Jump to content
  • Searches Community Forums, Blog and more

  • 0
SupermanCannedy

Appealing Denial for SMC T based on SMC R2 criteria

Question

Has anyone on this site put in a claim for SMC-t? Do you know of anyone who has been awarded it? I am the sister of a pre 9/11 veteran who has been rated at 100% for TBI P&T. I am his full time caregiver and have been appointed his fiduciary. I also have helped him with his claims...and have done well, until this one. I do my best to give him a high quality of life, but need to hire because his body is fit, but his memory and cognitive skills are in constant decline.

He is a textbook case for SMC T because, in addition to the first 2 requirements, his VA neurologist has also filled out the forms to state that "Without regular in home care the veteran would need to be placed in institutional care". That is a major requirement for an SMC T. We submitted the claim for an SMC T 2015 and they granted him A&A at the L 1/2 rating, which we didn't realize is also required to qualify for SMC t...actually SMC L or higher. We submitted the SMC t claim again April 2016 and they denied it based on R2 criteria. After not knowing what to do about that and not getting any help from the local VSOs (they aren't familiar with this SMC T) a pro bono attorney offered assistance, so we took it.

The decision board came back with a "We got your new claim...we can give you an answer within 30 days or you can have up to a year to submit more evidence." I have NO IDEA what that really means or what to do...So, I submitted for the extra time. Now, I need some guidance.

Should I have people we know write up some buddy letters to explain how much help the vet needs in his daily life? Should I hire one of those VA lawyer firms that take 20% of whatever award is granted? Do any of you know of anyone who has worked on an SMC t? The last report I read was from Dec of last year when the congressional coding was recommended to be changed in order to make the criteria more clear and the "open". The charts show that as of 2011, when the Fast Letter first went out, only 120 or so veterans have been awarded this SMC. So, that's why I am hitting brick walls!

We appreciate any help. Thank you!! 

 

 

 

Share this post


Link to post
Share on other sites

Recommended Posts

  • 0

If you have the paperwork from the doctor I would personally go to your RO and they can help you file the right paperwork for his SMC. It may greatly increase the chance of getting it the first time around.

Share this post


Link to post
Share on other sites

Ad


  • 0

We filed the original claim through the RO in Austin.  The rep was unfamiliar with the SMC-t, but so were all of the other VSOs I spoke with. I presented all of the documentation that I could gather, based on the information we had access to, and she filed it.  She was very unenthusiastic and told me two times that I should place him in a VA care facility.  When the claim was denied, she was "done". The denial letter states the reasons for denial as physical ones and noted other things that are required as criteria for r2....that's not the SMC we filed for. 

After asking for help from several VSOs in the area and one tried to explain the different choices I could make in the appeals process, but I couldn't get an apt to see them in person for awhile. I agreed to have the lawyers draw up the NOD because they could get me in to see them. Maybe that isn't even the step that we should have taken. 

So, go back to the RO?...don't be as concerned about finding a VSO who understands the SMC t, but rather one who is good at navigating us through the appeals process? 

 

Edited by SupermanCannedy

Share this post


Link to post
Share on other sites
  • 0

Keep trying. I'm sure there is somebody out there that has more knowledge on SMC issues. You can try posting the denial letter and maybe it will spark someone's attention. Make sure you edit out private info i.e.: names, addresses, SS number...

Share this post


Link to post
Share on other sites
  • 0

Could you post a redacted copy of the Denial Letter?

Semper Fi

Share this post


Link to post
Share on other sites
  • 0

SupermanCananady:

    It looks like you have done your homework: You know the criteria for SMC T.  Dont overlook the basics, tho, the 3 caluza elements.   (I wish had a key on my computer that copied the Caluza elements of a)Current diagnosis, b)  in service event or aggravation and c) nexus or docs opinion that the previous caluza elements are at least as likely as not related.  

     Do not forget the basics.  VA wont.  

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Ads


  • Advertisemnt


  • Latest News
  • Our picks

    • Survivors- a Must read
      If you are new to hadit and have DIC questions it would help us tremendously if you can answer the following questions right away in your first post.

      What was the Primary Cause of Death (# 1) as listed on your spouse’s death certificate?

      What,if anything, was listed as a contributing cause under # 2?

      Was an autopsy done and if so do you have a complete copy of it?

       It can be obtained through the Medical Examiner’s office in your locale.

      What was the deceased veteran service connected for in his/her lifetime?

      Did they have a claim pending at death and if so what for?

      If they died from anything on the Agent Orange Presumptive list ( available here under a search) when did they serve and where? If outside of Vietnam, what was their MOS and also if they served onboard a ship in the South Pacific what ship were they on and when? Also did they have any major  physical  contact with C 123s during the Vietnam War?

      And how soon after their death was the DIC form filed…if filed within one year of death, the date of death will be the EED for DIC and also satisfy the accrued regulation criteria.
        • Like
      • 17 replies
    • If you are a Veteran, represented by MOPH, you need to know that MOPH is closing down its offices.  This can have a drastic effect on your claim, and it wont be good for you.  You likely need to get a new representative.  

      This station confirms MOPH is closing its doors:

      http://www.kwtx.com/content/news/Waco--Purple-Heart-veterans-service-center-to-close-its-doors-480422933.html

       
      • 0 replies
    • Retroactive Back Pay.
      Retroactive Back Pay - #1Viewed Post Week of March 19. 2018

      My claim is scheduled to close tomorrow for my backpay.
      Does anyone know if it does close how long till the backpay hits the bank?
      Also does information only get updated on our claims whenever the site is down?
      • 44 replies
    • Examining your service medical records...
      * First thing I do after receiving a service medical record is number each page when I get to the end I go back and add 1 of 100 and so on.

      * Second I then make a copy of my service medical records on a different color paper, yellow or buff something easy to read, but it will distinguish it from the original.

      * I then put my original away and work off the copy.

      * Now if you know the specific date it's fairly easy to find. 

      * If on the other hand you don't know specifically or you had symptoms leading up to it. Well this may take some detective work and so Watson the game is afoot.

      * Let's say it's Irritable Syndrome 

      * I would start page by page from page 1, if the first thing I run across an entry that supports my claim for IBS, I number it #1, I Bracket it in Red, and then on a separate piece of paper I start to compile my medical evidence log. So I would write Page 10 #1 and a brief summary of the evidence, do this has you go through all the your medical records and when you are finished you will have an index and easy way to find your evidence. 

      Study your diagnosis symptoms look them up. Check common medications for your IBS and look for the symptoms noted in your evidence that seem to point to IBS, if your doctor prescribes meds for IBS, but doesn't call it that make those a reference also.
      • 9 replies
    • How to get your questions answered on the forum
      Do not post your question in someone else's thread. If you are reading a topic that sounds similar to your question, start a new topic and post your question. When you add your question to a topic someone else started both your questions get lost in the thread. So best to start your own thread so you can follow your question and the other member can follow theirs.

      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.



      Leading to:

      Post clear questions and then give background info on them.



      Examples:

      A. I was previously denied for apnea – Should I refile a claim?



      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?




      B. I may have PTSD- how can I be sure?


      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?





      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
      • 2 replies
  • latest-posts-activity.pngstart-new-topic.pngsearch.png

  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • Advertisemnt

  • 14 Questions about VA Disability Compensation Benefits Claims

    questions-001@3x.png

    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
    Continue Reading
     
  • Advertisemnt

  • Ads

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

×

Important Information

{terms] and Guidelines