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:  
t-sgli@usmc.mil.  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.//