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Complicated Smc And Eed Question

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Guest Morgan

Question

The SMC regs say if a vet is entitled to SAH, he is also entitled to corresponding SMC level, and vice versa. Loss of use lower extremities is an M level, I think.

My question is, if the loss of use alone qualifies vet for M level, would that mean this should be rerated starting with the M level, then adding another single SCD at 100%, other SCDs combined at 50% or more and A&A? Vet also has one K rating. If this can be reconsidered I believe vet's rating should be at N1/2 + K, which I think now qualifies the vet for the R1 rating if skilled care is ordered. (It is.)

Can anyone help me with this?

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Morgan

Your IME said "could" and "probably". I think you should try and get stronger language. Why docs say things like "may" or "could" or "possibly" is beyound me when dealing with the VA. If the doctor would just say " at least as likely as not" you would be better off. With two 100% conditions you should win the claim anyhow with luck.

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Morgan; You have several facts and applications correct, but I think the one item you are misinterpretting is P (3) and P(4). First off, you need 100% to be considered, then the factual need for A&A must be for S/C conditions beyond the 100% (as if the 100% were not present). You have that and you have the "K" award. You can only have P(3) or P(4) applied and only once. Sometimes the VA will do the P(3) 50% then later award an additional 100%, but if they do that you cannot apply P(4), since P(3) was already applied. (Only an EED would be able to change that). The loss of two lowers is an "M", but is that the need for A&A, or part of the 100%? If so they won't pay twice for the same disability. So if you have a "M" and can add the P(4) that is an "M + one full step or an "N" along with the "K" = "N+K". "R1" can only be paid if you have factual need + "N 1/2+K" or an "O" award. (The P's are not actual ratings, but are used to 'adjust' ratings for 5 various reason, if they are distinct from the original rating). The way it works out is you might be able to use P(1), or P(2), or P(5) to get that "N 1/2+K". You can use all P applications, but again either P(3) or P(4) NOT both!!

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Say what?

".....after another VA blunder with his medications sent him to the hospital for ...."

If this vet incurs any additional disability due to a VA medication error- he can also submit claim under Sec 1151.

A VA medication "blunder" was instrumental (documented proof from OGC) in causing my husband's death.

I am interested in this SMC stuff as I am trying to figure out how VA will pay retro posthumous SMC for my husband

under Sec 1151 at well over 100% and also under Nehmer at well over 100%.

This is in additional to fact he was 100% SC for PTSD.

They might attempt to award the "S" as that is a no brainer here

100% SC plus 100% Sc for 3 other things so over 60% -

but an "S" is unacceptable to me-

It is quite difficult to interpret how VA with rate SMC awards -thank God we have Rich as our expert on this- I dont think many SOs really have a clue on it all.

What the heck is the VA doing to this guy with those medication problems? That is very upsetting.

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Special Monthly Compensation Codes and Rates

October 4, 2004 M21-1, Part I

Change 48

Appendix B

SPECIAL MONTHLY COMPENSATION CODES AND RATES

Entitlement Codes

www.warms.vba.va.gov/admi...ectXII.doc

Special Monthly Compensation (SMC) Rate Table

www.vba.va.gov/bln/21/Rates/comp02.htm

WARMS

www.warms.vba.va.gov/TOCindex.htm#b sectXII.doc

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