser (42:06):
Yeah, correct.
So I guess it depends on whereyou're at too, you know.
I mean, I know some folks thathave a lot easier time getting
their stuff done than some folksI know.
Location, location, location, Iguess right.
Ray Cobb (42:23):
Yeah.
J Basser (42:27):
Now, it's hard, but DBQ had a list of ADLs, you know
, like bathing and hygiene andthings like that.
Did you put check marks in theboxes or what did you do?
Bethanie Spangenberg (42:40):
You're supposed to circle it and then
describe which.
Again, they don't leave muchroom to it.
But now what's interesting isthey've actually done a fair job
I still think there's room forimprovement actually done a fair
job.
I still think there's room forimprovement.
But they recently when I sayrecently, February of 2023, they
(43:01):
updated the aid and attendanceform and it's more specific as
far as particular activities.
Before that, they would leave ablank space and you would just
have to talk about ADLs for theveteran.
But this time you actuallycircle what they require
assistance with, and it'sspecifically bathing and
(43:23):
showering, eating orself-feeding, dressing,
ambulating within the home orthe living area, tending to
hygiene needs, transferring inor out of the bed or chair,
toileting, medication,management.
And then it does talk aboutadditional activities.
Now the ones that arereferenced here are actually
(43:45):
considered IADLs, which areIndependent Activity or
Instrumental Activities of DailyLiving.
And that is, the more complexthings, such as shopping and
meal preparation, house cleaningand home maintenance,
transportation, things like that, and so there is a space for
them to talk about thoseinstrumental activities of daily
(44:06):
living as well.
J Basser (44:07):
Right, okay, everybody needs to know this.
Good for doing this?
Yeah, a lot of folks, I think,need that attention.
This Good for doing this?
Yeah, a lot of folks, I think,need that attention, but have no
idea.
Yeah, we'll see how that goes.
Bethanie Spangenberg (44:26):
I think the fact that a lot of times, if
a veteran still has a livingspouse or a live-in, maybe a
child lives with them andthey're doing a lot of the meal
preparation or assisting withlike buttons and medication
management, they don'tnecessarily recognize their need
(44:49):
until that individual is gone.
And so, you know, having thisdiscussion, you know, makes
veterans start to really reflecton you know, the role that
others play in their activitiesof daily living and their
day-to-day lives.
A lot of veterans don't reallyrecognize the significance of
(45:09):
their significant othersignificant other.
J Basser (45:13):
You take sensory neuropathy, diabetic neuropathy
and motor skills in your handsand your fingers and you deal
with medications.
You know you can probably getthe bottles down after you drop
them to as many times as youpick them up.
But when you start puttingpills, you know you start mixing
and putting pills on littlebitty containers.
(45:35):
That becomes an issue becauseusually you wind up with pills
all over the floor.
And that's when you step in andhelp somebody do that.
As far as help, that's one initself, all by itself.
I'm sure Ray's been throughthat, but he's got neuropathy in
his hands too, isn't it, ray?
Ray Cobb (45:54):
Yeah, and another thing is neuropathy in the hands
will affect.
What it affected me is thatwhen I do at the time before Pam
started giving me injectionssometimes giving the injection
right as or right before orwhatever giving the injection
(46:15):
right as or right before orwhatever you kick the needle at
the wrong angle and it actuallybends the needle.
And I had several times that Ibent the needle strictly because
(46:36):
of not being able to properlyhold or control your hands or
fingers.
Really, in that particular case,one time I actually bent the
needle and it was as tall as theskin, because when I pulled it
back the needle actually hadbroken and, you know, fell, and
if I had gotten it in there andthen done it, then I would have
(46:58):
broken the needle off inside me.
And now you've got a wholeother situation.
Ad (47:05):
But you've got to bend it.
Ray Cobb (47:08):
With bad diabetes, you know, you can get to a certain
point where it's not safe foryou to give your injections
Right.
J Basser (47:22):
You know, even with they'll say, been there done
that you know prosthetic devices.
Like you know, braces, evendiabetic pumps and things like
that you know, even your, evenyour deck concepts.
You know, if you've got badshoulders and bad arms and you
have to wear it on the back ofyour arm, you have to.
You know you can't reach themto both your arms.
(47:43):
You got to have to put it onabsolutely Absolutely.
Absolutely.
That's where the caregiver actcomes in, but I don't know.
Ray Cobb (48:05):
That whole thing is going to come to a head here
pretty soon, I think.
J Basser (48:10):
March is next year.
Come to a head.
I don't know what they're doing.
I mean, I think that needs tobe done in an adjudication way.
I think the regional office onthe handle it decides to be a
they can do a form or whateverand help out, but I don't think
they have any businessadjudicating claims, in my
opinion.
Ad (48:27):
Yeah business of getting clean, in my opinion.
J Basser (48:31):
Yeah, my opinion though.
We got to get clean in thespecial case.
Bethanie Spangenberg (48:39):
You know, one thing that kind of triggered
in my memory is some socialworkers will try to fill this
out, Some social workers willtry to fill this out and while
(49:02):
it is evidence, the VA may sendyou for a reexamination by an MD
, DO, PA or nurse practitioner.
I think a lot of times thesocial worker does a better job.
As far as capturing theveterans' need and painting the
picture, but they will notaccept it from a social worker.
Ray Cobb (49:19):
Liveny, that's a good point, because with myself it's
been a few years ago, but thesocial worker was in a form with
Pam and I and then she says nowI'm going to go over this and
have the doctor sign it.
And that's exactly whathappened.
(49:41):
We never met with the doctorwhen we turned the form in and
she went over it and the doctorsigned it.
She went over it and the doctorsigned it.
Then, after the next day orwhatever, she called me and
informed me that she had goneover it with the doctor.
Bethanie Spangenberg (50:01):
The doctor agreed with everything and it's
signed and it's been submitted.
Ray Cobb (50:04):
I think that's appropriate.
It went right straight through.
Bethanie Spangenberg (50:09):
I got it the first time.
That's good.
I'm glad to hear that that'swhat they're doing.
I think, honestly, that's thebest use of your team and your
clinical skills.
I think the social workerthat's essentially what they're
there for is to identify theveteran's needs and put those
resources out for the veteran.
So I'm glad to hear that theydid that.
(50:35):
So the other thing that goesalong with aid and attendance,
that it's not necessarily acompensation or pension benefit,
but it is a benefit through theVA system is if a veteran needs
accommodations, whether it'sfor their home or for like the
(50:57):
shower, for grab bars, for likea handrail, the clinician can
order an occupational therapyconsult inside the home and the
therapist will come out andidentify what needs that the
veteran has in order to assuresafety during activities of
(51:19):
daily living like showering orbathing.
So they may provide a showerchair to the veteran, they may
provide the handrails around theshower.
And that's not again, that'snot a benefit through
compensation of pension, butthat's something that you can go
into the clinic and you can askyour clinician for.
(51:41):
So let's just say you haven'tqualified for in attendance yet
or you haven't received a grantfor that condition.
You can still go into yourprimary care provider and
discuss the needs that you havewithin your home and ask
specifically for someone to comeout and assess the home for
things that you may need toassess with your activities of
(52:02):
daily living.
Ray Cobb (52:05):
You mentioned grant.
They actually came into my homeand that's when they
recommended the HESA grant andredid my shower with a fold-down
shower seat, a roll-in shower,a handicapped sink so that I can
sit on my walker and shave inthe mornings, Things of that
(52:28):
nature.
Bethanie Spangenberg (52:31):
There's a lot of different applications
for those for, like you orveterans that need.
They'll do the home adaptationand then they'll do the vehicle
adaptations and I know you guyshave talked about the vehicle.
I guess you guys have a guru onthose vehicle adaptations.
I heard that podcast.
J Basser (52:52):
Oh yeah, he's a pretty good guest, Of course.
I think Ray dug anotherwoodwork.
Ray Cobb (52:56):
How many?
J Basser (52:57):
has he done for you, Ray?
Ray Cobb (53:00):
I'm on my third vehicle now, so he's done three
different.
You know, I think he's gottenme a couple of scooters, two
lifts, and now I have a vehiclethat is wheelchair accessible,
that the ramp comes out and Ijust roll up into the van and
(53:24):
they fix me a nice seat thatcomes back and I can transfer
right straight from thewheelchair into the seat and
then pull forward like a normalpassenger.
But yeah, he's good at what hedoes.
J Basser (53:42):
You know I'll tell you something else on aid
attendance.
You know it's not like aregular claim.
I mean they can actually goback to the date to condition
rules on that and Bethany wastalking about, like the HISA
grant.
They put in certain things foryou and you know evidence.
That's half of the time they'reusing reason and the basis to
(54:02):
put that in.
But they'll have a diagnosis ofwhat's going on and get that in
there.
That could actually affect youreffectiveness in your age
attendance.
I've seen you go back on oneguy.
I forget how far they went back.
He worked on one for like 10years.
Ray Cobb (54:20):
Oh, wow.
Bethanie Spangenberg (54:24):
That's actually what I'm anticipating
for the Purple Heart recipientthat I was talking about earlier
.
Unfortunately, I can see thepotential, but I don't think the
family sees the potential.
From my understanding, theyhave not made any further
movement since the last time Italked to them on any type of
(54:47):
disability reimbursement claims.
And I've tried to stress but Ithink that's a large burden too
is the family doesn't reallyunderstand and you try to
emphasize it, but without theirhelp you can't receive the
benefit.
J Basser (55:02):
Yeah, you all realize too.
Now, if this benefit'savailable to this veteran and
this veteran without thenecessity of the care that he is
receiving, that he would be ina nursing home.
That would be an R2, wouldn'tit right?
Ray Cobb (55:19):
Yeah, that's.
One of the main criteria isthat you can exist in your home
without any assistance.
But if you have to have anyassistance in that and you would
have to be as they refer to itor the way they refer to mine,
would have to beinstitutionalized, which means a
(55:41):
nursing home or a hospital thenthat is one of the main things
that gets you to that R2.
J Basser (55:50):
Too well.
Ad (56:00):
It is what it is.
J Basser (56:04):
It's kind of hard, but you've got to realize too that
any time you're dealing with aVA, it's their responsibility
because of the adjudication theydon't take, but the VA is their
responsibility to maximize thebenefit and the best of the
favor You're supposed to yeah,they're supposed to do that.
If I say it boils down to it,it should do.
(56:26):
Of course it's anon-adversarial system too, but
that's kind of strange.
You know, I know the CMPexaminers that work for the VA
in town.
They're trained, you know, andthey're told, basically, you
know some of these veterans aremaybe in bad mood and things
like that.
You know to give them respectand be kind and things like that
(56:47):
.
You know, I know I'm seeing alot of examiners in my day, that
are like hey man, I'm youngerthan you.
What are you doing this for?
You know that has nothing to dowith it, right?
Yeah, Because we can't take outthe human factor.
Folks, Humans are going to behuman.
(57:11):
If we don't want this, we couldhave stayed home and went back
to college and done somethingelse, right, Ray could have
played football and played inthe band.
Ray Cobb (57:17):
Yeah, we'd still be rocking.
J Basser (57:27):
That's uncalled for, Ray.
Ray Cobb (57:33):
You don't be saying that Pam and I had a good
conversation.
She picked up a name we had togo to her doctor today
concerning her heart and he toldher how come she gets these
anxiety attacks.
And of course I'm saying she'sworried about me and she, you
(57:53):
know she doesn't agree with thatand I said, well, maybe not,
because when the band wasplaying she would get up and run
around and would fly down thehall and stuff and they actually
named her Fireball because theythought the house was on fire.
Fireball because they thoughtthe house was on fire.
So that stuck with her.
And still every once in a whilewhen I'm teasing her I'll say
(58:15):
slow down, fireball.
It is a lot of work on ourspouses to take care of us and I
know sometimes I stop and thinkand don't appreciate or at
least tell her that I appreciatewhat she does.
(58:36):
She needs to do more of that.
All you veterans out therelistening, you think about that.
You think about little things,not necessarily you couldn't
eventually do, but it makes it awhole lot easier because she
(59:03):
helps you do it every single day.
J Basser (59:05):
Bethany, I want you to give everybody your contact
information in case folks needan item from Valor for Vets.
Bethanie Spangenberg (59:08):
I want to give you your badge.
J Basser (59:10):
All right.
Bethanie Spangenberg (59:10):
You can check us out at wwwvalor4vetcom
or you can give us a call at888-448-1011.
J Basser (59:23):
There you go, and guess what guys?
She kept the show.
She kept her voice during theshow.
She's been a little bit underthe weather, but she got it in.
Bethanie Spangenberg (59:32):
Let's hope I still don't have this illness
the next month.
J Basser (59:35):
You've had it two months in a row.
Now we're going to quit this.
Big change is coming to showfolks.
Oh, by the way, one quick noteVAgov and the VA search engine
has now got the 2025, the summer2024 pay rates in the system
for compensation custom of thecompensation.
So look at it and see what kindof cookie you got, because they
(59:59):
paid us some cookies this yearand not money.
I think I got an Oreo orchocolate chip or something like
that.
Other than that, guys, I'mgoing to shut her down.
Thanks for coming on, bethanyRay.
Thanks for being there for me,buddy.
We appreciate you.
Ray Cobb (01:00:15):
Thank you.
Thank you, thanks for having me.
J Basser (01:00:17):
All right, this is John, on behalf of the Exposed
Vet Radio Show.
Thanks for listening.
You have been listening to theExposed Vet Podcast.
Any opinions expressed on theshow are the opinions of the
guest speakers and notnecessarily the opinions of
Exposed Vet, exposedvetcom orBlogTalkRadio Tune in next week
(01:00:40):
for another episode of theExposed Vet Podcast.
Thanks for listening.
Ad (01:00:47):
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break-ins and unexpected fires.
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