ptsd Does Filing For Smc S Jeapordize Rating?

[hedgey]

Hi again,

Thanks, Bronco, for the encouragement.

To clarify, my husband has nothing whatever to fear about anyone finding anything "wrong" in his file. There is not an iota of fraud or misrepresentation of his condition or status. Um... I don't think that came out quite right, but am I making any sense?

I'll try to say it again: Neither my husband nor I have any concerns about fraud or anything like that at all when it comes to our ratings.

What my DH is worried about is more what Bronco was talking about.... that suggestion by the VSO that anytime you put in a claim (a rightful claim, because we wouldn't do anything else!) you are essentially poking a hornet's nest with a stick. The whole attitude is "be grateful for what you're getting". So that makes my DH worry.

So there he sits, very clearly meeting the criteria for SMC-S (100% for PTSD + 80% for multiple other SC disabilities) and he is afraid to apply.

[john999]

I have had VSO's warn me not to ask for an increase etc. It is a common fear. There is a possiblity that the VA might review the entire award and propose a reduction. However, I have filed many claims since I got rated 70% including TDIU,P&T and 6 other claims related to DmII. My attitude is once I have it nobody is going to take it away from me. If your DH is over 55 there is only a small chance his claim would be reduced. The VA has a massive backlog looking at them. They don't have time to review every claimant that puts in for an increase. If you have a "S" claim that is based on a statute then even less reason to review.

[71M10]

If the decision is less than a year old file a NOD indicating they did not grant SMC S. Since you would be asking in the context of an appeal they couldnot reduce the rating.

[broncovet]

I went through a similar thing...when I got 100%...and I struggled with whether or not I should appeal the effective date and seek SMC, fearing they would find something wrong instead and reduce.

I made the choice to move forward, seek the EED and SMC S, and here is why.

First, we all know the VA can and does do reductions. But remember, this is when the Veteran shows "actual improvement". Katrina Eagle had a post on reductions a couple years ago, but it has been taken down.

In order for the VA to reduce a 100% P and T Vet, the VA not only has to show the VEteran's condition improved, but "under ordinary conditions of life", that is, the Vet is working. I definately got that to mean the VA cant reduce a 100% P and T Vet unless he is working.

The other thing is, if the VA "continued" the rating, the VA has to show you improved after the continuance. Its not enough for the VA to show you do not meet the criteria any more, because the criteria is highly subjective...(otherwise, we could just have computers rate Vets with things like GAF scores).

Importantly, given that a reduction is possible..you need to consider if its probable. A guy in Florida was asleep in his bedroom when a sinkhole sucked him in and killed him. Sure that is possible, but I am not losing any sleep worrying about it.

I also weighed the possibilities of:

1. A reduction if I applied for SMC/and or EED.

2 A reduction if I did NOT apply for SMC or EED.

I considered those dead even and here is why:

Remember, its almost a given whenever you apply for VA benefits you will have to appeal to get it. That does not change. The odds of you getting benefits without appealing are less than 50/50. This means it is inevitable for your increase to wind up in appeals.

Also remember that the VA has ONLY ONE copy of your C file. ONE. So, while your file is at the BVA or CAVC, who is looking at it for a reduction? Right..no one. The BVA and CAVC do not do reductions in the first instance. They do not have jurisditiction.

I think there is even a reasonable chance that having your claim in appeals actually reduces the chances of a reduction, simply because the VARO will not have access to your C file.

Bottom line: Apply for all benefits you genuinely feel entitled to, and dont worry about reductions. In other words, if you were honest then, you have nothing to fear now. I am in appeals now.

[Teac]

If the decision is less than a year old file a NOD indicating they did not grant SMC S. Since you would be asking in the context of an appeal they couldnot reduce the rating.

That's the first I have ever heard that.. you may be confusing the De Novo review process with the appeals process... While technically, the de novo review is an appeal, it is the only instance that I am aware of that when reviewed the award cannot be reduced. Any other appeal and reductions are always possible if the medical evidence warrants it. Now if I am incorrect and something changed that I am not aware of please share with us the references that indicate the va can't reduce on appeal. Also I would never go with an appeal where it is apparent the VA made a mistake.. Go with the CUE.......

[carlie]

Hi again,

Thanks everyone for your replies and advice. As always, HadIt members are my best friends.

I read through his decision letter 3 times and there is no mention at all of SMC. It talks about additional benefits, but include only things like dental, dependent educational assistance, ID card access, voc rehab, etc. Not a word or line about SMC.

How can we get a list of his disabilities and percentages?

hedgey,

Since the decision makes no mention at all of SMC/S to include nothing in the narrative,

then SMC/S would not be an issue to file a NOD on, as VA has never made a decision on

SMC/S, there is no decision on this issue, to disagree with.

For clarity, was there anything in the decision regarding housebound in-fact ?

In the past I have actually had good luck (Sorry, I have to admit it when something works right)

with calling the 800 # to get an exact breakdown of my SC'd conditions to include

each separate Diagnostic Code (DC), effective date and percentage evaluation.

Since he has VSO representation, I would write something up on a 21-4138 requesting SMC/S

(with my question as to the procedural error of why SMC/S was not addressed on the most recent decision)

and also if one or more of his medical providers are willing to write something up stating in their opinion

he is housebound due solely to the SC'd disabilities , and support the opinion with full medical rationale

(this would surely be helpful too). This is what I would want my VSO to submit.

JMHO