A VA adjudicator called the facility and asked if the facility provided “medical care” to the vet, and the facility said “No”.
A veteran was denied the full amount of his Aid and Attendance because he lived in the “independent living” wing of an assisted living facility. The VA approved his A&A for his pharmaceutical cost but did not approve of the rent paid to the independent living, because the VA adjudicator called the facility and asked if the facility provided “medical care” to the vet, and the facility said “No”.
You must, if you are a veteran or a family member acting as agent, filing for aid and attendance, inform the facility that ABSOLUTELY NOBODY from the facility has permission to speak to the VA. If a VA rep calls, he/she should be referred back to the agent of record.
Basically, they’re two categories of services, both of which can result in an award for A & A. One, medical skilled care, e.g. wound care, respirator care, trach care, therapy, etc. The other, nursing services, which an assisted living usually provides; e.g. help with medications, ADL's, protective environment, etc. If the independent wing of an assisted living facility is providing a "protective environment" and the doctor's 21-2680 states the need for this "protective environment" is provided by such a facility, then the claimant should be rated A & A and all associated fees should be allowed.
Consequently, if you state your claim correctly, have all your necessary documentation, and don’t allow any parties to talk to the VA adjudicator, you may not have been denied.
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