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Navy04

Put in for PTSD Increase and SMC L

Question

Due to some good advice and help on here, I decided to put in a claim last week for an Increase to my current PTSD 70% and SMC L. My wife is paid to be my Caregiver thru the VA Post 9/11 VA Caregiver Program. I had my Yearly Reassessment recently and the VA decided to continue my at the highest Tier, and listed me as not being able to Bath, or do activities of daily living without the help of my wife. My PTSD has been very bad for a few years, but I was scared to put in for an increase, as I did not want to rock the boat. As most of you know the VA has done alot to mess with me to include my recently being Reviewed, Even though I am 100% P&T. The VA actually reduced my Scars from 30 to 10% even though the Review Exam was for Urology issues. So I printed out the DBQ and Aid and Attendance forms. I will give those to my VA Docs over the next month or so. I uploaded all the VA Caregiver Assessments which go back to Feb 2014, stating that I need a caregiver full time with activities of Daily Living. Also my wife typed up a 6 page Spouse Support Letter which I uploaded, and my best friend of 30 years is going to write a letter in support as well. It looks like I might have a few surgeries and procedures by the end of the year. I will tackle those with the VA afterwards. I am a nervous wreck and scared to death. This is the first time, that I feel that I am going head first at the VA. Just so tired of them Reviewing this, or doing that every other month. What is the point of being P&T, if I still have to look over my shoulder and sleep with one eye open. I have had more then one good Vet on here tell me to put in for this, and I hope now is the right time. I am going to Upload my SSDI letter that states that I am Permanent for PTSD and found unable to handle finances and daily living activities. I am well documented in the VA system since 2013 with all of my health issues. I really hope this works out, and need you guys to Pray for me. I chose the traditional claim, instead of filing as a FDC due to still needing the DBQ and A&A paper work filled out. You know how long that stuff takes, if I can even get them to fill the paper work out. Thanks again to all on here for the Support, and God Bless!!!

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I'm not sure if you realize this but if you are being paid the SMC T with your wife as caregiver, you are already receiving SMC L in essence- and then some. The award of SMC T is higher than L and encompasses Aid and Attendance.  The requirements for L are 

(b) Ratings under 38 U.S.C. 1114(l). The special monthly compensation provided by 38 U.S.C. 1114(l) is payable for anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less or being permanently bedridden or so helpless as to be in need of regular aid and attendance.
(1) Extremities. The criteria for loss and loss of use of an extremity contained in paragraph (a)(2) of this section are applicable.
(2) Eyes, bilateral. 5/200 visual acuity or less bilaterally qualifies for entitlement under 38 U.S.C. 1114(l). However, evaluation of 5/200 based on acuity in excess of that degree but less than 10/200 (§ 4.83 of this chapter), does not qualify. Concentric contraction of the field of vision beyond 5 degrees in both eyes is the equivalent of 5/200 visual acuity.
(3) Need for aid and attendance. The criteria for determining that a veteran is so helpless as to be in need of regular aid and attendance are contained in §3.352(a).
(4) Permanently bedridden. The criteria for rating are contained in § 3.352(a). Where possible, determinations should be on the basis of permanently bedridden rather than for need of aid and attendance (except where 38 U.S.C. 1114(r) is involved) to avoid reduction during hospitalization where aid and attendance is provided in kind.
3.352 for A&A:
§ 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.
SMC T is awarded on a temporary basis only at several levels (R1 and R2). The highest level of T is the same as R2 or $8,318. 95 per month. You cannot pyramid SMC L on top of SMC T. While it might sound like VA is paying your wife the T, the check is drawn on your entitlement. Eventually, VA is going to find you "better" and take the SMC T away. At that point, if you can establish entitlement to L using any of the scenarios listed above from 3.350(b), you would be awarded it along with any SMC K awards you qualify for as well. 
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Asknod thanks for your info and help as usual. The pay that my wife gets is not an SMC what so ever. It is thru a totally different program called Post 9/11 VA Caregiver Program. The pay is a separate entity and division of the VA all together. The only SMC that I currently get is K for the L Testicular Surgery. Along with advice on Hadit, a few Docs thru the VA Mental Health have asked me to put this in, in the past. I have been very scared, Nervous and did not want to sound ungrateful or rock the boat. Another great fellow Vet on here PMed me and gave me some good insight and advice. I decided to go ahead and hope for the best. I have been so stressed since I pushed the Button last week on Ebenefits. Im Tired, and I mean Tired of the VA coming after me because I am so young. My family and you guys on Hadit give me the strength to get thru the tough days, and I truly mean that. Quick question for you sir, what is the pay for SMC L and the other SMC where a Vet has one single 100% Rating and then a separate 60% rating? I ask cause it looks like I will be having in implant put in my back to make my bladder work correctly, and I am currently 40% SC for the urine issues I have now. So if the SMC L works out and my PTSD gets bumped to 100% and then the Urinary goes up to 60% then I would qualify for the other SMC RIght?  Thanks again, and I could only hope to have your knowledge one day, so that I can help more Vets. 

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Sorry about that. I had to look it up to refresh my memory. My brain box is filled with new info I'm studying for my agent's exam and sometimes it short circuits. Here's the info on the VA Caregiver Platform  http://www.va.gov/purchasedcare/docs/pubfiles/factsheets/factsheet_11-02.pdf

Looks like pay ranges from around $435/month on up to mid-tier ($1,088/month) with a possible high tier of $1,740ish per month. Total, utter disability a la paraplegia/helplessness would rate the SMC T award. 

To address SMC S and L, the current S amount is $3,415.74/month for a married Vet plus comp. for any rugrats. SMC L is currently $3,779.09/mo. with no children. Add about $120 for the first child and $80 for each additional one under 18. Here's the link for SMC amounts- http://www.benefits.va.gov/COMPENSATION/resources_comp02.asp

Investigating further, I note you would not be entitled to the Caregiver program if you were awarded SMC L based on Aid and Attendance as that would constitute pyramiding under 4.14. Again, I stress this is a bridge entitlement that is designed to reintroduce you to society on a temporary financial basis. If you exhibit any ability to work or volunteer for a food bank,  say sayonara to the check. Likewise, if your spouse takes any part-time employment that would cut into the allotted caregiver hours, kiss it goodbye.

Each SMC K award is $103.23 ( above and beyond SMC L) and you could technically have any number of these up until you reach SMC O. If you were awarded two full 100% schedular awards (not TDIUs), you would advance from L to M. If you only had 50% or more disabilities such as the migraine issue, and were awarded L for A&A, you would be advanced to L 1/2 which currently pays $3,966.07. plus the SMC K.

Remember that loss of bladder or bowel control is also a prime ingredient for SMC L. This puts you in a different category as well. If you qualify for two of the ingredients for L,M, N, or O and one of them is A&A, you can advance automatically to R1 for $7,414.70/ month plus kids. Entitlement is a dance with getting good nexus letters from doctors as to your disabilities denoted in minute detail. SMC is one of those gifts that requires you fulfill all the disabilities to qualify-not just some. VA doctors tend to downplay the severity of disabilities. This is why I prefer objective civilian assessments which are not driven by VA politics.

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With all due respect, Alex, no A and A does not require you meet all the criteria, see the red highlight below.  

(Source: 

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.

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Loyal, SMC L is not Aid and Attendance in and of itself. A&A is just one component (the lowest dollar A&A) and begins with SMC L.  I was discussing SMC L requirements alone re N4Life's recent filing. A&A has two higher tiers (R1 &R2/T).  To be awarded L, M, N or O/P, you must qualify completely with any of their listed items. A&A, as a stand alone, is not SMC L but merely a component(one of several) that entitles you to SMC L. I try not to confuse folks with extraneous add-ons or "build-ups" that intensify or bump up SMCs into the higher ratings. Understanding SMC, even without all the little codicils, sometimes takes years to wrap your noggin around. SMC S is simple in comparison. You absolutely have to qualify for the tenets of 3.352(a), or a majority such that a doctor can say you "fit" the criteria, in order to qualify for A&A. However, you could have loss of use of lower extremities or any of the others listed in 3.350(b) and qualify for SMC L but still not be entitled to A&A. If you had loss of use of only one lower (or upper) extremity, you would only qualify for SMC K for that appendage. But presto-if you have loss of use on one lower and one upper extremity, you move to M-again- not necessarily with A&A. Think of A&A as a component part of the family of entitlements in the SMC library. SMC L can equal A&A but A&A doesn't automatically equal SMC L. It can just as equally be a component part of M, N, O/P, R1 and R2/T. Or, your spouse may qualify for it. 

I have to preach to the lowest common denominator or risk the explanation flying over everyone's head due to the complexity of all the possibilities. SMC has more twists and turns than the Mississippi River. Where else can you find pyramiding permissible to reach R1 or R2/T? 

 

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