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.//