SPECIAL COMPENSATION FOR ASSISTANCE WITH ACTIVITIES OF DAILY LIVING

R 131541Z JAN 25
MARADMIN 006/25
MSGID/GENADMIN/CMC WASHINGTON DC MRA MP//
SUBJ/SPECIAL COMPENSATION FOR ASSISTANCE WITH ACTIVITIES OF DAILY
LIVING//
REF/A/MSGID:DOC/PL 111-84/28OCT09//
REF/B/MSGID:DOC/PL 111-163/05MAY10//
REF/C/MSGID:DOC/PL 111-383/07JAN11//
REF/D/MSGID:DOC/USC/01FEB10//
REF/E/MSGID:DOC/DOD/23JUN08//
REF/F/MSGID:DOC/DOD/31OCT19//
REF/G/MSGID: DODFMR//MAR24
NARR/REF A IS THE NATIONAL DEFENSE AUTHORIZATION ACT FOR FY 2010.
REF B IS THE CAREGIVERS
AND VETERANS OMNIBUS HEALTH SERVICES ACT OF 2010. REF C IS THE
NATIONAL DEFENSE AUTHORIZATION ACT FOR FY 2011. REF D IS SECTION
439 OF TITLE 37, UNITED STATES CODE. REF E IS
DOD DIRECTIVE 5124.02, UNDER SECRETARY OF DEFENSE FOR PERSONNEL
AND READINESS. REF F IS THE DODI 1341.12, SPECIAL COMPENSATION
FOR ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. REF G
IS THE DEPARTMENT OF DEFENSE FINANCIAL MANAGEMENT REGULATION
VOLUME 7A, CHAPTER 13.//
POC/T. HERRON/CIV/WWR/-/TEL: (703) 784-3694/DSN 278-3694//
POC/Y. JONES/CIV/WWR/-/TEL: (703) 784-3689/DSN 278-3689//
POC/J. BRUNER/CIV/MPO/-/TEL: (703) 784-9371/DSN 278-9371//
POC/T. AZZAZY/CWO5/RFF/-/TEL: (703) 432-9318/DSN 224-9318//
GENTEXT/REMARKS/1. This MARADMIN publishes the Marine Corps policy
on Special Compensation for Assistance with Activities of Daily
Living (SCAADL) as outlined in references (a) through (g). SCAADL
is an authorized compensation paid to the service member that
offsets the economic burden borne by a primary caregiver providing
nonmedical care, support, and assistance for the member. SCAADL
is taxable income for the service member.
2. Responsibilities. Deputy Commandant for Manpower & Reserve
Affairs, Manpower Plans and Policy Division, Military Manpower
Policy Branch is the Office of Primary Responsibility with Wounded
Warrior Regiment as Office of Coordinating Responsibility.
3. Program Guidance
3.a. Effective 31 August 2011, service members of a regular or
reserve component must meet the below criteria to receive SCAADL:
3.a(1) Have incurred or aggravated a permanent catastrophic illness
or injury in the line of duty.
3.a(2) Be certified by a licensed Department of Defense (DoD) or
Veterans Affairs (VA) physician to have a permanent catastrophic
injury or illness and need assistance from another person to perform
the personal functions required in everyday living or require
constant supervision and, in the absence of such assistance, would
require hospitalization, nursing home, or institutional care.
3.a(3) Be an outpatient.
3.a(4) Have a designated primary caregiver who assists with at
least one of the following activities of daily living (ADL) due to
the service member's:
3.a(4)(a) Inability to dress or undress himself/herself.
3.a(4)(b) Inability to bathe or groom to keep self-clean and
presentable.
3.a(4)(c) Frequent need of adjustment of any special prosthetic or
orthopedic appliances which by reason of the particular disability
cannot be done without aid (this will not include the adjustment of
appliances which uninjured persons would be unable to adjust without
aid, such as supports, belts, lacing at the back, etc.).
3.a(4)(d) Inability to independently use the toilet or attend to
toileting without assistance or maintain perineal hygiene.
3.a(4)(e) Inability to feed himself/herself through loss of
coordination of upper extremities or through extreme weakness or
inability to swallow.
3.a(4)(f) Difficulty with mobility (inability to transfer safely
from bed to chair, safely position himself/herself in bed, or walk
safely on various surfaces).
3.a(4)(g) Incapacity, physical or mental, which requires care or
assistance on a regular basis to protect the service member from
hazards or dangers incident to his or her daily environment.
3.a(4)(h) Requires supervision or assistance as a result of
seizures.
3.a(4)(i) Difficulty with planning and organizing.
3.a(4)(j) Difficulty with sleep regulation.
3.a(4)(k) Requires assistance or supervision due to delusions or
hallucinations.
3.a(4)(l) Difficulty with recent memory.
3.a(4)(m) Self-regulation (requires supervision or assistance
due to aggressive or combative behavior toward self or others or
verbally disruptive).
3.b. In addition to meeting the above criteria, the service
member must also meet all the following criteria:
3.b(1) Requires continual medical management or is at high risk for
personal safety;
3.b(2) Without caregiver support providing personal care services
or assistance with activities of everyday living, would require
hospitalization, a nursing home, or other institutional care; and
3.b(3) Not be provided concurrent services by another entity.
4. Eligibility for SCAADL requires the service member to be in an
outpatient status and no longer determined to be an inpatient at a
military treatment facility, Department of VA Medical Center,
civilian hospital, nursing home, or other residential institutional
care. Although individuals may be temporarily placed in an
inpatient status during the month for tests, examinations, or
treatment, they remain eligible for the full monthly SCAADL payment
provided they are in an outpatient status the majority of the time
within a 30-day period. (i.e., 16 days or more in a 30-day period).
5. If a member meets all eligibility requirements stated above, the
effective date of entitlement of SCAADL will be the date a licensed
DoD or VA physician certifies the member meets the criteria for
special compensation (item 6k of the Department of Defense Form
(DD Form) 2948 - Application for Special Compensation for Assistance
with Activities of Daily Living (SCAADL)).
5.a. Service members may not designate another active-duty military
member or a reservist on active-duty orders as their primary
caregiver.
5.b. SCAADL may not be paid to a qualified member if any other
federal agency is providing outpatient or in-home services to assist
with ADL or supervision to avoid harm to self or others.
5.c. SCAADL may not be paid to a qualified member if their primary
caregiver is receiving a monthly caregiver stipend from the
Department of VA under the Caregivers and Veterans Omnibus Health
Services Act of 2010.
5.d. Service members who qualify for and accept in-home assistance
with ADL (custodial care) paid with supplemental health care program
funds provided by a Tricare-authorized Home Health Agency (HHA) are
not eligible for SCAADL.
5.d(1) If a service member is returned to duty through
rehabilitation, or is found fit by the physical evaluation board,
or otherwise returned to duty status as unfit but retained on active
duty, the service member will be removed from the SCAADL Program
effective the month prior to the approval to return to full duty.
5.d(2) Service members who qualify for SCAADL shall have the
qualifying payments continue until the earliest date of the
following conditions:
5.d(2)(a) The last day of the month 90 days after separation or
retirement of the member (example: 1 February 2025 separation
date plus 90 days equals 1 May 2025. The member will receive
services until the end of the month, 31 May 2025).
5.d(2)(b) The last day of the month during which a member dies.
5.d(2)(c) The last day of the month during which the member is
determined to be no longer afflicted with the catastrophic injury
or illness. The relevant month is the month during which the
member becomes no longer afflicted with a catastrophic illness
or injury. A service member is not entitled to SCAADL if the member
is no longer afflicted with a catastrophic illness or injury but has
not met with a physician.
5.d(2)(d) The last day of the month preceding the month during
which the member begins receiving compensation under the VA
Caregivers and Veterans Omnibus Health Services Act of 2010.
6. The Commanding Officer (CO), Wounded Warrior Regiment (WWR) will
ensure all SCAADL applications are independently reviewed by a
licensed DoD or VA physician other than the physician who certified
the DD form 2948.
7. Determination of the amount of monthly SCAADL compensation.
7.a. The WRR Pay and Entitlement Section will certify SCAADL
entitlements via unit diary and will ensure the amounts are computed
properly based on the entitlement certification.
7.b. The amount of compensation for each service member will be
based on a three-tier system that, in turn, is based upon a clinical
determination of the number of ADL needs of the service members and
the hours, up to 40 hours per week, required by a caregiver to
perform each ADL or significant mental health and/or behavior
impairment of the service member requiring continuous supervision.
A licensed DoD or VA physician will utilize DD form 2948 to
determine the member's level of dependency based on the degree to
which the member is unable to perform one or more activities of
daily living or the degree to which the member is in need of
supervision or protection based on symptoms or residuals of
neurological or other impairment or injury. If the service member's
attending physician is a civilian provider not affiliated with DoD
or VA, arrangements will be made to have a licensed DoD or VA
physician review the case and complete the certification process.
Based on the clinical evaluation and score, the member will be rated
as follows:
7.b(1) High Tier: Service members who score 21 or higher will be
presumed to need a full-time caregiver, one who provides 40 hours
of personal care services per week.
7.b(2) Medium Tier: Service members who score 13-20 will be
presumed to require 25 hours per week of caregiver assistance.
7.b(3) Low Tier: Service members who score 1-12 will be presumed
to require 10 hours per week of caregiver assistance.
8. The CO, WWR has delegated the initial SCAADL adjudication to the
supervisor, Pay and Entitlements and their deputy.
9. Processes for Requests and Appeals
9.a. Requests for SCAADL payment must include the completed DD form
2948 and statement of understanding with the ADL, supervision, and
scoring guide completed by a licensed DoD or VA physician. Requests
will be forwarded, via the service member's chain of command, to the
CO, WWR (Attn: Pay and Entitlements), 1998 Hill Avenue, Marine Corps
Base, Quantico, VA 22134-5001, for approval and payment. Requests
can also be forwarded via e-mail to the WWR organizational mailbox:
[email protected]. The DD form 2948, and the Statement of
Understanding may be retrieved from www.woundedwarrior.marines.mil.
To the greatest extent possible, all responsible parties should
complete the SCAADL application (DD form 2948) within 30 days from
the initial licensed DoD or VA physician certifying eligibility
date.
9.b. Appeals of an initial determination that a service member is
not eligible for SCAADL will be submitted to the CO, WWR (Attn:
Pay and Entitlements). Ensure all medical reviews and opinions are
included. The service member may also appeal their tier level,
start date, and scoring. Following a thorough review and
development of a medical advisory opinion by the Regimental Surgeon,
Command Advisor, and Regimental Nurse, the CO will review the appeal
to determine SCAADL entitlement.
10. Recertification and Procedures
10.a. At a minimum, recertification for SCAADL is required every
180 days. A new DD form 2948 must be completed by a licensed DoD
or VA physician and forwarded to the CO, WWR for approval and
payment. The reevaluation and recertification shall be consistent
with the certification process used to establish initial SCAADL
eligibility.
10.b. Service member eligibility for SCAADL shall be continuously
evaluated to ensure eligibility remains intact. If a service
member's eligibility changes prior to the 180-day recertification,
(i.e., change of location, improvement/regression in medical
condition) the reevaluation and recertification paperwork will be
submitted at that time.
10.c. The Service member's recovery team, to include the primary
care manager, recovery care coordinator, non-medical case managers,
and unit leadership, shall ensure that whenever any marked changes
in the service member's medical condition (which may warrant an
increase or decrease in the level of caregiver support required)
are identified, the member is referred to a licensed DoD or VA
physician for a reevaluation.
10.d. Service members will also be required to recertify upon
release from a hospital stay of 16 days or more in a 30-day period,
a change in location, or if their medical condition changes.
10.e. The WWR Pay and Entitlement Section will notify service
members via separate correspondence 30 and 60 days prior of their
termination date of their requirement to recertify. If a service
member fails to recertify their SCAADL, the entitlement will be
terminated at the end of the month they are required to recertify.
11. Definitions
11.a. ADL. Feeding (including special diets), dressing and
sheltering; personal hygiene services; observation and general
monitoring; bowel training or management (unless abnormalities in
bowel function are of a severity to result in a need for medical
or surgical intervention in the absence of "skilled services");
safety precautions; general preventive procedures (such as turning
to prevent bedsores); passive exercise; transportation; and other
such elements of personal care that can reasonably be performed by
an untrained adult with minimal instruction or supervision. ADL may
also be referred to as "essentials of daily living" as defined in
part 199.2(b) of title 32, code of federal regulations. For the
purposes of eligibility of SCAADL, ADL and "personal functions
required in everyday living" are the synonymous.
11.b. Catastrophic Injury and Illness. A permanent severely
disabling injury, disorder, or illness incurred or aggravated in the
line of duty that compromises the ability of the afflicted person to
carry out ADL to such a degree that the person requires personal or
mechanical assistance to leave home or bed, or constant supervision
to avoid physical harm to self or others.
11.c. Inpatient. A patient who has been admitted to a hospital or
other authorized institution for bed occupancy for purposes of
receiving necessary medical care, with the reasonable expectation
that the patient will remain in the institution at least 24 hours,
and with registration and assignment of an inpatient number or
designation. Institutional care in conjunction with in and out
(ambulatory) surgery is not included within the meaning of
inpatient, whether an inpatient number or designation is
made by the hospital or other institution. If the patient has been
received at the hospital, but death occurs before the actual
admission occurs, an inpatient admission exists as if the patient
had lived and had been formally admitted.
11.d. Outpatient. An individual who uses a health care facility
for diagnosis or treatment without being admitted to a hospital or
other authorized institution as an inpatient; sometimes called a day
patient. Outpatient status also includes in and out (ambulatory)
surgery.
11.e. Primary Caregiver. An individual who renders to an eligible
service member, services to support ADL and specific services
essential to the safe management of the beneficiary's condition.
11.f. Guardian. A person who legally cares for another person who
is incompetent to act for themself.
11.g. Custodial Care. Treatment or services, regardless of who
recommends such treatment or services or where such treatment or
services are provided that either can be rendered safely and
reasonably by a person who is not medically skilled or designed
mainly to help the patient with ADL.
11.h. Line of Duty. The relationship of an illness, injury or
disease to a member's military duty or duty
status that is sufficient to satisfy the duty or duty status
component of eligibility for disability retirement under Chapter 61
of Title 10, USC.
12. This message is applicable to the Total Force.
13. Release authorized by Brigadier General David R. Everly,
Director, Manpower Plans and Policy Division, Manpower and Reserve
Affairs.//