New Here - Looking for help for brother

ThisLife, sorry you're not getting straight forward reliable answers. I'll come back and leave an update here once we start the process, which I expect is days away. Sorry it looks like you'll have to find a new placement soon. I understand getting a bed in a veterans facility is difficult per ratio of beds to veterans.

Marta,

Thanks for your interest. ThisLife was speaking of her husband in terms of retired Air Force. In my case it's a brother. He had an honorable discharge after about 8 years of service. Currently he's working at what can best be described as a family business. Earlier today I was talking to a friend I met through my brother. She was of the understanding that he can not be fired when already showing outward signs of disability at work.

Tonight I drove my brother and his wife to the MRI. While he was inside, I had the opportunity to cover many things with my SIL out of his earshot. Discussed the need to engage an CELA to talk through various scenarios and the best way to handle this. She's in agreement and definitely wants me there with them at the appointment. I told her I picked up the business cards earlier this week. She asked me to go over it with my brother after he talks with his docs about the results of his recent tests.

My interpretation is that when using the Tam Cummings stages of disability, stage 4 would be a bit soon to apply. The above seems to be applicable once the PWD can no longer be left alone.

Does that match your experience?

Info about VA priority groups. Pay special attention to priority group #4.

 https://www.va.gov/health-care/eligibility/priority-groups/

Back in March I wrote, "ThisLife, sorry you're not getting straight forward reliable answers. I'll come back and leave an update here once we start the process, which I expect is days away." The days away was delayed as we worked to connect with a CELA and to get DB's financial life in order. As quoted above from another member:

I would contact the nearest Veterans Health Care facility and talk to a social worker. Your LO would need to be enrolled in the Veterans Health Care system, I think, in order to get these other benefits.

Our task yesterday was to get DB into the Veterans Health Care System. We checked in, and then were taken back for a private interview. In addition to reviewing DB's DD12 (I think that's the form documenting his time in the service) questions were asked of DB and SIL of their combined income last year, and excessive amounts spent on medical and dental care. The gentleman asking questions had a very friendly outgoing personality and was very service oriented. During the conversation DB was asked about service related disabilities. I mentioned DB recently being diagnosed with dementia, but we have yet to establish it as service related. Paraphrasing, he said let someone else figure that out, just list every issue you're dealing with. He looked at brother with glasses on and said to list vision issues, he asked him if he gets anxious when he stands in lines (DB said yes), he can claim anxiety, a mental health issue. He said list everything applicable as that will affect disability percentage. DB was given a form to fill out and some handout materials. DB was told his initial assessment is priority group 5, he discussed the copay amounts for medical services (these were low, $50 or less for each of the various examples, some down around $15) he also discussed the copay amounts for tier 1, 2 or 3 perscriptions. He said after he completes the forms and his level of disability is further defined, these costs could go down or disappear. They took his photo and issued him his ID for the healthcare system. (He said something about later in the process he may be issued a new ID with some designation on it). He explained his ID can allow him access to the commissary, and free enterance to National Parks etc. We went to Long Beach, CA (L.A. County) as we were instructed that this was the hub that dealt with our portion of southern California. He gave us info on a health care facility that was a short drive from his home (Orange County, CA), and business office that was near his work. My notes were left with DB and his paperwork. I believe the office near his work is where we go to connect with the VA social worker. We'll go there tomorrow morning.

Later when reviewing this with older brother, who has a friend that used to work in the VA system on disability assessment, we were encouraged not to be shy in listing out issues. He reminded us to document that he had been self employed as an IT consultant and had to close down his business due to his disability. He encouraged us to document his difficulty with Oral Communication, difficulty with written communication. Brother encouraged being specific about such issues. The light bulb went on that I can use some of the wording from the Tam-Cummings assesment, memory deficits, difficulty with word finding, issues with skipping steps in tasks, difficulty with arithmetic, difficulty with complex tasks, etc.

I'll update after we meet with the social worker.

For future reference, I'm including the body of an email I recieved a few weeks back from the DAV while I was under the impression I should go through them. This is more information on the process for anyone that comes accross this discussion. I've omitted the introductory paragraphs specific to my DB. (Note at this point I'll continue to work with the VA directly.)

For DAV to help with pursuing benefits through the Department of Veterans Affairs (VA), it is essential to begin preparing the claim before submission. For the most part, for a claim to be successful we must provide evidence and documentation that supports a:

• Current condition, illness, or disability

• In-service disability, injury, or incident

• A medical link between the current disability and the in-service event, injury, or illness. Or, if a disability or injury existed before military service, a medical link explaining the pre-service disability was aggravated by active military service beyond its natural progression

The following are the types of evidence typically used along with a brief explanation of how they help. For more information, please watch “Seven Ways to Establish Service Connection” and “Who Should File a VA Claim?” by clicking on their hyperlinks.

• Any Military Service Records such as DD Form 214s, and service medical or personnel records. These are helpful as they may show a record of an event, a disability, or the onset of symptoms during service.

• Any private medical and Vet Center records from the date of military discharge to the present. These are helpful as they may show evidence of treatment, the diagnosed disability, and its severity. If not able to obtain, a VA Form 21-4142 must be completed for each health facility. Upon receipt, the VA will also request the records from the health facility.

• A personal statement explaining how the condition is related to active military service and having an effect currently. It should include as much information as possible on the incident in the military, such as the “five W’s”: who was involved, what happened, where it happened, when it happened, and why it happened (if known). Preferably, the statement should be typed.

• Buddy statements from family members, friends, or fellow service members who can corroborate the in-service event or injury. These can be extremely useful in establishing the chronicity of the condition claimed.

• Any photographs; police reports; media or unit articles and/or magazines; and flight, deck, or base logs corroborating the in-service disability, injury, or incident.

• Medical Opinion from Qualified Health Professional(s). Medical opinions can establish a link between the current disability and it was caused or made worse by their military service. Medical opinions should show the date of examination or treatment and should furnish symptoms and findings as well as diagnosis.

Upon collecting all supporting documentation and evidence, please complete the attached VA Form 21-526ez and if needed, the VA Form 21-4142 for each health facility. All VA forms can also be retrieved by searching “here”. Once completed, if a small size (20 Mb or less) please scan and email back. If larger than 20 Mb, multiple emails can be sent. If preferred, all can be returned by mail or in-person instead of email to the address listed below.

Thank you. Luckily we requested that a few months back, so we have a copy. I now need to take a deep breath and start working on the 21-526EZ on behalf of my DB. Wish me luck.

Re the comment above re veterans who are not retirees. The point to ponder here is captured in this email to older brother. Edited for privacy.

This is from a publication from the VA.  As discussed yesterday we can record that xxxxx lost income from his self-employment as an IT consultant. I found out this morning that xxxxx's work for the (private businessman) could range between 17,000 to 25,000 a year.  I don't (yet) have visibility into his other lost income, but I can find that out.  From a documentation point of view, we have the issue that xxxxx is still employed.  xxxxx's reality is probably described in the item highlighted below, but that would be difficult to discuss in front of xxxxx.  Any thoughts?

It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran’s earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination.  (Authority: 38 U.S.C. 501(a))

Thank you to all who have contributed to this discussion. @thislife pointed someone here in another discussion, so I thought I'd provide an update on the journey.

An important distinction I've found is VA Benefits and VA Health Care. Earlier this week we went to the local Veterans Service Office. This was housed in a building that housed other county level services such as the local council on aging. We were able to get an appointment as walk-ins and were seen after a short wait.

They are all about the paperwork, getting everything documented properly to get approved for benefits (payments as opposed to healthcare services). A good portion of what he showed us were things folks here had shared. I felt very prepared for the meeting. He went over presumptive conditions for approval. He didn't seem familiar with the "catastrophic disability" for Alzheimer's. I wasn't concerned as we're early in the process. He echoed what the person at the Long Beach VA said: document all of your conditions/disabilities and let someone else sort out if they are service related. When looking in the system re dementia he relayed there is a known connection between hearing loss and dementia. He recommended when we go to the healthcare system, request testing for hearing loss. He provided us forms and handouts and encouraged us to set another appointment if we need help.

Here is an update on our journey with respects to the VA. For context, we had an appointment with the private neurologist for an APOE4 blood test, and a PET scan. We wanted to check if the VA could do these at less expence.

BLOODWORK - A week ago we went in to have the VA blood draw. I had the paperwork on the APOE4 testing. We were told that the person doing the blood draw couldn't add the order from the outside Dr. If DB had already been working with a VA PCP he could have checked with the DR about adding that.

PCP APPOINTMENT - In another thread someone had talked about bringing copies of the file from the private neurologist and providing it before the appointment. The day I read that advice I called the neurologist, had copies made, and dropped it off to the VA. The Dr we had the appointment scheduled with today was out, so we were seen by a PA. I really liked her and she was very thorough in her interview with DB, but was still learning when it came to process questions. We learned there is a separate audiology clinic and we could self refer. (Appointment set for late June). She went over all the blood work and took down all his current meds. We went over the dates of the other tests by the neurologist, and it seemed that had not added the paper work to his file yet. When asking him how he slept and if he woke up during the night, he stated he was in bed by 9 but woke up during the night like around midnight, 2 am, and then up for the day at 4. She offered to refer him …I was expecting to hear for a sleep apnea study (older bro and I both dx)…but she said something about a mental health doctor that could help him with that. He's willing to try anything that would help. We talked about our order for a PET scan and wether the VA could do that, she was going to follow-up with her collegues on that. She asked DB about his perceptions around his dementia. He mentioned his fogginess causing him to stop supporting clients as an Tech Guy. He mentioned he's still doing fine where he's worked for decades with his brother. (More on this later.) We spoke with her briefly about working with the Social Worker available there at the VA med clinic. She indicated that would come later if he was having difficulties with ADL. I held my tongue on somethings a DB was right there. We set six month followups on bloodwork and next PCP appointment.

A couple of hours later she called me and had a question on his referrals. I started asking again on the Social Worker. She was suggesting I work through the VSO (benefits coordination). I discussed my concerns about DB's disability rating. I told her that although he's still working with YB, if this weren't the company he'd been working at for decades and that YB was his boss, he wouldn't still be working there. I'm hoping that the testing that will be done will help with his disability rating, and that my understanding is that if he has a confirmed ALZ dx that it would qualify him as "catastrophically disabled". We did a little back and forth as to whether his disability rating would come through the medical arm as a result of testing or if it came through VSO and the administrative benefits arm. (My take is the Benefits side makes determinations based on what the Medical side provides, and that the Social Worker from the medical side can help with evaluations of his disabilities (manifestations of his dx).) It started to feel like a chicken or egg discussion, and she said she'd ask for a nurse or the social worker to call me back to answer my questions.

I'll will continue to provide updates in hopes it can help someone else on the same path.