Question:

I'm working with a veteran that is TDIU PT on an extra schedular basis. Has been for years. His combined rating is 50%. He applied for the PCAFC and was promptly denied due to his rating not being 70% or more. Is there a work around for this? Normally, those veterans receiving TDIU would, by default, qualify to apply for the program due to the eligibility criteria for TDIU. I have scoured the regs and VHA directives and have gotten zilch. Speaking to the Caregiver Support line and the VAMC caregiver people is like talking to a wall because they don't have the same critical thinking skills that VSOs have when it comes to the appeals process. To them it's black and white and I think it's partially because they don't understand TDIU or what P&T actually means. As for meeting the ADLs, he definitely meets them but just cannot get past the initial eligibility criteria for the PCAFC. Is he dead in the water?

Jim's Reply:

'Dead in the water'? Hardly. 
 

When you tell me, "I'm working with a veteran", it would help if I knew in what capacity you are representing the veteran? Are you an attorney or VSO? How is it that you're representing this vet?
 

You've turned up an entirely new problem, at least in my experience. You're correct that your contacts don't understand the TDIU rating, much less an extraschedular TDIU rating and they are always committed to the black and white of the regulation that they see. They generally feel that they have no authority to get around what they're reading and they're correct, if they were to approve what you're asking without permission from far above their pay grade, they know they'd be in trouble.

Searching The Federal Register and looking over the history of this convoluted PCAFC process tells me that the exclusion of the extraschedular rated veteran is an oversight, not all that surprising since few people understand TDIU ratings and even fewer understand the extraschedular process.
 

So, how do we escalate this to a proper authority? We have choices and the choice I suggest is to follow the approved process and appeal to the BVA by sending a completed VA Form 10182 to:

Board of Veterans’ Appeals
P.O. Box 27063
Washington, DC 20038
 

If you're comfortable writing an appeal to the Board of Veterans Appeals I'd suggest you go for it, the sooner the better. You can research PCAFC decisions by the BVA by using the BVA search tool. 
 

Good luck!