ptsd Requesting review to see if I qualify for SMC-S

[DocC03]

100% TDIU

Schedular rating 90%

70% PTSD

50% Headaches (Reason for TDIU)

10% Ankle

10% Tinnitus

0% Back

0% Hemmorhoids

I have a few new claims going on but I was granted TDIU exactly 2 years ago and all this has not changed since then.

Thanks in advance.

[john999]

I just sent in a letter to the VARO and asked for "S" when I got an extra 60% and quoted Bradley vs Peake.   Then I got "S" plus 2 years backpay and they called it a CUE because they are so negligent that they don't check your rating for possible SMC until you bring it up.   You get the money for being Housebound but don't expect the VA to consider you housebound unless you are actually bedridden.  They still expect you to make it to your C&P exams and appointments even if you die getting there.   Muhammed does not go to the mountain, but mountain (vet)  must go to Muhammed be he housebound or not.

 

[DocC03]

So I just received my denial letter for SMC-S. This is the reason for denial

"Entitlement to SMC-S is not warranted because the criteria regarding housebound have not been met. There is no indication that the claimant is substantially confined to his dwelling and immediate premises due to disability, nor does he has a singe service connected disability rated as totally disabling and additional service connected disabilities that are independently rated as 60% disabling. Review of record of evidence shows individual unemployability was granted based on your service connected PTSD AND muscle tension headaches. This does not meet the criteria for SMC under Bradley vs. Peake. TO be qualified under this court ruling individual unemployability has to be granted based on one condition considered totally disabling, not a combination of disabilities."

Thought on this??? 

Is this correct? 

Should I dispute this or did they handle this correctly?

Thanks

Doc

[TALON II FE]

I wish I had an answer for you, good luck!

[FormerMember]

Well, now. Here's a classic example of why a lot of us here are leery of tossing out advice when we haven't seen the ratings sheet or someone gives us incomplete information. You will notice I said you would be entitled to SMC S if, and only if, the VA did NOT combine the PTSD with the migraine headaches. It hinges many times on the order in which they are awarded. For example, if you filed for, and were awarded the headaches first, and were awarded the PTSD later, it could never be said that the headaches were secondary to PTSD. On the other hand, if you were awarded the PTSD and the migraines simultaneously, or the PTSD prior to the migraines, they could be combined as you can review  here in 38 CFR 4.124a:

Diagnostic Code8045 Residuals of traumatic brain injury (TBI):
There are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation.
Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”
Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified".However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table
Evaluate emotional/behavioral dysfunction under § 4.130 (Schedule of ratings—mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” Having all the facts as well as the c-file is the gold standard for making a cogent decision in this business. I profoundly apologize for the advice offered but I can only opine on the facts given.

[DocC03]

No apologies needed. I reviewed the previous rating before I filed and I overlooked the part where the decision was based on both.

When I read the C&P notes from the TDIU decision it was clear that the doctor stated I was unemployable due to headaches and that I WAS NOT unemployable due to PTSD.

It's a learning experience for me as this is all new to me.

I am still confused on how the C&P says that PTSD DOES NOT keep me from working but the rater decided it does???

The following is what was in my TDIU C&P. This is where the confusion comes in. If you read this you will understand why I feel that the decision to deny SMC-S was done in error.

HEADACHE C&P NOTES: Veteran's headache condition impact his or her ability to work? [X] Yes [ ] No If yes, describe the impact of the Veteran's headache condition, providing one or more examples: the veterans headache condition at this time makes him unemployable, his daily severe pain prevents his ability to work a full time job. He can manage a few hours occasionally but could not be expected to work a full time job. He has these severe headaches daily, he has reported to his PCP that his headaches were preventing him from working, he is on SSDI due to his headaches as well. he has tried multiple modalities to improve his headahce condition and he states he hopes to find out what is causing them so they can be treated and he can get back to work, however at this present time he cannot work a full time job because of his headache condition.

 

PTSD C&p NOTES: Regarding Individual Unemployability: Veteran reports that most of his impaired functioning at this time is secondary to his headaches, however this is deferred to medical opinion. Independent of his physical limitations, he is independent in his ADL's. He remains capable of completing multi-step well learned tasks. His concentration, persistence, and pace can be expected to be moderately impaired in a work setting secondary to his PTSD symptoms. Given his PTSD symptoms, he would work best away from the public and independently, but is capable of superficial interaction with a few co-workers.

Edited April 26, 2016 by DocC03