Jump to content

Ask Your VA Claims Questions | Read Current Posts 
Read VA Disability Claims Articles
Search | View All Forums | Donate | Blogs | New Users | Rules 

  • tbirds-va-claims-struggle (1).png

  • 01-2024-stay-online-donate-banner.png

     

Attn: Veldrina

Rate this topic


Recommended Posts

  • HadIt.com Elder

Hi Veldrina - I'm looking for how the VA decides SMC(s) claims/awards. As near as I can tell the VA is not supposed to use the combined ratings chart when totaling the additional 60% for a SMC(s) claim. Can you tell me how they handle these claims, specifically regarding the 100%+60% claims?? If so, can you link me to any official documents(M-21, fast letters, OGC decisions, etc.) telling the RO's how to handle the claims?? Thanks!!!

pr

Oooops - wrong forum title- any moderator, please move to SMC Forum. Thanks!

Edited by Philip Rogers
Link to comment
Share on other sites

  • Replies 12
  • Created
  • Last Reply

Top Posters In This Topic

We now have an SMC calculator that takes some of the guesswork out for us. The 100% plus additional 60% is for housebound. There is SMC for other levels of disability, such as anatomical loss or loss of use, and aid & attendance if u need a higher level of care or are so helpless u need the assistane of an aide to do acivities of daily living,. As for links, i only found this: http://www.vba.va.gov/bln/21/Rates/comp02.htm The explanation under CFR 3.305 is apparently an intranet thing, but i think u might be able to find it on hadit. I would have to copy & pate it from work. I will try to do so tomorrow.

Hi Veldrina - I'm looking for how the VA decides SMC(s) claims/awards. As near as I can tell the VA is not supposed to use the combined ratings chart when totaling the additional 60% for a SMC(s) claim. Can you tell me how they handle these claims, specifically regarding the 100%+60% claims?? If so, can you link me to any official documents(M-21, fast letters, OGC decisions, etc.) telling the RO's how to handle the claims?? Thanks!!!

pr

Oooops - wrong forum title- any moderator, please move to SMC Forum. Thanks!

Link to comment
Share on other sites

Veldrina.... I believe you misunderstood what PR was asking. For SMC housebound under the 100% plus 60%.... After one reaches 100%, either under the rating schedule, or extra schedular, the additional 60% is not a "combined evaluation", but rather an independent 60%, ADDING disabilities as oppose to using the combined rating chart. According to VA training module 4F 12-06 "Special monthly compensation is also payable if the veteran has one single service-connected condition rated 100% disabling plus other, separate service-connected condition(s) independently ratable at 60% or more in combination, or if veteran is permanently housebound, or is in need of regular aid and attendance." It does not state "combined evaluation", nor does it state "which combine". USC 1114 states ....."additional service-connected disability or disabilities independently ratable at 60 percent or more". PR is asking is, after the 100% rating, can the additional rating of 60% be found by using 30% + 20% +10%, instead of making a combine evaluation 30%+20%=44% 44%+10%=50%?

Old soldiers never die.... we just fight new wars!

Proud to have served, U.S. Army WAC

Link to comment
Share on other sites

  • HadIt.com Elder

Veldrina - WAC-Vet75 correctly explained my question. The claimant has a single 100% rating and was denied SMC(s) for HB/A&A. They now have 100%+20%+10%+10%+10%+10%, which I feel should qualify them for an SMC(s) award and am just trying to confirm I'm correct. It concerns me that the VA now has an SMC calculator. Could you perhaps run that total on the calculator and see what it brings?? All our research shows that once a claimant is 100% the additional disabilities are combined using standard math addition, not using the combined ratings chart. You might want to try 100%+30%+20%+10% also. If the calculator totals 50% for SMC then there could be a programming error. Again, thank you for your assistance!!!!

pr

Link to comment
Share on other sites

  • HadIt.com Elder

I have SMC S rating and VA has sent a nurse twice a week and an aide 3 times a week to help me. The nurse takes vitals, reviews my medication and makes sure I have set up meds correctly for the week. The nurse also counsels suggesting strategies for the week and checks my feet and inquires about my current health and any problems.

The aide helps me wash feet up to knees and applies lotions prescribed by Doc. Checks for any skin conditions or sores does light cleaning. The VA pays for this when I checked my records they are paid over 1,000 a month.

They have been doing this for over 2 years prescribed by my Doc originally cause I was overwhelmed with keeping track and complying with my medications. At the current time I have over 40 active prescriptions from VA and a couple of over the counter vitamins and fish oil recommended by my VA Doc.

My question is should I ask VA for a higher rating than S I am 100% for Panic Disorder with agoraphobia and 30% for pes planus. I really have a poor understanding of higher ratings over 100%.

If I am busting a thread and not wanted I will delete this post.

Pete

The more I learn about the VA the less I know.

Veterans deserve real choice for their health care.

Link to comment
Share on other sites

  • HadIt.com Elder

Pete

If you need assistance with daily life activities then you should ask for a higher level of SMC. It sounds to me like you do. You need help with your meds and your nurse or attendant does cleaning and washes you. I think you should ask for more! Without the nurse's help you might have big trouble with your feet so this to me shows a need for care and assistance with daily living. I really feel for you with the foot situation. One bad sore that is not identified early and you have big problems. This is why you need the extra care and compensation.

Link to comment
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


  • Tell a friend

    Love HadIt.com’s VA Disability Community Vets helping Vets since 1997? Tell a friend!
  • Recent Achievements

    • Lebro earned a badge
      First Post
    • stuart55 earned a badge
      Week One Done
    • stuart55 earned a badge
      One Month Later
    • Lebro earned a badge
      Conversation Starter
    • Sparklinger earned a badge
      First Post
  • Our picks

    • Caluza Triangle defines what is necessary for service connection
      Caluza Triangle – Caluza vs Brown defined what is necessary for service connection. See COVA– CALUZA V. BROWN–TOTAL RECALL

      This has to be MEDICALLY Documented in your records:

      Current Diagnosis.   (No diagnosis, no Service Connection.)

      In-Service Event or Aggravation.
      Nexus (link- cause and effect- connection) or Doctor’s Statement close to: “The Veteran’s (current diagnosis) is at least as likely due to x Event in military service”
      • 0 replies
    • Do the sct codes help or hurt my disability rating 
    • VA has gotten away with (mis) interpreting their  ambigious, , vague regulations, then enforcing them willy nilly never in Veterans favor.  

      They justify all this to congress by calling themselves a "pro claimant Veteran friendly organization" who grants the benefit of the doubt to Veterans.  

      This is not true, 

      Proof:  

          About 80-90 percent of Veterans are initially denied by VA, pushing us into a massive backlog of appeals, or worse, sending impoverished Veterans "to the homeless streets" because  when they cant work, they can not keep their home.  I was one of those Veterans who they denied for a bogus reason:  "Its been too long since military service".  This is bogus because its not one of the criteria for service connection, but simply made up by VA.  And, I was a homeless Vet, albeit a short time,  mostly due to the kindness of strangers and friends. 

          Hadit would not be necessary if, indeed, VA gave Veterans the benefit of the doubt, and processed our claims efficiently and paid us promptly.  The VA is broken. 

          A huge percentage (nearly 100 percent) of Veterans who do get 100 percent, do so only after lengthy appeals.  I have answered questions for thousands of Veterans, and can only name ONE person who got their benefits correct on the first Regional Office decision.  All of the rest of us pretty much had lengthy frustrating appeals, mostly having to appeal multiple multiple times like I did. 

          I wish I know how VA gets away with lying to congress about how "VA is a claimant friendly system, where the Veteran is given the benefit of the doubt".   Then how come so many Veterans are homeless, and how come 22 Veterans take their life each day?  Va likes to blame the Veterans, not their system.   
    • Welcome to hadit!  

          There are certain rules about community care reimbursement, and I have no idea if you met them or not.  Try reading this:

      https://www.va.gov/resources/getting-emergency-care-at-non-va-facilities/

         However, (and I have no idea of knowing whether or not you would likely succeed) Im unsure of why you seem to be so adamant against getting an increase in disability compensation.  

         When I buy stuff, say at Kroger, or pay bills, I have never had anyone say, "Wait!  Is this money from disability compensation, or did you earn it working at a regular job?"  Not once.  Thus, if you did get an increase, likely you would have no trouble paying this with the increase compensation.  

          However, there are many false rumors out there that suggest if you apply for an increase, the VA will reduce your benefits instead.  

      That rumor is false but I do hear people tell Veterans that a lot.  There are strict rules VA has to reduce you and, NOT ONE of those rules have anything to do with applying for an increase.  

      Yes, the VA can reduce your benefits, but generally only when your condition has "actually improved" under ordinary conditions of life.  

          Unless you contacted the VA within 72 hours of your medical treatment, you may not be eligible for reimbursement, or at least that is how I read the link, I posted above. Here are SOME of the rules the VA must comply with in order to reduce your compensation benefits:

      https://www.law.cornell.edu/cfr/text/38/3.344

       
    • Good question.   

          Maybe I can clear it up.  

          The spouse is eligible for DIC if you die of a SC condition OR any condition if you are P and T for 10 years or more.  (my paraphrase).  

      More here:

      Source:

      https://www.va.gov/disability/dependency-indemnity-compensation/

      NOTE:   TO PROVE CAUSE OF DEATH WILL LIKELY REQUIRE AN AUTOPSY.  This means if you die of a SC condtion, your spouse would need to do an autopsy to prove cause of death to be from a SC condtiond.    If you were P and T for 10 full years, then the cause of death may not matter so much. 
×
×
  • Create New...

Important Information

Guidelines and Terms of Use