00:00:00
Did you know you can obtain a temporary
00:00:03
100% evaluation under paragraph 29 and
00:00:08
paragraph 30? In today's video, I am
00:00:11
going to be explaining both and giving
00:00:15
examples. Make sure you stick
00:00:25
around. Before we get into today's
00:00:27
video, make sure you hit that like,
00:00:29
subscribe, and notification button. So,
00:00:32
paragraph 29 and paragraph 30 temporary
00:00:36
100%. So, if you're not, let's say
00:00:39
overall 100%, let's say you're at 90%.
00:00:43
And you'reos hospitalized or you have a
00:00:46
surgery for a service connected
00:00:48
condition, you can get a temporary 100%.
00:00:52
So, I'm going to share a few slides with
00:00:54
you and walk you
00:00:56
through how you get it. Slide number
00:00:59
one. Here in slide number one, I'm
00:01:02
taking you to the M21-1. Okay? But I
00:01:05
want to remind everybody as I go through
00:01:07
these slides, I did not copy the entire
00:01:11
M21-1. Some of these were really long,
00:01:13
but I made sure I copied some of the
00:01:16
most important parts. Okay. So, this
00:01:19
M21-1 covers hospitalization under 38
00:01:23
CFR
00:01:25
4.29, also known as paragraph 29. And it
00:01:29
states periods of hospitalization at a
00:01:32
Department of Veterans Affairs, VA, or
00:01:36
an approved hospital or hospital
00:01:40
hospital observation at a at VA expense
00:01:44
in excess of 21 days for medical
00:01:47
treatment of a service connected
00:01:49
disability. There it is, folks. has to
00:01:52
be service connected or a disability
00:01:55
required hospitalization in access of 21
00:01:59
days for medical treatment for which
00:02:03
compensation is payable which
00:02:06
compensation is payable under either
00:02:08
1151 or 1160. So
00:02:12
1151 that is for benefits for persons
00:02:15
disabled by treatment or vocational
00:02:19
rehabilitation. Now, I've seen veterans
00:02:22
going to a VA hospital and they screw it
00:02:26
up.
00:02:27
Okay? I've seen some really horrible
00:02:31
cases. Okay? So, that's what they're
00:02:33
talking about under 1151.
00:02:36
1160 special consideration for certain
00:02:39
cases of loss of paired organs or
00:02:43
extremities. Now, when it comes to these
00:02:45
two,
00:02:47
1151 or
00:02:49
1160, this is where the veteran is going
00:02:52
to have to invest the time and go out
00:02:55
and do that research to see if they
00:03:01
qualify. Okay. In the notes section,
00:03:04
competency must be addressed when
00:03:06
assigning a temporary 100% evaluation
00:03:09
for a mental disorder under 38 CFR 4.29.
00:03:13
So, what does that mean? If you look at
00:03:15
I want to say it's the last page on a
00:03:18
mental health DBQ and ask the question,
00:03:21
can the veteran manage their financial
00:03:24
affairs? If it's
00:03:26
yes, it's good to go. Okay? So, they're
00:03:29
not going to propose incompetency. If
00:03:31
it's no, then they have to do a what is
00:03:34
called uh
00:03:36
proposal of incompetency. All
00:03:39
right? A lot of vets get confused.
00:03:42
they're married and they'll say, "Oh,
00:03:44
well, my wife does all the
00:03:45
bills." But if you aren't married, can
00:03:49
you manage those bills? Yes. So, you
00:03:53
don't want to tell them no just because
00:03:55
your wife manages the bills. If you can
00:03:59
do it, you want to make sure you check
00:04:02
that yes box. Okay. Second bullet
00:04:05
comment,
00:04:07
hospitalization in a uniform services
00:04:10
facility, also known as a military
00:04:14
treatment facility, is considered an
00:04:16
approved hospitalization for the purpose
00:04:19
of determining entitlement to a
00:04:21
temporary evaluation under 4.29. So, if
00:04:24
you know you're going to beos hospital
00:04:26
um hospitalized more than 21 days, you
00:04:30
need to come here. Invest the time. Look
00:04:33
at M21-1 to 38 CFR for
00:04:36
4.29. Let's keep going. Slide number
00:04:39
two. Here's slide number two. When
00:04:42
provisions of 38 CFR 4.29 do not
00:04:47
apply, treated as a resident in a state
00:04:50
veteran's home. Okay.
00:04:53
currently receiving a total rating for
00:04:56
the disability for which hospitalization
00:04:58
was required. Okay. A resident in a VA
00:05:02
do program or a participant in a livein
00:05:08
workout program being utilized to
00:05:11
facilitate transition to community
00:05:14
living. Again, this is different for
00:05:17
each veteran. You have to come here and
00:05:20
see, okay, do either one of these bullet
00:05:24
comments prevent me from obtaining 4.29.
00:05:29
If you got to sit there and guess and be
00:05:31
like, "Oh, maybe." You might want to ask
00:05:33
somebody. A lot of people ask me, and
00:05:35
I'm like, I have to look at all that
00:05:37
evidence, all that medical evidence, you
00:05:40
know, is it at a state home? Is it at a,
00:05:43
you know, VA facility? All that is what
00:05:47
raiders are looking at to make that
00:05:50
determination. Let's keep going. Slide
00:05:52
number three. Here's slide number three.
00:05:55
38 CFR 4.29 rating for service connected
00:05:58
disabilities requiring hospital
00:06:00
treatment or observation. This is the 38
00:06:02
CFR. A total disability rating 100% will
00:06:06
be assigned without regard to other
00:06:08
provisions of the rating schedule when
00:06:11
it is established that a service
00:06:14
connected disability. There it is.
00:06:16
Service connected disability has
00:06:18
required hospital treatment in a
00:06:21
department of veterans affairs or an
00:06:24
approved hospital. So, if it's not a VA
00:06:28
medical center, but a regular medical
00:06:31
center, but the VA approved it, that's
00:06:33
what they're telling you, you still
00:06:35
qualify for a period in excess of 21
00:06:39
days or hospital observation at a
00:06:42
Department of VA expense for service
00:06:46
connected disability. It has to be
00:06:49
service connected for a period in excess
00:06:51
of 21 days. If you feel you qualify, you
00:06:55
need to be investing the time. Go out to
00:06:57
the VA's website, the M21-1 and 38 CFR.
00:07:01
Do that search for 38 CFR 4.29 to see if
00:07:06
you qualify. Okay. Now, would you want
00:07:10
to the type of evidence that you want to
00:07:12
get the date that you went into that
00:07:16
hospital and the date that you left? And
00:07:19
you need to start counting. Is it over
00:07:22
21 days? Is the condition service
00:07:25
connected? If it's yes and yes, do you
00:07:28
meet these other parameters? Submit the
00:07:30
claim. Let's keep going. Slide number
00:07:32
four. Here in slide number four, we're
00:07:35
switching over to paragraph 30. Okay.
00:07:39
So, if you
00:07:41
meet, see these three bullet comments,
00:07:43
if you meet one, it doesn't have to be
00:07:46
all of them, one, you can be service
00:07:50
connected. Now, let's look
00:07:52
at bullet comment number three.
00:07:55
Immobilization of at least one major
00:07:57
joint. I rated a case one time where a
00:08:01
veteran had surgery on an ankle and they
00:08:05
were in one of those boots, walking
00:08:07
boots, right? And then the examiner or
00:08:11
the surgeon said, "Okay, you can remove
00:08:14
the boot." But then they had um it was
00:08:17
like a shoe, but it was it was weird. It
00:08:20
was blue and it had like a white sole
00:08:21
and it was flat and they were in that.
00:08:24
And so I was like, "Okay, I know I can
00:08:27
grant the temporary 100% for the time
00:08:29
they were in the boot, but what about
00:08:32
that shoot?" So I had to reach out to
00:08:34
the QRT team and I showed them the
00:08:37
medical evidence that the veteran
00:08:39
submitted and they said,
00:08:41
"Yes, that covers it as well." All
00:08:45
right. So in this case, you might want
00:08:48
to reach out to someone and ask them,
00:08:52
someone that knows and ask them, does
00:08:55
this particular uh device qualify? If no
00:09:00
one knows or you can't find anybody, go
00:09:02
ahead and submit the claim and let them
00:09:05
tell you yes or no. And if you disagree
00:09:08
in the notification letter, they will
00:09:10
explain your options
00:09:13
as what you can do as it pertains to an
00:09:16
appeal. All right, let's keep going.
00:09:19
Slide number five. When the provisions
00:09:21
of 38 CFR are not applicable, the first
00:09:25
bullet comment, a temporary total rating
00:09:28
under 38 CFR 4.29 is in effect at the
00:09:33
time of hospital discharge. Now, what
00:09:36
does that mean? Let's say you're in the
00:09:41
hospital for a separate service
00:09:43
connected condition and you've been in
00:09:45
there for two months and examiner say,
00:09:47
"You know what? While you're here, we're
00:09:49
going to go ahead and give you your knee
00:09:52
replacement and while you're in there,
00:09:54
you have that knee replacement."
00:09:57
Okay? So, what they mean is they're
00:10:00
going to give you that temporary 100%
00:10:03
for paragraph 29. But you're not going
00:10:05
to get that temporary 100% for paragraph
00:10:10
30. They can't stack it. That will be
00:10:14
pyramiding.
00:10:16
Okay? It's simple, people. Raiders are
00:10:20
looking for the date you went in for
00:10:23
that uh hospitalization, the date that
00:10:26
you left. Now, here's another example.
00:10:29
Let's just say you leave the
00:10:32
hospitalization after 48 days. Okay?
00:10:36
Then a couple days
00:10:37
later, you have a major joint
00:10:41
replacement. That temporary 100% is
00:10:45
going to flow together. There won't be
00:10:48
any break dependent on when you went in
00:10:52
um for that particular surgery. Okay?
00:10:55
So, let's just say you exit the hospital
00:10:58
March
00:10:59
29th and on April 1st you have that
00:11:03
major joint replacement. Let's just say
00:11:05
it was a knee replacement. Okay, that
00:11:08
100% that temporary 100% is just going
00:11:11
to flow through is there won't be any
00:11:13
break there. Okay, let's keep going.
00:11:16
Slide number six. Here in slide number
00:11:20
six, this is the 38 CFR for paragraph
00:11:25
30. A total disability rating 100%. Will
00:11:28
be assigned without regard to other
00:11:31
provisions of the rating schedule when
00:11:34
it is established by report. Okay,
00:11:37
that's what they're looking for. those
00:11:38
reports at hospital
00:11:41
discharge, regular discharge or release
00:11:43
to a nonbed care or outpatient release
00:11:49
that entitlement is warranted under
00:11:51
paragraph subpar a one and two or three
00:11:55
of this section. Now if you look down
00:11:57
below I have those highlighted surgery
00:12:02
ne uh necessitating at least one month
00:12:06
of convolescence.
00:12:07
Okay. Surgery with severe post-operative
00:12:11
residuals such as incompletely heal
00:12:14
surgical wounds, stumps of recent
00:12:18
amputation, immobilization by cast
00:12:20
without surgery or one major joint or
00:12:23
more. I gave you an example that key
00:12:26
thing here to keep in mind service
00:12:31
connected. It has to be service
00:12:33
connected. Okay, I think that was pretty
00:12:37
simple, but I know a lot of veterans are
00:12:39
going to be confused. First thing you
00:12:41
need to think about service
00:12:44
connected is the treatment more than 21
00:12:49
days. It is at a VA medical center or an
00:12:53
approved location. Paragraph 30 service
00:12:57
connection.
00:13:00
Now, this is where it gets dicey
00:13:02
because, for example, a knee
00:13:04
replacement. Years
00:13:06
ago, you were going to get 12 months
00:13:09
temporary right off the bat. That was
00:13:11
it. Now, that's no longer the case. So,
00:13:15
veterans have to be a little bit
00:13:17
crafty. You need to ask that examiner,
00:13:20
hey, how long am I going to be off work?
00:13:24
Do I need any physical therapy?
00:13:27
and what do you think I am going to need
00:13:30
as it pertains to going back to work but
00:13:34
having restrictions and if the examiner
00:13:36
says four months okay so you're going
00:13:39
through those four months you have a
00:13:41
hiccup right whether you have to stay in
00:13:46
physical therapy additional 30 days and
00:13:48
not to not have to report to work or you
00:13:51
report the work and you're on
00:13:55
restriction longer than what you
00:13:57
anticipated. So let's just say the
00:13:59
doctor says four months. You need to
00:14:01
gather all that have that doctor to
00:14:04
write that letter for four months but on
00:14:06
that third month it needs to be
00:14:08
extended. So you go back to that
00:14:11
examiner and say hey you said four
00:14:14
months I need you to write another
00:14:15
letter basically stating that the
00:14:18
convolescence need to be extended two
00:14:21
months because of X Y and Z and have
00:14:24
that proof and when you submit it the VA
00:14:26
should say okay instead of giving you
00:14:28
four months now we're going to give you
00:14:32
six months that's the nugget when I rate
00:14:35
it that's what I was looking for those
00:14:37
dates that information from the examiner
00:14:40
and a lot of veterans did not get that
00:14:43
correct information from that examiner.
00:14:46
Therefore, they were lowballed on that
00:14:49
temporary 100% as it pertains to
00:14:52
paragraph 30. With that being said, make
00:14:54
sure you like, subscribe, hit that
00:14:56
notification button, and as always,
00:14:59
share this video with your fellow
00:15:00
veterans. Thank you.
