My answer to a SMC rated R-1 veteran who was denied PCAFC caregiver benefits. The question was, what do I do now? My answer:
I already know that there was no proper “Statement Of The Case” included in the written decision from the Vetrans Health Administration, (VHA) informing you of the reasons and basis of the decision and a viable reason that you did not qualify. The VHA, unlike the DVA, is not required to give you a Statement Of The Case.
I am a R-2 rated veteran and was denied level 2 PCAFC caregiver benefits through six appeals. You have options on your appeals process that were not available to me at the time. You can climb up the appeal steps, one at a time in any order that you choose, Or you can skip some, or all, and go straight to the top. Your choice. Your options are as follows.
#1 appeal the VHA decision through the VAMC Patient Advocate. You get two appeals that will be adjudicated before the same VHA people who just denied you and you can expect to be denied on both of those appeals.
#2 you can file a VA form 20-0996 for a Higher Level Revue (HLR) appeal. In submitting a HLR, you cannot submit additional evidence and once again, the decision is up to the VHA, the same people who have already tossed you under the bus.
#3 You can file a VA form 20-0995, Decision Revue Request, Supplimental Claim. You can submit additional evidence but once again, the same VHA people who have been denying you get to shoot you down again.
#4 file a VA form 10182 Decision Revue Request and ask the BVA to revue your claim. If you are in fact an R-1 rated veteran it will be a slam dunk at the Board. Filing the VA form 10182 will remove your case from the eyes of the VHA and place it in the more capable hands of the Veterans Benefits Administration (VBA). There you will find justice according to the regulations that govern the PCAFC caregiver program.
I would suggest that you avoid all of the VHA denials and go straight to the Board by filing a 10182. At the same time ask the Board to advance your case on the docket based upon the reason that you are an R-1 rated veteran.
When my dog was first in the fight, I did not have the right to take a PCAFC case to the BVA. After my final VHA appeal, and thanks to the Beaudette V. Mc Donough CAVC court case, ( FYI)-VA Has Begun Mailing Court-Ordered Notice to Hundreds of Thousands of Veterans and Caregivers as a Result of Beaudette v. McDonough Class Action) I gained the right to appeal my case to the BVA. On June 22, 2021, I won the very first ever PCAFC caregivers case to ever be heard and granted for level 2 caregiver benefits at the BVA. (BVA docket No. A22011682.)
James M. Cripps
US ARMY 1967-1970
VA THE REDNECK WAY, YOU DON'T HAVE TO GO IT ALONE! 
James, I appreciate all that you write and help all of us with. I couldn’t agree with you more about your advice here. I have been experiencing the exact same things with the West Los Angeles VA. It’s been 3 years, 3 VHA denials, one BVA Appeal that got remanded because they evaluated me under the wrong guidelines, then it took them a year and 2 months to send the same exact denial they gave the first times completely disregarding the evidence they should have used and what the remand Instructions were. its crazy because I can tell for one reason or another they don’t like me and they are manipulating my answers and honestly lying on my denials about what was said or what the situation is in order to deny me.
I just appealed to the BVA once more and this time went gangbusters on evidence showing the answers I gave in my interviews and the answers they said I gave in my denial showing the discrepancies, as well as letting them know I’ve already been admitted twice to the program at the top tier when I was only 70-80% (I was removed the first time because I moved to Portland and randomly got called in for evaluating and knew how they greeted me it was over. Then a year later moved to Redding CA and the VA there asked why I wasn’t in it, admitted me again, and then I got divorced and it was taken again. I’ve now been 100% Service Connected P&T since 2016, US Army 11B Combat Veteran, CIB)
I’m really worried they are going to just remand it again because the VHA didn’t follow instructions which means I’ll lose another year until the remand, then another year and 2 months to be denied again to go back to another BVA Appeal so they can finally approve it. I want to beat my head against a wall.
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If your BVA remand fails to produce favorable results, you might consider taking it up to the CAVC. I don’t know how capable you are of going pro-se. You might consider hiring a law firm or a independent agent. They can represent you with a private contract between yourself and the firm. CCK, out of Rhode Island would be my first choice, as they are the top law firm in the Country.
As far as an Independent Agent, Alex Grham would be tops, but probabaly too busy to take it. He can reccomend another agent if he can’t take it himself.
Thanks for the reply, good luck, and keep me posted if you will!
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Thanks so much for the response! I couldn’t agree more with you and have already decided I’m taking your advice and if this round at the BVA doesn’t work for whatever reason, Im lawyering up and going the CAVC route.
To be honest, I really felt the BVA was on my side with it all and it was the VHA messing with me. They knew damn well what they were doing and it makes no sense to me. Because the VHA never issued a proper statement of the case with favorable and non favorable findings as they should have with my original denial, the BVA Law Judge had their hands tied on making my decision. Really hoping and praying this time around with their being an actual proper Statement of the case due to the remand requirements the new BVA Law Judge will have the ability to just rubber stamp it but we’ll see. 🤞 I was advanced on the docket again so hopefully I’ll know sooner than later.
Thanks again for what you do. You may not know it but a lot of us vets know who you are and find answers/comfort in your posts that are relevant and get us through another day. Youre very appreciated. I’ll keep you posted!
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I just remembered I did have one last question you may or may not have the answer to. In my remand just at the end of the the BVA Judge requiring they reevaluate me under the correct guidelines of safety and protection she stated “Veterans Claims Folder Must Be Reviewed”. Do you know why she would say that or what she was getting at?
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The BVA is required to look at and consider your need for protection, supervision and safety. That Judge is also repremanding the VHA because they did not consider those points. The BVA would ask that the VHA revue your claims folder to check for related issues, especially if you have a mental health history.
You should get a proper statement of the case from the VHA as a result of the BVA remand, as that too should have been ordered by the Judge, along with an expedited status.
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Well buddy, we are now in the end of Sept 2024 and My claim has been sitting with a judge for a decision for two months now. That being said, I’ll have my new decision any day now and I’ll keep you in the loop on what happens. Hoping for the best bro. 🤞🏼
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hang in there and expect a remand back to the VHA and never give up!
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