[SMC awarded back to original Effective Date?]

On ‎10‎/‎29‎/‎2016 at 5:13 PM, asknod said:

When applying for SMC L using Aid and attendance as the predicate, certain disabilities (but not all listed) are what is needed. In order to get the VA rater to see your disability picture as so great as to render you in need of Aid and attendance, you will have to support that proposition. Look at all the reasons you might qualify. Here's the list from 38 CFR 3.352

(a) Basic criteria for regular aid and attendance and permanently bedridden. The following will be accorded consideration in determining the need for regular aid and attendance (§ 3.351(c)(3):

>inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable;

>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 normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.);

>inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness;

>inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment.

>“Bedridden” will be a proper basis for the determination. For the purpose of this paragraph “bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice.

It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others.

 

When you ask for reconsideration or an earlier effective date for A&A, you must pick a date that you can point to with medically supporting documents and declare that is the day you qualified for SMC L. You will need a favorable, completed a 21-2680 from your PCP supporting your hypothesis. Your wife cannot make that determination unless she has medical credentials (RN at a bare minimum). Even with that, they will still call you in for extensive workups. Lay testimony here is not what will carry the day. Your current list of disabilities (40/20/20/10) equals 66% rounded up to 70%. As no single disability is greater than 40% and the combination is  70%, you will have a hard time painting a disability picture that will reflect that necessary to attain A&A. Mind you, I am not trying to dissuade you from attempting it. I merely point out the inevitable roadblocks. 

I'm 290%. My upper and lower extremities are finally beginning to succumb to peripheral neuropathy. I must file first to get them SC due to my Hep C and/or porphyria from Agent Orange or even I will never get SMC L. I could have total loss of use of the legs but if they are not SC, I cannot claim SMC L.  Similarly, if I can still pick up a fork or spoon or operate the bidet, I would not qualify for  SMC L under the A&A codicil. 

A C&P exam will delve deeply into your arm and leg strength and perceived radiculopathy. Pain alone on excursion, is not a defining requirement to attain A&A. They give you things to squeeze to see what your grip strength is. Trust me, they are trained to spot fakers. A test for  peripheral neuropathy in your extremities, including an EMG, will reveal if your muscle responses are genuine. A DBQ is merely a report card-not a confirmation of need for aid and attendance. There is no DBQ specifically for A&A. One thing I've seen is a Vet saying he can no longer wipe his butt after defecating. VA usually solves that by giving him a bidet. That's way cheaper than A&A. They can give you an electric can opener under the ILP program to aid you in eating and preparing your own meals. You have no idea what you are walking into yet. If you are not at SMC S with a 100% or TDIU, plus a 60% rating for another unrelated disability, or if you are under 55, VA is going to make you work for it. Dr. Bash or Dr. Ellis might even have a problem writing an IMO for that one. Another thing will be SAH/SHA improvements to the home or a vehicle grant. Often, absent these, they will not even discuss SMC L under any perceived entitlement-be it loss of use of lower or lower/upper extremities or A&A. If you still have a driver's license, they'll say that proves you are capable of ambulation and do not need A&A. 

I would have a doctor opine as to your abilities with a 2680 before approaching the VA. Even with that, if you can walk and are not considered housebound in the truest medical sense, you may not prevail. SMC is reserved for the most egregious cases otherwise you would see more of us receiving it.  

 

 

Asknod,

I really appreciate your detailed input. I was able to get my PMC to fill out the 2680 in what I would perceive as a favorable response. she clearly spoke to my weakness/loss of strength in both my right arm and leg. At present the pain is so great my spine and pain management treatment consists of them preparing to burn the nerves in my back for temporary relief. Thoughts?

[Do I have a chance at R1 or R2?]

5 hours ago, THOMAS89031 said:

OIG Investigation at various RO's have found that if you are rated 100% PT; you are  entitled  to SMC "S"  BUT the RO's are failing to award based on thinking you need an additional 60%.    If you do not leave your house for "work", you should be awarded SMC "S".

Only problem is that I am not housebound. However, my wife routinely provides me assistance in dressing, bathing, getting in and out of bed and the car when my pain is at its worse. This quaifies me for the SMC L A&A.

[SMC awarded back to original Effective Date?]

Buck52,

In your opinion, do I need to get a VSO, or can I simply submit a FDC via eBenefits?

I plan on submitting the following as evidence:

1. All medical records originally submitted that resulted in VBA granting a Service Connected rating

2. All medical records since my approved rating

3. Clarification on the symptoms of these conditions:

                                         

1. 1. 1. All SPINE conditions already granted as Service Connected, previously approved date of 11/25/12

Lumbar Spine degenerative disc disease with thoracolumbar strain (rheumatoid arthritis-lower back, upper back herniated discs, and thoracic spine stenosis)	40%	Service Connected
Cervical spondylosis with degenerative arthritis	20%	Service Connected
Radiculopathy, right upper extremity	20%	Service Connected
Radiculopathy, right lower extremity	10%	Service Connected

 

1. 1. 1. Thoracic / Lumbar strain is an injury to the lower back.

         1. This results in damaged tendons and muscles that can spasm and feel sore.

         2. Symptoms include back pain and stiffness that worsens with activity, bones, muscles or ligaments may place pressure on the spinal nerves or spinal cord. Resulting in numbness, weakness, and pain that travels down the leg, instability and weakness, & decreased mobility of the thoracic region

         3. Pain can be exacerbated when taking a deep breath or coughing

      2. Cervical Spondylosis is the Degeneration of the spinal column which chiefly affects the vertebral bodies, the neural foramina and the facet joints.

         1. Cause pressure on nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, and muscle weakness in the limbs

      3. Radiculopathy refers to a set of conditions in which one or more nerves are affected and do not work properly. The location of the injury is at the level of the nerve root. This can result in pain, weakness, numbness, or difficulty controlling specific muscles

Thoughts?

[SMC awarded back to original Effective Date?]

Can I get SMC awarded back to original Effective Date?

Not having been aware of the SMC at all, has anyone ever successfully been awarded SMC back to their original Effective Date?

In reading these blogs, I came across a webpage providing an overview of all SMC’s. One line stood out:

“If the VA did not give Special Monthly Compensation in a case that qualifies, the veteran can request for his case to be reviewed, and Special Monthly Compensation will then be given dating back to the original VA Rating Decision.”

I plan on filing for SMC “L”:

 – In regular need of another person to help dress, clean, feed himself, and use the restroom (aid and attendance)

My justification is that I have always needed assistance from my wife to dress and sometimes bathe as a direct result of:

Lumbar Spine degenerative disc disease with thoracolumbar strain (rheumatoid arthritis-lower back, upper back herniated discs, and thoracic spine stenosis)	40%	Service Connected
Cervical spondylosis with degenerative arthritis	20%	Service Connected
Radiculopathy, right upper extremity	20%	Service Connected
Radiculopathy, right lower extremity	10%	Service Connected

 

I’m in constant pain while the condition is getting worse, i.e. loss of feeling/strength in right arm.

 

[Do I have a chance at R1 or R2?]

I definitely do not qualify for "S", but after further review, I think I qualify for "L".

[Do I have a chance at R1 or R2?]

I received my approval for 100% T&P back in May 2014. Like many Veterans, I perceived the 100% rating as the end of the line. Although I thoroughly researched the 38 CFR, I neglected to consider filing a NOD, review the SMC and other benefits. I just assumed that 100%was the highest level of compensation available.

My question is this, Do I qualify for the SMC R?

At present I am receiving SMC (K-1) on account of loss of use of a creative organ. Additionally, my cervical spine condition has worsened. Presently suffering from loss of feeling and strength in my right arm and constant lower back pain. Receiving weekly treatment from a Spine treatment specialist through Tri-Care. Does this show cause to file for SMC R1?

After reading these posts I am also sick over my having followed the advice of my VSO on not filing a NOD for conditions I was treated for while on AD.

Please advise, your assistance is greatly appreciated.

Semper Fi!

70%=	PTSD
50%=	Sleep Apnea
40%=	Lumbar Spine
20%=	Hematochezia
20%=	Right ankle arthritis
20%=	Cervical spondylosis
20%=	Radiculopathy, right upper extremity
10%=	Tinnitus
10%=	Radiculopathy
10%=	Left wrist tenosynovitis
10%=	Left ankle arthritis, status post fracture
10%=	Right elbow olecranon bursitis
10%=	Deviated septum, traumatic
10%=	Painful scar of right axilla
0%=	Right hand DeQuervain's tenosynovitis
0%=	Erectile Dysfunction

 

Not Service Connected=	Renal cyst
Not Service Connected=	Right knee patellofemoral syndrome
Not Service Connected=	Hypermetropia
Not Service Connected=	Migraine headaches
Not Service Connected=	Left shoulder acromioclavicular
Not Service Connected=	Left knee condition
Not Service Connected=	Right wrist condition
Not Service Connected=	Epididymal cyst/spermatocele
Not Service Connected=	Right shoulder rotator cuff impingement
Not Service Connected=	Bilateral hearing loss
Not Service Connected=	Bilateral cubital tunnel syndrome
Not Service Connected=	Traumatic brain injury