ptsd Special Monthly Compensation, Please help

[Peaches911]

Good Evening Everyone!

Okay I have a few questions regarding my Disability claim as well as my husband.  First let me start off by listing all my  service connected disabilities:

1.) PTSD-100%

2.) 60% Asthma

3.) 50% Migraines

4.) 50% Endometrosis with IBS

5.) 10% Eczema

6.) 10% Rt. Knee

7.) 10% Left Knee

8.) 0% scar left breast

9.) 0% hernia

10.) 0% rt breast scar

 

I'm currently rated 100% SMC S and I'm paid at the housebound rate.  I'm a little confused.  Another veteran told me I should be rated L or L1/2 because I was getting paid the housebound rate prior to Migraines and Asthma being increased from 10% to now 50% and 60%.  Is this true?  I read on one forum (can't remember where) that I should receive the letter S and 3 K's which ultimately equals L.  Just confused.

 

Also, my husband was medically retired due to Lupus.  He's currently rated at 100% for Lupus and 100% for Depression.  I recently applied for Aid & Attendance because with two kids and my own disabilities (no family within 2 1/2) its extremely hard.  When he has flares he can't do anything.  He has flares anywhere from 2 to 3 times a month lasting anywhere from5 to 7 days.  His civilian dr filled out the Aid & Attendance form and explained how bad he needed this benefit.  Well of course the VA denied it.  They stated Aid & Attendance is for someone in regular need of assistance.  They also stated since he can walk with a cane 25 ft he doesn't need it as well.  I'm really at the end of my rope with the VA.  To add insult to injury, when I filed a claim for his kidenys (he has stage 3 kidney failure) they said that falls under Lupus.  I understand if I opened a claim regarding back, joint or neck pain, but Kidney failure!  We have a two young kids and we will make due, but I can't make it to my MST meetings unless I have someone here with my husband. Sorry, folks I had to vent.  Please help

 

 

[Chuck75]

If a veteran has this many ratings and qualifies for the SMC S's L's L1/2 K's and so on ect,,ect,,such as this veteran

Is it the VA Duty to assist the Veteran in this? and put it together and explain it to the veteran?

It is. The problem i to define the level of help required by law. The VA's idea of "help" can be radically different than that you or I might consider help.

"We sent you the form(s)", that's "Help"

Actually, if you want to require a bureaucrat to do something, you need to exactly spell it out. Otherwise, the requirement will be minimized, or conversely, interpreted in favor of the bureaucrat or governmental entity. If the non governmental party involved has significant political clout, things can change.    

[jmmrlnd]

Hi, I am Jim Moreland,  lupus 100%, 70%, SMC L, K. I am in.the process of applying for increase in SMC  as I write. I am a Physicians Assistant with ober 30 years of experience. If I can be of any assistance let me know. 

Sincerely

Jim

[broncovet]

I just read this again.  You posted, 

 "His civilian dr filled out the Aid & Attendance form and explained how bad he needed this benefit.  Well of course the VA denied it.  They stated Aid & Attendance is for someone in regular need of assistance.  They also stated since he can walk with a cane 25 ft he doesn't need it as well.  "

YOu need to file a NOD if this decision was within a year.  The VA has to rate ON THE CRITERIA.  You can read the criteria again, but I did not see "must be able to not walk 25 feet without a cane" as the criteria.  That is a bogus denial.  The VA can not say, "We are denying you because you have purple spiked hair and root for the Panthers in the Superbowl.  We dont like that"

If you read BVA decisions, they often say, "the criteria for xx has (or has not) been met".   The law is simple:  YOu meet the applicable criteria you get the benefit.  If you dont meet the criteria, you do not.  If your ability to walk 25 feet is not one of the criteria, then it can not be used as a reason for denial.  I would insist they rate you on the criteria only, Panther Fans will get their justice on Feb. 7, not in a VARO rating decision.    

Edited January 26, 2016 by broncovet

[broncovet]

If your medical exams are ambigious and dont clearly state the need for A and A (or what level of A and A), then you need to cure that ambiguity with another medical opinion, that is, an IMO/IME or even VA doctors written opinion resolving the ambiguity in your favor.  

If you dont have a copy of your cfile and medical records, then you should get one.  

[broncovet]

Note the criteria says "regular need of aid and attendance".  Regular does not mean "constant" need, and it does not necessarily mean you can not walk over 25 feet without a cain.   You could well need help changing bandages or other medical equipment, and still be able to get up and walk to the bathroom without assistance.  It says "regular", not constant.  

The VA denied mine because they say I was not bedridden.  That is also a bogus denial.  If you carefully read the criteria, bedridden is not required.  It says "ONE" of these on the list and bedridden is on the list. A Veteran can get A and A and not be bedridden by simply meeting one of the "other" criteria on the list.  

[jmmrlnd]

Broncovet gives solid advice and shows command of the regs. Medically speaking lupus effects all systems of the body. The criteria for SMC L or higher are spelled out and lupus rated at 100% aottomatically should qualify you for SMC L. Read again those criteria that qualified you for lupus 100%, in that you need the assistance of another to make it through your day. I have to believe you have the genuine need for SMC L OR you should never be rated at 100%.  I hope this makes sense, if it does then let's put our heads together and figure out your pathway. Broncovet is right on in what he is saying. Best of luck.