hypertension I Just Found Out Have Additional Disabilities That Should Qualify Me For Smc "s" Award

[Philip Rogers]

Here's a listing of my disabilities from the "blue" ratings sheet:

9411 PTSD 100%

9411 PTSD w/alcoholism 100%

7913 Type II Diabetes 20%

6260 Tinnitus 10%

7101 Hypertension associated w/PTSD w/alcoholism 10%

8520 L leg PN associated w/diabetes 10%

8520 R leg PN associated w/diabetes 10%

bilateral factor of 1.9% for diagnostic codes 8520.

Any thoughts on SMC??

pr

[jbasser]

Flip, you have got me thinking also.

There ought to be a higher level of SMC paid for a person who has more than 1 100 % disabilities. SMC S doesnt seem to cut it.

The SMC regs are so complex it can confuse even the VA employees.

Keep me posted on what you find out.

John

[Philip Rogers]

John, I know what you mean. What has me puzzled is that they listed PTSD twice?? If they are each considered a separate rating then they owe me 10 yrs retro, cuz the 2nd 100% covers the 60% requirement for "S" SMC. I originally thought the two 8520 PN ratings were an error until I found out they were each for a different leg. I'll keep you posted with whatever shakes out.

pr

Flip, you have got me thinking also.

There ought to be a higher level of SMC paid for a person who has more than 1 100 % disabilities. SMC S doesnt seem to cut it.

The SMC regs are so complex it can confuse even the VA employees.

Keep me posted on what you find out.

John

[carlie]

Here's a listing of my disabilities from the "blue" ratings sheet:

9411 PTSD 100%

9411 PTSD w/alcoholism 100%

Any thoughts on SMC??

pr

pr,

Not to pry but has the alcoholism caused any residual additional disability's,

like liver problems, seizures, tremors or anything like that ?

This would be the reason I could see for it being listed twice on the blue sheet.

Seems to me like you should be eligible for SMC "S"

I believe the regs for it actually read - Total plus 60% versus 100% plus 60%.

[Chuck75]

This is interesting, in that code 9411 is listed twice. I'd almost bet that this, according to the VA, will be considered a duplication, and not considered as separate items.

(Bi-laterals, on the other hand, get the additional factor added.) I'd look at the alcoholism as secondary to PTSD, with it's own code.

Here's a listing of my disabilities from the "blue" ratings sheet:

9411 PTSD 100%

9411 PTSD w/alcoholism 100%

7913 Type II Diabetes 20%

6260 Tinnitus 10%

7101 Hypertension associated w/PTSD w/alcoholism 10%

8520 L leg PN associated w/diabetes 10%

8520 R leg PN associated w/diabetes 10%

bilateral factor of 1.9% for diagnostic codes 8520.

Any thoughts on SMC??

pr

[Philip Rogers]

No problem, Carla, you can pry. ;-) No other residuals, in 2001, when the alcoholism, secondary to PTSD, was awarded. Recently I had the pancreatitis thing which should relate to the alcoholism but that's a new claim.

The award dates are PTSD@1989, Tinnitus@2000, PTSD w/alcoholism@2001, Hypertension@2001, Diabetes@2007, Left leg PN@2010 and Right leg PN@2010.

I was never notified of the Hypertension award in 2001, nor the two PN awards in 2010. I only discovered them when my atty sent me a copy of my recent denial for IHD, that included a copy of the blue sheet.

I received the blue sheet yesterday and realized last night that, w/the hypertension and PN awards, I should be able to received SMC. I don't understand the two PTSD ratings but will find out, as I'm going to call a CUE on the 2001 PTSD award, which should have awarded SMC, if the two awards are correct.

There's also a couple of lines, on the blue sheet, that states:

Combined Evaluation For Compensation:

100% from 04/26/1989; 100% from 07/19/2010 (Bilateral factor of 1.9 Percent for diagnostic codes 8520, 8520)

Thanks!

pr

pr,

Not to pry but has the alcoholism caused any residual additional disability's,

like liver problems, seizures, tremors or anything like that ?

This would be the reason I could see for it being listed twice on the blue sheet.

Seems to me like you should be eligible for SMC "S"

I believe the regs for it actually read - Total plus 60% versus 100% plus 60%.

[Philip Rogers]

Chuck75 - I agree they'll probably call it a duplication, especially since it will cost them $30k retro on a CUE claim, if it isn't. Both the PN's are listed as secondary to diabetes and the Hypertension is listed as secondary to alcoholism but the alcoholism is not listed as secondary to PTSD. Thanks!

pr

This is interesting, in that code 9411 is listed twice. I'd almost bet that this, according to the VA, will be considered a duplication, and not considered as separate items.

(Bi-laterals, on the other hand, get the additional factor added.) I'd look at the alcoholism as secondary to PTSD, with it's own code.

[john999]

What would be your effective date for "S". If the VA did not award "S" and you are entitled to it then it is a CUE. You would want to claim the SMC as soon as you became eligible for it. I got $8200 in retro on mine. I guess you take meds for the DMII? Have you ever had your legs tested for any sort of artery disease? I did by accident and found a problem related to DMII that eventually became rated as heart disease secondary to DMII. If you get a CT scan of your legs you might find a problem there and it is most certainly secondary to DMII (almost presumptive the association is so strong). CAD disease often starts in the legs for those with DMII. Just complain about pain in your legs and cramping when you walk. That should get you a scan and I bet they find something like calcification in the arteries.

[Philip Rogers]

john999 - If it were awarded, for the CUE, it would be 1/2001. If awarded for the two recent PN awards it would be 7/2010. Either one should be a CUE as they should have been picked up, automatically, by the rater, at the time of the awards. When I filed for IHD they gave me a stress test which supposedly showed negative for IHD. I've never been diagnosed w/IHD but figured since I'm 65yo I should have some type of heart disease. I guess I don't but will request the leg scan. Thanks!!

pr

What would be your effective date for "S". If the VA did not award "S" and you are entitled to it then it is a CUE. You would want to claim the SMC as soon as you became eligible for it. I got $8200 in retro on mine. I guess you take meds for the DMII? Have you ever had your legs tested for any sort of artery disease? I did by accident and found a problem related to DMII that eventually became rated as heart disease secondary to DMII. If you get a CT scan of your legs you might find a problem there and it is most certainly secondary to DMII (almost presumptive the association is so strong). CAD disease often starts in the legs for those with DMII. Just complain about pain in your legs and cramping when you walk. That should get you a scan and I bet they find something like calcification in the arteries.

Edited January 5, 2011 by Philip Rogers (see edit history)

[john999]

Phil

You know the only way to really tell if you have a heart problem is a heart cath, but it is invasive and has its own risks.

[Philip Rogers]

John, I don't do invasive. Ya know sometimes we're better off not knowing.

pr

Phil

You know the only way to really tell if you have a heart problem is a heart cath, but it is invasive and has its own risks.

[Berta]

Carlie made a good point. Under Allen V Principi you could claim any disabilities due to alcoholism that is secondary to PTSD.

Not saying this applies to you Flip but EVERY vet who has ED should attempt to see if they can get SMC K award for it.

It could be directly due to a SC disability or even caused by SC meds.

[Philip Rogers]

Berta - I tried for the "K" award yrs ago and was denied, as they decided it was caused by hypogonadism. I filed a timely NOD, with a statement from my urologist, and have failed to follow up on it, so it should still be pending. What are your thoughts on the two 100% PTSD awards??? I'm filing a CUE for the "S" award from 7/2010 and will probably file a CUE for the "S" award on the two 100% ratings, back to 2001, and see what happens. I also have a 20 yr on going claim, for housebound/A&A, that was remanded by the court and I think some of this is due to that.

pr

Carlie made a good point. Under Allen V Principi you could claim any disabilities due to alcoholism that is secondary to PTSD.

Not saying this applies to you Flip but EVERY vet who has ED should attempt to see if they can get SMC K award for it.

It could be directly due to a SC disability or even caused by SC meds.

[carlie]

pr,

What was the nexus to SC for your Type II Diabetes ?

[Philip Rogers]

Carla - no nexis, it just states "TYPE II DIABETES [Agent Orange/Diabetes], service Connected, Vietnam Era, Incurred, 20% from 09/27/2007." I'm trying to attach the document.

pr

[carlie]

pr,

The way I read it going by this is they SC'd the diabetes as related to AO.

I was thinking perhaps the diabetes was secondary to the alcoholism,

that's why I asked.

I think it's pretty strange that your PTSD was SC'd over 20 years ago

but the one that states PTSD with alcoholism is dated 2001.

I think what they have done is just rated you as PTSD from

4/26/1989 thru 1/31/2001.

Then on 1/31/2001 you filed a claim (whether formal or informal) for Hypertension and the VBA

SC'd and associated your Hypertension to alcoholism (probably self medicating).

Since the Hypertension was granted as associated to alcoholism they redefined

your then current PTSD to PTSD with Alcoholism.

Something else I noticed is that your Tinnitus has hit the 10 year protection stage

and your Hypertension hits 10 years the end of this month.

I would be real sure to keep the paper that shows your PTSD was originally rated

at the 100% level in 1989 which covers you for the 20 year protection rule.

In my way of thinking, one day the VBA might try to say - oh no - look right here,

you were granted PTSD with Alcoholism on 1/31/2001, so you aren't covered by

the 20 year protection rule.

Maybe I'm a little bit paranoid.

I do not think this will really pan out to be 2 separate 100% awards - but you never know : - )

[Philip Rogers]

Carla - I agree on the 2-100% ratings but ya never know. I'm not sure when I filed on the hypertension but they denied it and I never appealed it, so I was surprised to see it's now sc'd. I filed on the alcoholism back in 89 or 90 and it was denied as "willful misconduct." Then I reopened in probably 2001 and won that but it brought no additional money. I'm protected w/the 20 yrs, so no need to worry, just need to get the "s" award, then the "k" award and I'll be happy. Thanks!!

pr

[Berta]

I have never seen 2 PTSD awards like that Philip.

But certainly a vet can have more than one SC 100 award.

These additional awards either play into the SMC "S" criteria or in some cases can put the vet into a higher SMC rating.

For example:

You know BVA awarded my AO death claim a few months ago.

The VARO sent NO rating again for his AO IHD , or for his AO DMII and the AO CVA rating is still wrong.

I have a CUE claim under Nehmer as well as a recent AO IHD claim for proper rating.

All of these disabilities, heart, brain, and DMII have been acknowledged by the BVA and OGC.I have 3 IMOs that support them too as due to AO.

100% P & T SC PTSD granted 1997

80 % for 1151 CVA (Strke) ,which is now AO CVA (wrong rating and I have cued it as it should be 100% per their own regs and med evidence )

AO DMII (they refuse to rate)shoud be 20 to 40% SC due to AO

IHD due to AO -should be staged up to 60% for 4 years per med recs then 60% for almost two years with final 100% SC rating as cause of death.per their own regs. It has never rated at all.

That is 3 100% awards even if they never rate his DMII.

It is three awards under both Section 1151 (all misdiagnosed)as well as Agent Orange direct SC.

The only way I could get beyond a 100 % plus 60 for the SMC "S" award (which I told them to keep)

was to study M21-1 as well as all SMC regs -

I found in M21-1MR that three 100% awards plus A & A generate the SMC "M" award.

I sent them evidence that warranted the A & A award as well as evidence for the other ratings and asked them for SMC M as accrued benefit to me under Nehmer.

My long point here is that the PTSD due to alcoholism might well be a separate award for you-I dont know- anything is possible-but to get compensated for multiple 100% awards - usually only gives the vet a SMC S award unless they do fall into the higher SMC levels.

I don't think this is fair at all.Yet the higher levels consider loss of or loss of use of arms, hands, feet, or legs etc and

it is this loss of that puts the vet into the higher SMC criteria which seems to be the sole way a vet with multiple SCs and at least one at 100% or TDIU can get a rating that goes beyond the S award which isn't enough money in my opinion anyhow.

[broncovet]

Phillip

Perhaps the 2 PTSD 100% awards could be used to your advantage, Philip. Remember, that after a decision is one year old, it becomes "final" independent of whether that decision is right or wrong. The VA would have to appeal it as a CUE. However, the VA can not appeal BVA decisions and cant appeal their own decisions either. ONLY the Veteran can appeal RO or BVA decisions.

The courts were set up for Veterans to appeal adverse decisions, not for the VA to "fix" their mistakes.

I really dont know how (or if) the VA can "fix" its own errors in decisions that are favorable to the Veteran. I realize there is "CUE" but the cases I have seen are always the Veteran initiating the CUE and never the VA trying to say, "Gee, I awarded you too many benefits in error". However, if there is "something fishy" then I know the VA can reverse Veteran favorable decisions, such as maybe that guy was not a Veteran at all, or if his discharge meant he was not eligible for benefits, such as a dishonorable discharge. But I am not sure the VA can easily "unaward" 100% even if they think he should only get 30% later, without going through the "reduction" process. In the "reduction" process, the VA has to show that the Veterans condition improved...it is not enough that another VA decision maker thinks that the Veterans condition never warranted 100% in the first place.

[john999]

Go for it, Phil, you will get it. This gives you a goal.