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Expert Advice Or Thoughts On Smc?


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I was trying to figure out what the results of my latest request for increase is? If I already have 100% for LOU of lower extremities bilaterally and LOU of upper right extremity rated {70%} then if another disability gives me 100%, where does all that put me?

So these are my contentions, VBMS (New), left upper extremity weakness due to MS (New), neurogenic bladder with urinary urgency due to multiple sclerosis (also claimed as suprapubic catheter) (Increase), diplopia (Increase). The 100% I stated as another is for the suprapubic catheter which was put in me in July last year after several bouts with uti's and a couple of hospitalizations for the same problem.

Under diagnostic code 7516 Bladder,fistula of: Rate as voiding dysfunction or urinary tract infection, whichever is predominant. Postoperative, suprapubic cystotomy.

So unfortunately this is where I am at in the progression of this disease but I hate to say it "it is what it is". Just wondering where I go to next SMC R1 or "O", I am at SMC M + K now any thoughts?

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what SMC rate do you get now?

Have you accessed similar cases at the BVA web site?

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I am rated at M + k Berta. I have browsed the BVA site a little but have not worded my search correctly to come up with the right results.

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Asknod, our member here, is the SMC GURU:

https://asknod.wordpress.com/2013/02/27/special-monthly-compensation-what-is-it/

And has a great explanation of attaining those higher levels here in the SMC forum.

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Thanks Berta, I have had a discussion from Asknod last year about this smc and his Mr. potato head is awesome but I think he will have to pick this particular scenario differently. I say that because I understand the loss of use of arms and legs but how does loss of use of bladder come into the picture and get added to the smc?

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LOU of bladder falls into

(h) Special aid and attendance benefit; 38 U.S.C. 1114®

(1) Maximum compensation cases. A veteran receiving the maximum rate under 38 U.S.C. 1114 (o) or (p) who is in need of regular aid and attendance or a higher level of care is entitled to an additional allowance during periods he or she is not hospitalized at United States Government expense. (See § 3.552(b)(2) as to continuance following admission for hospitalization.) Determination of this need is subject to the criteria of § 3.352. The regular or higher level aid and attendance allowance is payable whether or not the need for regular aid and attendance or a higher level of care was a partial basis for entitlement to the maximum rate under 38 U.S.C. 1114 (o) or (p), or was based on an independent factual determination.
3.352(a) inability to attend to the wants of nature;

The three extremities rule:

(5) Three extremities. Anatomical loss or loss of use, or a combination of anatomical loss and loss of use, of three extremities shall entitle a veteran to the next higher rate without regard to whether that rate is a statutory rate or an intermediate rate. The maximum monthly payment under this provision may not exceed the amount stated in 38 U.S.C. 1114(p).

Technically, there is no stricture of piling 3.350(f) (5) on top of 3.350 (f) (3 or 4) . VA might plead differently but few of us ever get this disabled and try to test the rule. In the past we've always had VSO minders who dissuaded us from even thinking about attempting this.

I'm even working with a gal who's husband is in the TBA zone after the VA weenies dumped him on the floor in the VAMC. She's going to try to put a can opener into SMC T even though he is pre-9/11/2001. Any statute/reg. that is legally at odds with others sets off a wave of disparity in the administration of benefits. SMC is so unique, I doubt anyone has ever examined all the possible permutations or combinations that can present. As such, each is a unique matter of first impression. We pretty much know what VA's take will be but that's immaterial. It's what the Fed. Circus or SCOTUS' take is.

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Thanks for that great answer to my question, so I guess I am heading in that direction of uncertainty and by myself. Yes it just me and my wife/caregiver, she is my awesome caregiver paid by the VA for bladder care, taking this journey by ourselves with the guidance from the people on this forum.

My next question is if I have to be admitted to the VA hospital and I am rated at the R1 level, how and when does the rating get adjusted?

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Thanks, Asknod for your help explaining this SMC. To answer jefmils most recent (how and when) question, SMC is supposed to be "inferred" so no application should be necessary. However, I do not reccommend you count on the VA going through your records and saying, "Gee, we better increase this Vet's SMC as it looks like he deserves a higher level". You may wait a long long time for that to happen. Instead, if you think you are eligible for a higher level of SMC, send in a request for increase, and it may not hurt to use the new "intent to file". Your effective date of the increase, if VA does award a higher level of SMC, would still likely be the later of the date you file or the date the doc said you had the increase. If in doubt, apply.

It sounds like you are likely eligible for "Aid and attendance", if you are not already getting that. Someone can chime in, but I think there are 2

"Aid and attendance's"

1. An additional rate of SMC paid to you, above and beyond "housebound".

2. I think you can, in some circumstances, get VA to pay your provider of A and A for you. And, I think this can even be a relative who cares for you, since you may well need assistance with the "wants of nature" at hours when your A and A caregiver has gone home. I seem to recall the later A and A is ONLY for Iraq era Vets, somehow Vietnam Vets dont get this one.

The "How", is you file an intent to file.

The "When" (for you) is whenever you think an increase is warranted.

The "When" (for VA) is whenever they get around to it, and, if you dont like the effective date, appeal it.

The VA likely wants to break Vets claims into "pieces", since this allows them to delay you more.

For example, you get denied service connection, so you appeal. The BVA awards, and the RO implements this at 0%.

Next, you appeal the percentage. So, BVA says you get a higher percentage, and you get awarded benefits. However, the VA decides to save money and award them with an effective date 5 years after you applied. So, you appeal the effective date.

See how they delay you? That is 3 appeals where one should do. But you are not done yet. Now you can jump on the SMC hamster wheel AGAIN, pretty much like the above, so they can ring you around the rosie for 3 times there, also.

With an average BVA appeal taking about 4 years, this means the VA can hold off paying you for 4 years times 6 appeals or 24 years. Asknods took about 20 years, but he is not done yet, I dont think. Mine has taken a "mere" 13 years, so I am still a newbie, and can look forward to another 8 years or more of appeals.

I would like to see VA executives paid on the "Veterans benefit" time frame, and see how they like that. If there pay is short 100 bucks, then they will expect that to be corrected in 2 weeks for next payday...all while making Vets wait 20 years for their money.

Edited by broncovet (see edit history)
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According to the thread, he's already at M with a bump up from SMC L from the 3.350 F (4) which was already Aid and Attendance, Mr. L. I think he needs to be looking at R1 and that is whole different ballgame. VA defends that like Seattle in the red zone on 4th and goal.

You could throw SMC O against the wall to see if it stuck:

(2) Paraplegia. Paralysis of both lower extremities together with loss of anal and bladder sphincter control will entitle to the maximum rate under 38 U.S.C. 1114(o), through the combination of loss of use of both legs and helplessness. The requirement of loss of anal and bladder sphincter control is met even though incontinence has been overcome under a strict regimen of rehabilitation of bowel and bladder training and other auxiliary measures.

One thing most do not understand is that R1 is given if you qualify but do not use a "licensed" caregiver. R2 is paid for a licensed one if required. and boy howdy will VA weigh in on the need for a licensed one to keep you out.

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Yes, Im sure you are correct about the A and A, but are there not "2" A and A's? The first one you mentioned, gets paid to the Vet, and the second one to the caregiver, which, I understand can be paid to a family member.

The second A and A, is probably done by VA to save money. Think about it. You have a caregiver come in for 8 hours a day, 5 days a week (most often less than that) to do things like change bandages, sometimes bathing, etc, if/when assistance is required. Well what about the rest of the time?

Often a family member needs to be there to help 24/7, sometimes to feed, sometimes to help them walk (to prevent falling) etc. I think this may be the second A and A, often paid to a family member, not to the Vet. I seem to recall some legislation on this, but it seems like this is ONLY for Iraq era Vets and not Vietnam Vets. That is kinda crazy as the older Nam Vets are probably more likely to need A and A rather than younger, often healthier, Iraq Vets.

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"That is kinda crazy as the older Nam Vets are probably more likely to need A and A rather than younger, often healthier, Iraq Vets."

Precisely so! That's why the benefit is limited. Cost, don't you know!

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SMC S is "Aid and Attendance 1". Aid and Attendance 2 is SMC L. R1 and R2 are another set of metrics for those in the SMC O and P bracket. SMC "T" is the $2900 a month caregiver stipend for an unlicensed caregiver of a post 9/11/2001 Vet. Animal Farm for Vets. Some pigs are more equal than other pigs.

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The "second" A &A benefit to which I was referring is paid to the caregiver, and is referenced HERE:
http://www.caregiver.va.gov/support/support_benefits.asp

As I remembered, unfortunately, this benefit apparently applies to Veterans after 2001.

Edited by broncovet (see edit history)
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Yes I am fortunate enough that my SCI clinic at the VAMC here pays my wife a stipend for my bladder care. It is a small amount every month but at least it is something.

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I think I am finally getting the "2" A&A's. I apologize to hadit members, including ASK NOD, if I misled anyone. I did not do it on purpose, I assure you.

The first A and A, as Asknod pointed out, is SMC L, the "higher rate" of housebound, SMC S.

The "Second" A and A, is a Caregiver benefit, paid to the caregiver. VA does not call this A and A, probably for good reason, even tho the Caregiver provides a similar, if not identical, service to the Veteran as in the SMC L benefit.

However, this "Caregiver benefit" would be good for the VET, since the Caregiver benefit would mean that at least part of his caregiver care would be paid by VA, not by the Veteran, assuming the Vet and the Caregiver qualifies under VA rules.

The way I read the regulations is that both the Caregiver and the Aand A benefits can be paid regardless of Service connection or not. If you are on NSC Pension OR Compensation, you can get both the A and A and Caregiver benefit if you meet VA's eligibility criteria for both benefits.

Edited by broncovet (see edit history)
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