Do I Qualify For Smc S?

[whoami?]

I was recently granted 100% P&T. I have one rating thats 100% SC and I have a bunch of individual ratings that add up to 59 which should round up to 60. When VA decided my claim they didn't say anything about SMC but after doing some reading here I believe it should have been inferred last year when they decided my claim. Since it hasn't been a year should I ask for a reconsideration or file a NOD. How should I proceed?

[whoami?]

I will list the ratings and you guys let me know what you think.

PTSD 100% P&T

Radiculopathy left lower extremity 20%

Left shoulder condition 10%

Radiculopathy Right lower extremity 10%

Rifght knee chondromalacia 10%

Lumbosacral Strain 20%

Chondromalacia left knee 10%

Ed SMC K 0%

Scalp 0%

[Chuck75]

There is a difference of opinion as to whether the SMC S "100 plus 60" is added or combined. YOu said yours was added, not combined. I suggest you "go for it", but you may be caught into the "added or combined" debate that WACvet posted some time ago. Im not sure that ever was resolved. Or, maybe you meant they "combined" to an additional 60 percent.

"There is a difference of opinion as to whether the SMC S "100 plus 60" is added or combined."

The VA likes to use "VA math", even though the 100% supposedly uses it up. The result of using VA math can make a difference in the SMC pay rate (Lower).

[FormerMember]

Let's play VA math. 20 +20= 36. Do the bilateral gig for 3.6% and hold that (40%). 10 +10=19 so you get another 1.9% /// 40 + 20= 52; 52+10=57; 57 + 10= 61; 61+10 = 65% rounds up to 70%. You have it on paper but you have the "independently rateable" hurtle of three different diseases. You fall afoul of trying to count up different anatomical segments or bodily systems.

If you only take the highest (independent) ratings from each bodily system (anatomical segments), you have 20% (Left lower radiculopathy) +20% (lumbosacral strain)+ 10% (Chondromalacia) +10% (left shoulder condition)= 53%.

[whoami?]

Thanks for your help asknod.

Edited July 18, 2015 by whoami?

[broncovet]

As Wac Vet said, "independently ratable" does not say whether they are added or combined above the 100 percent. You see, once you get to 100 percent, the whole man (VA math) falls apart, because you would never be able to go above 100%. In other words 100 percent combined with anything else is always 100% combined. We see that to a lesser degree when a 90% Vet tries to go to 100%. It takes a full 50 percent additional to go from 90 to 100 percent, because there is only 10 percent "left". However, unless the 100 percent is "reset" to zero, (which is what the VA wants to do, as it results in lower compensation) then you would always be adding "0" to the 100 percent. Example. The Veteran is 100 percent and gets an additional 90%. 90% of 0 is still zero.

Its an interpretation that Im not sure has been addressed by CAVC yet, whether that means added or combined. Of course, VA interprets it to mean "the lowest possible payment to the Veteran", while the BOD suggests that it be the higher number.

[HitemStraight]

It appears that if you were combined and then rounded to 60% you should be eligible for SMC-S. I would file the NOD before the one year time frame anyway; possibly a CUE?

I have a somewhat similar situation with SMC-S where they awarded it for rehabilitation periods after surgery, then they took it away ....

I am 100% P&T, which was awarded in 1980 for back and neck conditions. I filed a claim in Feb, 2014 and was recently awarded retro-active SMC-S for two total hip replacements. One surgery was in the Fall of 2004, and one in the Spring of 2006. SMC-S was awarded for the 13 months after surgery for each hip for rehabilitation (total of 17 months, as the time frames overlapped) (100% additional for each hip). At the end of the 17 months they re-rated the hips to 30% each, and stopped the SMC-S at that time (effective May, 2006).

I believe the SMC-S should have continued on from May, 2006! If the 30%'s are added, we get ratable 60%. If they are combined, and the bilateral factor is applied to the two 30% ratings, it rounds to 60% also. ((30% and 30% combines to 51%; 10% bilateral is 5.1% = 56.1% rounded to ratable 60%) (100% P&T plus 60% should qualify for SMC-S from May, 2006)) Am I wrong??

Any thoughts?

I am considering a CUE and/or NOD. as well.