J Basser: 0:00

Well, I guess they have no interruption.

Ad: 0:01

Don't talk to me.

J Basser: 0:05

It's time for the Exposed Vet Radio Show. The Exposed Vet Radio Show. We discuss issues affecting today's veteran. Now here's your host, john and Ray. Welcome, ladies and gentlemen, to the episode of the Exposed Vet Radio Show. It's a cold day here in Kentucky. It's a cold day in Tennessee too. How's it in Ohio, betsy? Is it cold up there?

Bethanie Spangenberg: 0:33

23 degrees currently 23.

J Basser: 0:37

That's 22 here on this December 5th 2024. Got our co-host, mr Ray Cobb. How you doing, ray.

Ray Cobb: 0:45

I'm doing great. A little cold down here. I actually got on a flannel shirt for a change.

J Basser: 0:51

Really. I told John Dorsey that he lives in Minnesota. I said you need to quit sending the 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 Cripps in there too. James, are you with us?

Ray Cobb: 1:06

I don't see him there. I think that's James there you go.

Ad: 1:11

I think we've got him.

J Basser: 1:31

There you go. I guess he's with us. He's just got some interference issues. Okay, we will discuss today. It's a topic that a lot of veterans need to understand and we we're going to start off the dbq 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. I think it'd be right that isn't f and c. A lot of people file for it and it depends on what the level is and things like that. But that's it's going to go over it and when she gets done we're going to discuss a lot of issues on it and try to everybody explain what activities are being led in your home and things like that. So, bethany, welcome aboard and go ahead and get started. You want to.

Bethanie Spangenberg: 2:15

All right. Well, this is a very important DBQ and discussion because I think a lot of veterans qualify for aid and attendance and they just don't utilize the benefits. I'm glad we're talking about this today. To the DBQ itself, it is four pages long. It is not the typical DBQ. The DBQ is embedded within an application, so the first couple pages is actually information that's related to the veteran and the claimant or, you know, whoever is trying to get the benefit for the aid and attendance. The DBQ is still found on the same VA website. In order to find the form and they can just go all the way to the bottom, click on the form for the aid and attendance and it's right there.

Bethanie Spangenberg: 3:14

But to break down, the first page, section 1 is the Veterans Identification Information. Section 2 is the Cant's identification information and what's interesting about this particular type of special monthly compensation is that it's available to not only veterans but their surviving spouses or surviving parents that may be eligible. So recently in our local area we had a Purple Hearts recipient who passed away and his spouse is in need of care, so she is eligible to receive benefits because of her husband. So now that her husband has passed, the family is able to collect these benefits for his surviving spouse who unfortunately had a stroke and is paralyzed on one side, so she's in significant need of assistance with her activities of daily living for aid and attendance and the criteria that is required in order for a claimant to be eligible. Page two is still part of the veteran or claimant information. It's asking about hospitalization. Is the individual currently hospitalized? Just ask for basic information the date that they were admitted, the name of the hospital and the address. Section 5 is the certification and signature of the claimant.

Bethanie Spangenberg: 4:57

Again, this DBQ is different because this application of this set of forms has both the claimant information and the medical examiner's assessment in there. Page 2, section 6 is actually where the examiner starts and it notes specifically in this DBQ that the examiner must be a medical doctor, which is an MD, a doctor of osteopathy, which is a DO, a physician assistant or an advanced practice registered nurse, which is your nurse practitioner. So it's very specific on who is able to fill out this form when the veteran goes to have this examination done. This is a required in-person examination. I do not believe video exams are appropriate because there's some assessments on here the medical examiner has to do in order to really capture the information pertaining to the veteran. This examination takes about one hour or more, depending on the severity of the veteran's condition. Any questions so far, before I start diving deep into the questions.

Ray Cobb: 6:19

No, I think one thing that, like I told you, every time you come on I learn something. The lady at the beginning, when you were talking about she now qualifies for it, was her husband, 100%.

Bethanie Spangenberg: 6:32

He was 100%.

Ray Cobb: 6:34

Okay.

Bethanie Spangenberg: 6:36

Sorry, I interrupted you there, did he?

Ray Cobb: 6:38

have aid and attendance as well.

Bethanie Spangenberg: 6:41

No, he was 100% service connected and the family, I guess, worked with a service officer many years ago and it just so happened that my husband had an interaction with him and the son was driving the dad's car and the dad had a purple heart on his license plate and he's like, hey, who's that purple heart for? And so he kind of told us the story and he's like, well, is your dad receiving benefits?

Bethanie Spangenberg: 7:11

So what happened is we sat down with the veteran and his family and his spouse and we talked to everybody and we were trying to help him get the aid and attendance benefits as well as an increase for his condition attendance benefits as well as an increase for his condition. He was actually a World War II veteran that had significant scarring due to shrapnel of the abdomen and the lumbar spine, and how that man functioned how he did for so long.

Bethanie Spangenberg: 7:40

I think, took a lot of mental power to overcome his physical disability. So when we talked with them they really didn't understand that he was also entitled to these benefits and unfortunately, a few months after we met with him he got an infection and passed away. So at this point the family is trying to receive the retroactive benefits on top of seeking the benefits for the spouse. So at the time he passed he was 100% service-connected, with an open application for the SMC aid and attendance. And then, of course, at this point the family's not only seeking like burial benefits, like they'll do transfer of the body and some of the burial costs but, also the retroactive benefits and the aid and attendance.

Bethanie Spangenberg: 8:38

So there's a lot moving on for this particular case that I had mentioned case that I had mentioned.

J Basser: 8:50

She needs her crew benefits and she needs her own agent. She qualifies for it, she needs it.

Bethanie Spangenberg: 8:58

Yeah, she does, she does, and it was actually pretty striking because she not only with her stroke did she have the paralysis, but she suffered from some dementia. But she was very. You know, as people develop dementia they tend to fixate on the past and sometimes the past becomes more vivid.

Ad: 9:19

And when.

Bethanie Spangenberg: 9:20

I was talking with her. You know I am very adamant that I force the family to be uncomfortable while an individual with dementia is talking, because when a person who has dementia is talking they really struggle and I need to be able to appreciate their struggles.

Bethanie Spangenberg: 9:38

A lot of times the family will step in and try to help them.

Bethanie Spangenberg: 9:41

You know, complete their thoughts and I'm very adamant that no, I need to see this struggle.

Bethanie Spangenberg: 9:46

I need you to just let her you know, talk about what she wants, and that was the case with this. But she was very at that time she was very fixated on telling me about her husband changed, how he had changed after the war and how difficult it was when he had returned. And you don't always hear that story as a family until you're in a situation like we were in, where we're trying to get benefits and we're talking about her husband's disability, you don't get to hear about what life was like back then and the changes that the family had as a whole, what life was like back then and the changes that the family had as a whole. So for this particular individual it was very memorable to me because that was the first time the family had really heard about the struggles that they had when he had returned from war. So very impactful story and case story and case. All right, any other questions before I dive into the examiner section no, go ahead.

Bethanie Spangenberg: 10:59

Okay, all right. So question believe it or not? On section six, we're already on Question 18 of the DBQ section and they're asking what disabilities are considered permanent and totally disabling. Now, this is based on the clinician's judgment, not necessarily what the legal requirements are or what has been determined from the veteran because or determined by the VA. Or what has been determined from the veteran or determined by the VA because the examiner is not going to have that information in front of them. If the examiner determines that a condition is considered permanent and total disabling, they are to describe it and how that it is disabling and why it won't improve. That it is disabling and why it won't improve.

Bethanie Spangenberg: 11:45

The next section is actual your basic vitals, your age, your height, your weight, your blood pressure, pulse, respiration just the basic general information that you would get at a doctor's office. There is a section on here that the examiner is to describe the nutrition status. That is a question that can be asked directly of the veteran, like if the examiner is trying to document something about the nutrition. They can say well, how do you eat? What does your typical nutrition breakfast look like? Or your meals look like? Or do you eat a lot of fried foods? Do you eat a lot of whole-baked foods? Tell me about it and so you can kind of collect that information and document it there. Document it there. Or, if you know, you can take observations. If they're too thin for their body habitus or if they're obese, you can document that and just kind of paint the picture of what the veterans nutritional status is an important section on here which I find interesting because it's the smallest section that they have is they want you to describe the veteran's gait. The medical examiner is supposed to talk about how the individual walks and ambulates. The reason why I find it interesting is because typically if there is an individual that's in need of aid and attendance because they can't do the basic activities of daily living, most of the time their gait or their ability to walk is not the greatest. So they leave a little bit of space and I have a previous aid and attendance exam that I did and I'm going to kind of talk about it a little bit and just kind of reference it as we go through some of these.

Bethanie Spangenberg: 13:40

So for this particular veteran that I saw, he was service-connected for his lumbar spine and his cervical spine. He was in an accident. A motor vehicle accident while he was on active duty Ended up breaking his leg as well. So for him we're looking at cervical spine arthritis, impairment of femur, lumbar spine arthritis. He had lower extremity radiculopathy, upper extremity radiculopathy, diabetes, kidney disease, heart disease, bladder cancer and arthritis of the knees. So he's a hot mess. So for his gait analysis I put that he walks with a roller walker, has lower extremity weakness which requires handrail to transfer. So not only is the gait or their ambulation important, but how does the individual get up from the chair in order to start ambulating? So it really needs to be something that is observed by the clinician so they can describe how well they go from sitting to standing and moving forward.

Bethanie Spangenberg: 14:52

And then the next page under page three, the rest of this DBQ, can actually be completed if the veteran has appropriate information in their statement in supportive claim. The only reason I bring this up is, let's say that a veteran goes to have an aid and attendance exam done and they get the report and they see the report and they're like well, they didn't talk about X, y and Z. Well then you can now argue if it is in your statement and supportive claim that you also require these additional things that the examiner did not discuss. So the next things that I talk about just keep in mind that all of these questions can be documented by the veteran, by the veteran's spouse, by the family members and submitted in a statement of support of claim as evidence. So if you're trying to, or the representative is trying to, argue for the aid and attendance, they can reference not only the exam but the family's testimony.

Bethanie Spangenberg: 16:04

So the next question is question 26, and it asks about if the patient or the individual is confined to the bed and indicate the number of hours in bed. Now, I put an asterisk by this because some individuals don't sleep in a bed. If you have heart failure, if you have lung issues, if you have back or arthritis issues, not everybody sleeps in a bed. Some individuals sleep in a recliner. That is a common place for veterans to be sleeping because it allows them to essentially lay back but keep their their chest elevated, so breathing isn'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 really painful. The recliner kind of allows for the back to be somewhat immobile in a more comfortable position. So you still want to document how many hours that you're in the recliner, and it's specific to certain timeframes, so you can put that in the statement.

Bethanie Spangenberg: 17:23

The examiner is essentially asking the veteran well, how often of the day are you sitting in your chair or how often of the day are you in your bed? And they would just simply document that. Question 27, does the patient require assistance with any of the following activities of daily living Bathing, showering, eating, self-feeding, dressing, ambulating within the home or their living area, tending to hygiene needs such as brushing their teeth, combing their hair, transferring in or out of the bed or a chair, toileting or even medication management? Again, all those can be put in a statement. So the examiner is asking these questions what do you need help with?

Bethanie Spangenberg: 18:11

The next question is about being legally blind. There is regulations within the 38 CFR that discusses blindness as a qualifier for receiving aid and attendance. Honestly, I do more aid and attendance related to physical needs, rather like their arthritis or diabetes, rather than anything to do with their vision. So the next question is does the patient require nursing home care? And then the examiner just discusses how they would need nursing home care. Question 30 is in your judgment, does the patient have the mental capacity to manage their benefit payments or are they able to direct someone to do so? This is always a tricky one because the examiner again has to use their clinical skills to decide. All right, is there evidence of memory loss?

Bethanie Spangenberg: 19:08

clinical skills to decide all right. Is there evidence of memory loss? What kind of things are they doing throughout the day? As far as self-care, are they able to operate a microwave? Are they able? To basically do some of those higher thought process tasks where it's like multiple tasks at a time, and this can be somewhat tricky too, because if the clinician says no, then that opens up a can of worms at the VA 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.

Bethanie Spangenberg: 19:58

I want to kind of talk about that because that was a very interesting case and it was kind of scary on my part, part of why I felt there needs to be more security with compensation and pension.

Bethanie Spangenberg: 20:09

But this individual was entitled to a large lump sum and in one of my assessments this is 10 plus years ago now, but in one of my assessments they wanted me to say whether they are not.

Bethanie Spangenberg: 20:26

They had the capacity to manage their benefit payments and I had to decide if this individual, this veteran who has a history of cocaine abuse, who admitted to active cocaine use, would be able to receive a large lump sum and manage it appropriately. And that was a very difficult situation because at that time I did not feel that a veteran who was an active drug user, who admitted to be an active user in cocaine, receiving a large lump sum of money was concerning to me. Who admitted to be on active use in cocaine, receiving a large lump sum of money was concerning to me. And so I had to get other people involved. So that's how I know it can open up a can of worms, but they. I don't remember what happened with that situation, but what I did was appropriate, by getting other people involved, because it wasn't just me, no-transcript, and so it was just a very challenging scenario.

Ray Cobb: 21:59

So anyway, yeah, bethany, I got one locally here that I got involved with, or I was asked to get involved with, about a year and a to get involved with about a year and a half, two years ago now, gentleman.

Ray Cobb: 22:13

Matter of fact is my age, vietnam veteran, a wheelchair, as famous as I am, and had no family. Well, he somehow, in some way way, had met a lady. He was, I think he was 73 at the time, and he met a 39-year-old young lady who he moved in with her and put her on his checking account and the bank called me, knowing what I do with veterans around here locally. His situation was that she was going in there and, as they've put it, wearing extremely nice clothes, pulling out large sums of money each week and then at the end of the month they were always four or five checks overdrawn. And she indicated to me that his VA income was over $5,000 a month and they wanted to know if I could have it looked into.

Ray Cobb: 23:29

They wasn't married they wasn't related but that's an example of how you kind of got to be careful.

Bethanie Spangenberg: 23:46

Yeah, and unfortunately it happens too often and a lot of it's not seen because, you know, as veterans get older, most of the time their family is not always involved or they're loners or they're to themselves, and it actually happens a lot more than you anticipate. I talk a little bit about my time working in the nursing home and doing dementia care, but it opened my eyes to a lot and I was only in dementia care for a year, dedicated dementia care for a year inside the nursing home, and you see a lot because not only I was there to see regular patients this wasn't veteran patients but you see a lot of the elderly because of their conditions, how they get taken advantage of and, like I said, I was only there for a year but it's probably the most learning and impactful time because it took a lot of resources to handle those situations and so you know you get to appreciate that as you get older or as you develop disabilities, and I'm not surprised to hear that about your veteran. All right, I'm going to go ahead and jump into the next few questions. Question 31 is what is the posture and general appearance of the patient? This is something that we do for all of our patients and all of our care notes, because we're just trying to paint a generalized picture Whether they're clean, shaven, well-dressed, alert, attentive, their thought process. That's simplistic for the examiner to document once they've interacted with the patient.

Bethanie Spangenberg: 25:30

32 is describe the restrictions of the upper extremity, with particular reference to grip, fine motor movements and ability to feed themselves, to button clothing, shave and attend to the needs of nature. They do not give much room for this. I always add an additional page on these exams because you really can't capture a full picture with the little bit of space that they give you. And if I reference an example that I gave for the same veteran we were talking about with the arthritis I talked about, the veteran has limited forward flexion, internal and external rotation of the bilateral shoulders with decreased strength. He has decreased strength in the grip of both hands with an intention trimmer in the right hand. He has difficulties buttoning his clothing. He does not shave. He has trouble with his balance while brushing his teeth due to lower extremity weakness.

Bethanie Spangenberg: 26:25

So, that gives a picture of what those limitations are as it relates to the upper extremities. If we jump to question 33, they're now asking the same question about the lower extremities and with particular reference to the extent of limitation of motion, atrophy or muscle, how the muscles shrink due to non-use or disease and contractures or other interference of the lower extremities. And for my veteran I put he has weakness in both legs that limit movements. For range of motion testing Weakness is worse in the right leg versus the left. He's unable to flex his right foot.

Bethanie Spangenberg: 27:05

And then obviously before I had annotated about his gait and the limitations with his transfer, so that contributed to the lower extremity limitations.

Bethanie Spangenberg: 27:21

34 is describe restriction of the spine, trunk and neck. For my veteran I put there is very minimal to no movement in the cervical spine in all planes. Range of motion in the lumbar spine is unable to be tested due to lower extremity weakness. Now for this veteran I did not feel that he was able to really assess range of motion in the lumbar spine. Normally when I assess range of motion of the lumbar spine I'll have the veteran stand on both feet with nothing in front of them, bend over, touch their toes, lean back and arch their back, take their left hand to their left knee, bend to the side and then I do right hand to the right knee, bend to the side and then I will have them twist or rotate as if they're looking over their shoulder for a vehicle if they're driving this veteran. Because of the lower extremity weakness he was not safe or stable to be doing that type of range of motion. So I did not do it with him and just annotated why I felt he was not able to be tested.

Bethanie Spangenberg: 28:20

And that's important to document because again you're demonstrating that there's a safety concern for this individual.

Bethanie Spangenberg: 28:31

If we go to page four this is the last page it says describe all other pathology, including the loss of bowel or bladder control or the effects of advancing age, such as dizziness, loss of memory or poor balance, that affects patients' ability to perform self-care, or if hospitalized beyond the ward or 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 per day or week and under what circumstances is the patient able to leave the home or immediate premises? So for this particular veteran I put, let me see here For him I can't find it as readily as I want to, but he essentially that he oh, here it is, the veteran will leave the house one to two times weekly to go through a drive-thru for a drink. Oh, here it is, the veteran will leave the house one to two times weekly to go through a drive-thru for a drink. So he would get in the car and he wanted like a Coke or a Pepsi or something, and he would have his wife go through the drive-thru and he'd be with them and get a drink, and so he never did the grocery shopping. The wife did all of that stuff for him.

Bethanie Spangenberg: 29:45

Thirty-seven are aids, such as canes, braces, crutches or the assistance of another person required for walking or ambulation. And this is just asking you know what kind of assistive devices are used and with that assistive device how far are they able to ambulate? One block, five to six blocks, one mile I think that's a stretch. For this particular veteran. I put three feet because he was not secure enough on that roller walker to walk more than three feet. He would have to sit and then be pushed or be you know kind of slat his feet if he could to pull himself forward. So yeah, if somebody's, you know, really struggling and in need of aid and attendance, I'm not sure how many can walk a mile Anyway. So the last section for the examiner is the examiner's signature and the examiner's information. And while it's the shortest DBQ maybe hypertension is about the same, but it is the most timeensive considering the length of the form and the data that 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 blocks are shorter than others, you know. But that's the one block is the lowest 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 on somebody that could even walk a block with, even with their roller walker or their assistance.

Bethanie Spangenberg: 31:40

There's always something that's impacted, but I do have one other case that I'd like to talk about. This is as it relates to dementia, or he was diagnosed with neurocognitive disorder. So this particular individual that I did for aid and attendance is a little bit different than most. So most of the time your aid and attendance is physical need. This one is for mental or cognition. So this person had a type of cancer that was Agent Orange related. He underwent radiation and chemotherapy and sometimes with radiation and chemotherapy it can cause an early, onsetified neurocognitive disorder, chronic fatigue syndrome. He had reflux and tinnitus. So for him there's a couple notes that I documented for his aid and attendance.

Bethanie Spangenberg: 32:49

As far as nutrition goes, the veteran's weight and nutritional status demonstrated obesity. The veteran limps during ambulation, his gait is slowed and his stride is shortened, so he's just taken real small steps for stability. In regards to medication management, I felt that he required medication management. He was not able to do it on his own and I documented that the veteran is not aware of what medications he is currently taking. He knows that he is taking medications for his stomach, but not specifically what medical conditions. If his wife doesn't remember to tell him to take medications, the veteran commonly does not remember to take them. He has not taken his medications as of noon today when I did the exam when I described his lower extremities I talked about. He has arthritis in both knees. His right hip is limited in rotation. He has fallen in the past due to balance troubles.

Ad: 33:49

And.

Bethanie Spangenberg: 33:49

I really on my additional page is when I really dive into where his need is and in the comments section I wrote the wife reports that while they were in the Walmart parking lot the veteran was driving. The veteran forgot where he was and circled the parking lot. He had to be reminded by the wife where they were and the directions back to home. Approximately four months ago from the time of this exam, the veteran drove the vehicle into the grass median, missing the entry to the parking lot, and drove the car onto a facility sidewalk. He was assisted by from a bystander in order to lift the vehicle off the facility sidewalk and back onto level ground.

Bethanie Spangenberg: 34:31

The veteran would struggle without the assistance of his wife and children. The wife assists with memory troubles and the children assist with physical troubles. The wife fears that the veteran would forget to eat if she was no longer around. During examination the veteran was easily agitated and debated the reports from his wife. He denies much of what his wife reports. The veteran was observed following the wife into another room if she was gone for too long. The veteran would require residential institutional care, nursing home care or hospitalization if he did not have anyone to assist him. The veteran's memory and behavioral outburst is his greatest limitation for independence. His memory troubles limit his ability to recall need of medications and driving directions. So this particular veteran, you know, some families may not consider that dementia may be a qualifier 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 was asked of me, of course it's been a while. They asked if I was able to get on a riding lawnmower and mow my grass which you know, using a walker. I don't know how they would expect me to climb on a riding lawnmower and I walked in with a walker. I think at that time I had not gotten my first scooter, so I didn't know if that was still. Is that a normal question or was that one the examiner came up with?

Bethanie Spangenberg: 36:18

That's a normal question as it pertains to coronary artery disease. There's a specific METS question that asks about the riding lawnmower. So that is a standard question for coronary artery disease when they're trying to capture the METS Not necessarily for an attendance we'll put a label for this year on this gasoline.

J Basser: 36:41

Now all these activities may live in the phrase. Attendance record is ruled that it does not have to be a constant need for care because you know, some vets are going to have good days and bad days, depending on what the situation is.

J Basser: 36:57

you know the environment, their life and how your disability affects you. You know on days that you know some days your blood pressure is high and you're not going to get as busy on the days that it goes low, because if it goes low it drops really low and you have issues and so it's not every day. But you know, as far as walking, walking blocks and things like that, you know if you've got issues with your legs and maybe some type of vascular disease or neurological issues like foot drop and things like that, then walking a block is not very good at all.

J Basser: 37:36

You know, but again, it's not a constant need. Yeah, you know. And don't be confused with activities. You've got your standard 8 to 10, you've got your level of activities of daily living. Don't confuse those with activities of daily living when it comes to the caregiver program, because theirs are a lot more concise and different. As far as you know, it's basically the same but they look at it a whole lot different.

Bethanie Spangenberg: 38:01

Yes, they do. Yeah, they're very similar as far as, like, the questions that they ask and the needs of the veteran, but they're different as far as the criteria and the process, heals and all that stuff. But they're different as far as the criteria and the process, heals and all that stuff. Now I will tell you that for my dementia veteran, he was denied on both his aid and attendance, his initial application for aid and attendance, and he was also denied on his initial application, or the wife's initial application, for the caregiver program, and so they had 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 reason for the denial. I guess you know the VA's got their own reasons for doing stuff and usually it takes a higher level of you or a supplemental or usually a BVA decision. Sometimes it takes the best of the court to fix it. You know.

Ad: 39:01

Yeah.

J Basser: 39:02

It's crazy. It is, but you know, for example, transferring. Transferring means, say, for example, if you want to transfer from the bed to the floor, to a wheelchair or to a walker or whatever you'd help doing that. You know, getting out of bed and things like that. You should have that in attendance. And he's got one of the alarm desk comm alarm.

J Basser: 39:33

But if he's using a device like a feed pap or something that makes noise or whatever and the vet doesn't hear the alarm go off, well you got that thing shared with your wife or your partner excuse me, I don't, you know and they hear it and they get up and they help you. They either get your, you know get your stuff to bring your sugar up a little bit. You know your glucose up and you know you're up for a while until it levels off and you can go back to sleep. But you know that keeps you out of the hospital. And so that's another issue too, because that will also I think that will also be part that should get somebody aid-dependent for having to do stuff like that. Or if you fall a lot, if you walk and you do things like that and get around. I mean there's different things like ambulation.

J Basser: 40:21

Basically, transfers have got a lot to do because even getting in the shower, you know to a transfer, like from a wheelchair to a shower chair or something like that, or you have to hold on. You know, in a shower, you know if you bend over to do something, wash your legs or your feet. You know in a shower and you know, if you bend over to do something, wash your legs or feet. You know you could crash and I know it. I've done it more than one occasion.

Bethanie Spangenberg: 40:45

Yeah, I would agree. If you have the hypoglycemic episodes and you require the assistance of another, that is absolutely criteria. The assistance of another, that is absolutely criteria. And in fact, even on the diabetes DBQ it asks about low blood sugars. And so if you've ever had the DBQ done when it comes to the diabetes and on there it talks about, you know, low blood sugar requiring assistance of another, and it says yes, then you could use that as evidence to argue 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 aid and attendance, you know people are filing claims for aid and attendance. I hate to say this, but aid and attendance 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. This form came out for people to put in so they could file a claim for it, so they'll be able to turn it in. It's still an ancillary benefit. If you need it, they should have awarded it in the first place. If you need it, they should have awarded it in the first 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 where you're at too, you know. I mean, I know some folks that have a lot easier time getting their stuff done than some folks I know. Location, location, location, I guess 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 and things like that. Did you put check marks in the boxes or what did you do?

Bethanie Spangenberg: 42:40

You're supposed to circle it and then describe which. Again, they don't leave much room to it. But now what's interesting is they've actually done a fair job I still think there's room for improvement actually done a fair job. I still think there's room for improvement. But they recently when I say recently, February of 2023, they updated the aid and attendance form and it's more specific as far as particular activities. Before that, they would leave a blank space and you would just have to talk about ADLs for the veteran. But this time you actually circle what they require assistance with, and it's specifically bathing and showering, eating or self-feeding, dressing, ambulating within the home or the living area, tending to hygiene needs, transferring in or out of the bed or chair, toileting, medication, management. And then it does talk about additional activities. Now the ones that are referenced here are actually considered IADLs, which are Independent Activity or Instrumental Activities of Daily Living.

Bethanie Spangenberg: 43:51

And that is, the more complex things, such as shopping and meal preparation, house cleaning and home maintenance, transportation, things like that, and so there is a space for them to talk about those instrumental activities of daily 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 living spouse or a live-in, maybe a child lives with them and they're doing a lot of the meal preparation or assisting with like buttons and medication management, they don't necessarily recognize their need until that individual is gone. And so, you know, having this discussion, you know, makes veterans start to really reflect on you know, the role that others play in their activities of daily living and their day-to-day lives.

Bethanie Spangenberg: 45:04

A lot of veterans don't really recognize the significance of their significant other significant other.

J Basser: 45:13

You take sensory neuropathy, diabetic neuropathy and motor skills in your hands and your fingers and you deal with medications. You know you can probably get the bottles down after you drop them to as many times as you pick them up. But when you start putting pills, you know you start mixing and putting pills on little bitty containers. That becomes an issue because usually you wind up with pills all over the floor.

J Basser: 45:43

And that's when you step in and help somebody do that. As far as help, that's one in itself, all by itself. I'm sure Ray's been through that, 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 that when I do at the time before Pam started giving me injections sometimes giving the injection right as or right before or whatever giving the injection right as or right before or whatever you kick the needle at the wrong angle and it actually bends the needle. And I had several times that I bent the needle strictly because of not being able to properly hold or control your hands or fingers.

Ray Cobb: 46:37

Really, in that particular case, one time I actually bent the needle and it was as tall as the skin, because when I pulled it back the needle actually had broken and, you know, fell, and if I had gotten it in there and then done it, then I would have broken the needle off inside me. And now you've got a whole other 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 for you 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, even diabetic pumps and things like that you know, even your, even your deck concepts. You know, if you've got bad shoulders and bad arms and you have to wear it on the back of your arm, you have to. You know you can't reach them to both your arms. You got to have to put it on absolutely Absolutely. Absolutely. That's where the caregiver act comes 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 to be done in an adjudication way. I think the regional office on the handle it decides to be a they can do a form or whatever and help out, but I don't think they have any business adjudicating 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 the special case.

Bethanie Spangenberg: 48:39

You know, one thing that kind of triggered in my memory is some social workers will try to fill this out, Some social workers will try to fill this out and while it is evidence, the VA may send you for a reexamination by an MD, DO, PA or nurse practitioner. I think a lot of times the social worker does a better job. As far as capturing the veterans' need and painting the picture, but they will not accept 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 the social worker was in a form with Pam and I and then she says now I'm going to go over this and have the doctor sign it. And that's exactly what happened. We never met with the doctor when we turned the form in and she went over it and the doctor signed it. She went over it and the doctor signed it. Then, after the next day or whatever, she called me and informed me that she had gone over 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's what they're doing. I think, honestly, that's the best use of your team and your clinical skills. I think the social worker that's essentially what they're there for is to identify the veteran's needs and put those resources out for the veteran. So I'm glad to hear that they did that.

Bethanie Spangenberg: 50:35

So the other thing that goes along with aid and attendance, that it's not necessarily a compensation or pension benefit, but it is a benefit through the VA system is if a veteran needs accommodations, whether it's for their home or for like the shower, for grab bars, for like a handrail, the clinician can order an occupational therapy consult inside the home and the therapist will come out and identify what needs that the veteran has in order to assure safety during activities of daily living like showering or bathing.

Bethanie Spangenberg: 51:23

So they may provide a shower chair to the veteran, they may provide the handrails around the shower. And that's not again, that's not a benefit through compensation of pension, but that's something that you can go into the clinic and you can ask your clinician for. So let's just say you haven't qualified for in attendance yet or you haven't received a grant for that condition. You can still go into your primary care provider and discuss the needs that you have within your home and ask specifically for someone to come out and assess the home for things that you may need to assess with your activities of daily living.

Ray Cobb: 52:05

You mentioned grant. They actually came into my home and that's when they recommended the HESA grant and redid 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 in the mornings, Things of that nature.

Bethanie Spangenberg: 52:31

There's a lot of different applications for those for, like you or veterans that need. They'll do the home adaptation and then they'll do the vehicle adaptations and I know you guys have talked about the vehicle. I guess you guys have a guru on those vehicle adaptations. I heard that podcast.

J Basser: 52:52

Oh yeah, he's a pretty good guest, Of course. I think Ray dug another woodwork.

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 gotten me a couple of scooters, two lifts, and now I have a vehicle that is wheelchair accessible, that the ramp comes out and I just roll up into the van and they fix me a nice seat that comes back and I can transfer right straight from the wheelchair into the seat and then pull forward like a normal passenger. But yeah, he's good at what he does.

J Basser: 53:42

You know I'll tell you something else on aid attendance. You know it's not like a regular claim. I mean they can actually go back to the date to condition rules on that and Bethany was talking about, like the HISA grant. They put in certain things for you and you know evidence. That's half of the time they're using reason and the basis to put that in. But they'll have a diagnosis of what's going on and get that in there. That could actually affect your effectiveness in your age attendance. I've seen you go back on one guy. I forget how far they went back. He worked on one for like 10 years.

Ray Cobb: 54:20

Oh, wow.

Bethanie Spangenberg: 54:24

That's actually what I'm anticipating for the Purple Heart recipient that I was talking about earlier. Unfortunately, I can see the potential, but I don't think the family sees the potential. From my understanding, they have not made any further movement since the last time I talked to them on any type of disability reimbursement claims. And I've tried to stress but I think that's a large burden too is the family doesn't really understand and you try to emphasize it, but without their help you can't receive the benefit.

J Basser: 55:02

Yeah, you all realize too. Now, if this benefit's available to this veteran and this veteran without the necessity of the care that he is receiving, that he would be in a nursing home. That would be an R2, wouldn't it right?

Ray Cobb: 55:19

Yeah, that's. One of the main criteria is that you can exist in your home without any assistance. But if you have to have any assistance in that and you would have to be as they refer to it or the way they refer to mine, would have to be institutionalized, which means a nursing home or a hospital then that 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 a VA, it's their responsibility because of the adjudication they don't take, but the VA is their responsibility to maximize the benefit 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. Of course it's a non-adversarial system too, but that's kind of strange.

J Basser: 56:35

You know, I know the CMP examiners that work for the VA in town. They're trained, you know, and they're told, basically, you know some of these veterans are maybe in bad mood and things like that. You know to give them respect and be kind and things like that. You know, I know I'm seeing a lot of examiners in my day, that are like hey man, I'm younger than you.

J Basser: 56:53

What are you doing this for? You know that has nothing to do with it, right? Yeah, Because we can't take out the human factor. Folks, Humans are going to be human. If we don't want this, we could have stayed home and went back to college and done something else, right, Ray could have played football and played in the 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 to go to her doctor today concerning her heart and he told her how come she gets these anxiety attacks. And of course I'm saying she's worried about me and she, you know she doesn't agree with that and I said, well, maybe not, because when the band was playing she would get up and run around and would fly down the hall and stuff and they actually named her Fireball because they thought the house was on fire. Fireball because they thought the house was on fire. So that stuck with her. And still every once in a while when I'm teasing her I'll say slow down, fireball.

Ray Cobb: 58:22

It is a lot of work on our spouses to take care of us and I know sometimes I stop and think and don't appreciate or at least tell her that I appreciate what she does. She needs to do more of that. All you veterans out there listening, you think about that. You think about little things, not necessarily you couldn't eventually do, but it makes it a whole lot easier because she helps you do it every single day.

J Basser: 59:05

Bethany, I want you to give everybody your contact information in case folks need an 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 at 888-448-1011.

J Basser: 59:23

There you go, and guess what guys? She kept the show. She kept her voice during the show. She's been a little bit under the 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 show folks. Oh, by the way, one quick note VAgov and the VA search engine has now got the 2025, the summer 2024 pay rates in the system for compensation custom of the compensation. So look at it and see what kind of cookie you got, because they paid us some cookies this year and not money.

J Basser: 1:00:03

I think I got an Oreo or chocolate chip or something like that. Other than that, guys, I'm going to shut her down. Thanks for coming on, bethany Ray. Thanks for being there for me, buddy. We appreciate you.

Ray Cobb: 1:00:15

Thank you. Thank you, thanks for having me.

J Basser: 1:00:17

All right, this is John, on behalf of the Exposed Vet Radio Show. Thanks for listening. You have been listening to the Exposed Vet Podcast. Any opinions expressed on the show are the opinions of the guest speakers and not necessarily the opinions of Exposed Vet, exposedvetcom or BlogTalkRadio Tune in next week for another episode of the Exposed Vet Podcast. Thanks for listening.

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