SPECIAL COMPENSATION FOR ASSISTANCE WITH ACTIVITIES OF DAILY LIVING (SCAADL) ELIGIBILITY
PRIVACY ACT STATEMENT
AUTHORITY: 37 U.S.C. Section 439; DoDD 5154.02; DoDI 1341.12, and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): To allow a licensed physician to certify or recertify that the applicant needs assistance from another person
to perform the personal functions required in everyday living or requires constant supervision and in the absence of the provision of such care would
require hospitalization, nursing home, or other residential institutional care. To allow the Services to provide certified, detailed monthly listings
of individuals with such determinations to the Defense Finance and Accounting Service of the effective start and stop date of payments for special
compensation for assistance with activities of daily living.
ROUTINE USE(S): The DoD "Blanket Routine Uses" found at apply to this
collection.
DISCLOSURE: Voluntary. However, failure to provide requested information may result in a denial or delay in processing your request for special
compensation for assistance with activities of daily living.
In accordance with DoDI 1341.12, the following information is provided to determine the compensation for the referenced Service member.
1. SERVICE MEMBER NAME (Last, First, Middle)
2. DOD ID NUMBER/
3. DATE OF BIRTH (YYYYMMDD)
SSN (Last 4 digits)
4. SOURCES USED TO COMPLETE THIS TOOL (X all that apply)
DIRECT OBSERVATION
CHART REVIEW
REPORT OF PRIMARY FAMILY CAREGIVER
5. FACILITY/LOCATION
6. SERVICE MEMBER ADDRESS (City, State and ZIP Code)
REFERENCES:
- Katz Basic Activities of Daily Living Scale
- The UK Functional Independence Measure and Functional Assessment Measure
- The Neuropsychiatric Inventory
SCORING GUIDE
4 - Total Assistance (Service member completes less than 25% of the task/activity or is unable to do the task without assistance).
3 - Maximal Assistance (Service member completes 25% - 49% of the task/activity with some hands on help).
2 - Moderate Assistance (Service member completes 50% - 74% of the task/activity with some hands on help).
1 - Minimum Assistance (Service member completes 75% or more of the task/activity with supervision/coaching assistance).
0 - Complete Independence (Service member completes task/activity without help).
TOTAL SCORE: High Dependence: 28 - 21
Moderate Dependence: 20 - 13
Low Dependence: 12 - 1
7. ASSISTANCE WITH ACTIVITIES OF DAILY LIVING (ADL)
(3) DID CLINICIAN
OBSERVE?
(1) AREA
(2) SCORE
(4) REASONS FOR SCORE
YES
NO
a. EATING
b. GROOMING
c. BATHING
d. DRESSING
e. TOILETING
f. NEEDS ASSISTANCE WITH
PROSTHETIC OR OTHER DEVICE
(beyond that of the average person)
g. DIFFICULTY WITH MOBILITY
(walking, going up stairs, getting in
and out of bed, etc.)
0
h. TOTAL SCORE
DD FORM 2948, SEP 2011
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