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Special Monthly Compensation, Please help

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Peaches911

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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

 

 

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On 12/1/2015 at 7:52 AM, broncovet said:

You can try keying your disabilities into "The SMC Formula", here:

 The SMC Formula - NC4VETS NEWSLETTER

This is a power point presentation and you will need power point (or the open office version) to open the file.  

}What level of SMC would this combination be?
}
}Existing:  Schedular ratings: 
}Heart 100%
}Diabetes Type II  40%
}Periphial Neuropathy  10% in each leg
}
}Not rated yet:
}Kidney Failure with 5 exchanges per day done at home – Peritonial Dialysis  should be rated at 100% in the SMC category of disabilities  This is secondary to the primary rated condition of Diabetes
}Aid and Attendance  can’t do all daily activities without help including dialysis exchanges and would have to consider full time home help or nursing home without wife being available for A&A
Thank you, 
Persistant
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Persistant:   Please Ask your question in a "new Topic".  Its confusing when you ask it in someone elses post.  THIS ONE TIME I will answer, tho you will have to start a new post in the future AND you will get more and better answers if you ask your question in a new topic.  

Based on what you posted, you should get SMC L for A and A. The reason is because you said you cant do daily activities without help.  You will need a doctors statement to the effect that you need help with daily activities, and what it is you cant do, and why.  

You can still get A and A if your caregiver is related to you.  See item C, below:

38 CFR 3.352 - Criteria for determining need for aid and attendance and “permanently bedridden.”

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§ 3.352 Criteria for determining need for aid and attendance and “permanently bedridden.”

(a)Basic criteria for regular aid and attendance and permanently bedridden. The following will be accorded consideration in determining the need for regular aid and attendance ( § 3.351(c)(3): inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. “Bedridden” will be a proper basis for the determination. For the purpose of this paragraph “bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others.

(b)Basic criteria for the higher level aid and attendance allowance.

(1) A veteran is entitled to the higher level aid and attendance allowance authorized by § 3.350(h) in lieu of the regular aid and attendance allowance when all of the following conditions are met:

(i) The veteran is entitled to the compensation authorized under 38 U.S.C. 1114(o), or the maximum rate of compensation authorized under 38 U.S.C. 1114(p).

(ii) The veteran meets the requirements for entitlement to the regular aid and attendance allowance in paragraph (a) of this section.

(iii) The veteran needs a “higher level of care” (as defined in paragraph (b)(2) of this section) than is required to establish entitlement to the regular aid and attendance allowance, and in the absence of the provision of such higher level of care the veteran would require hospitalization, nursing home care, or other residential institutional care.

(2) Need for a higher level of care shall be considered to be need for personal health-care services provided on a daily basis in the veteran's home by a person who is licensed to provide such services or who provides such services under the regular supervision of a licensed health-care professional. Personal health-care services include (but are not limited to) such services as physical therapy, administration of injections, placement of indwelling catheters, and the changing of sterile dressings, or like functions which require professional health-care training or the regular supervision of a trained health-care professional to perform. A licensed health-care professional includes (but is not limited to) a doctor of medicine or osteopathy, a registered nurse, a licensed practical nurse, or a physical therapist licensed to practice by a State or political subdivision thereof.

(3) The term “under the regular supervision of a licensed health-care professional”, as used in paragraph (b)(2) of this section, means that an unlicensed person performing personal health-care services is following a regimen of personal health-care services prescribed by a health-care professional, and that the health-care professional consults with the unlicensed person providing the health-care services at least once each month to monitor the prescribed regimen. The consultation need not be in person; a telephone call will suffice.

(4) A person performing personal health-care services who is a relative or other member of the veteran's household is not exempted from the requirement that he or she be a licensed health-care professional or be providing such care under the regular supervision of a licensed health-care professional.

(5) The provisions of paragraph (b) of this section are to be strictly construed. The higher level aid-and-attendance allowance is to be granted only when the veteran's need is clearly established and the amount of services required by the veteran on a daily basis is substantial.

(Authority: 38 U.S.C. 501, 1114(r)(2))

(c)Attendance by relative. The performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance.

 

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