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[Guest rickb54]

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Edited February 19, 2007 by rickb54 (see edit history)

[rigo]

rickb54, you are right, you can acquire Housebound Benefits two ways:

First: The veteran has to have a single service-connected disability rated as 100 percent and an additional service-connected disability (ies) (involving different system) that independently ratable at 60 percent.

Second: The veteran has a single service-connected disability rated 100 percent disabling and the veteran is permanently housebound because of a service-connected disability or disabilities.

The requirement of being permanently housebound is met (1) when the veteran is "substantially confined as a direct result of service-connected disabilities to his dwelling; (2) it is reasonably certain that the disability or disabilities will continue through a lifetime.

Manual M21-1MR provides that whenever a single disability is assign a rating of a 100 percent, the VA should consider entitlement to housebound benefits and aid and attendance, as inferred issues.

[jessejames]

On the intrepretation in dispute, I have personally been through this and have the SMC for housebound. The correct intrepretation is; you must have one disability rated at 100% PLUS one totally separate or multiple totally separate disabilities rated at 60%. And this 60% is figured using "VA Math", not simply by adding for instance, 3 20% disabilities.

[Philip Rogers]

rigo,

Yes I know there are two ways.. but I didn't read this the same why you did.

I read it as:

1. housebound is payable to a veteran rated at 100%

OR

2. housebound is payable to a veteran with multiple 60% ratings.

Sorry to butt in here, Rick - I agree with your interpretation, however if they are talking USDVA benefits they are in error. If there are state benefits, it may be correct. If you look at unemployability, it is wrong (actually partially right) for USDVA benefits but if there are state benefits it may be correct. jmo

pr

[Berta]

I interpret this exactly as Rigo did and that is how I understand the regs in 38 USC 1114.

The VBM always has additional information on these regs and also some good advise as to how to request Housebound or A & A , etc.

The VA is to infer SMC issues whenever the circumstances require this-

especially when the vet is 100% for one SC and then at least 60% for a separate SC.(which could include Section 1151 disabiliies.)

This is the point of one my CUE claims at the VARO.

Rod was 100% SC for PTSD and well over 100% under Section 1151.

VA said he was not eligible under any circumstances for SMC. I intend to see them eat those words.

I supported my CUE claim with section of M21-1 , a General Counsel Pres op and referred them to 5 BVA decisions.

M21-1 has an interesting statement- (Part VI- March 19,2004)

Under Inferred Issues and Ancillary Benefits, they state:

"An issue is sometimes derived from the consideration or outcome of a related issue."

I highlighted that statement as it was critical to my CUE.

VA says the vet never filed a Section 1151 claim in his lifetime.They denied accrued benefits on this basis.

The veteran's Section 1151 claim is right in his c file. A former VSM sent me the entire c file and it was right on top and had been in the rating board for 3 months when he died.

[Philip Rogers]

Thank you for all the replies.

I agree with every reply. Philip raises a good point in that this source may be talking about state benefits and if not state benefits have misquoted USDVA rules.

Ok... Then for the purposes of discussion;

Could you see a veteran with two seperate 60% ratings, for two seperate body parts (ie: back, Lungs) with loss of use of a foot, who is wheelchair bound,( with TDIU)be considered for housebound, especially when the veteran does not leave home except for medical appointments. In light of the rule requiring a single 100% plus 60% rating, would it benefit the veteran to request Housebound.

If it were me I'd apply. Worst scenerio the claimant loses. I feel very strongly about the HB postings I made previously. The BVA case I'm refering to still hasn't been posted. I think it takes them a couple of months. I'd also apply for A&A if claimant isn't already receiving. jmo

pr

[sixthscents]

OK, I need help here too...

After a great deal of research I know I am entitled to housebound under a single rating of 100% + 60% or more (actually 70%) of different etiology, or different systems etc.

I am currently being paid at the 100% + 50% rate L1/2

What is the smc rate for housebound. From what I can see its R1...

Is this correct, and if not what the heck is it?

As I understand the reg, I do NOT need a doctors opinion, it is presumptive at 160% combined. So, I would guess i just kindly point out that they made a rating error when they rated me at L1/2 (which was L until I pointed out the 50% rule)...

Sorry for such a noob question but nowhere could I find where it said what the smc rate would be.

Bob Smith

[Berta]

The VBM , pages 334 to 357 has considerable info on these types of SMC.

I am stuck on this :

They define the L1/2 and also put (P) before L1/2 on it-page 349

Under the P award , additional disabilities can be expanded-page 353-

Do you have a copy of the VBM? detailed info on these types of claims.

[Philip Rogers]

OK, I need help here too...

After a great deal of research I know I am entitled to housebound under a single rating of 100% + 60% or more (actually 70%) of different etiology, or different systems etc.

I am currently being paid at the 100% + 50% rate L1/2

What is the smc rate for housebound. From what I can see its R1...

Is this correct, and if not what the heck is it?

As I understand the reg, I do NOT need a doctors opinion, it is presumptive at 160% combined. So, I would guess i just kindly point out that they made a rating error when they rated me at L1/2 (which was L until I pointed out the 50% rule)...

Sorry for such a noob question but nowhere could I find where it said what the smc rate would be.

Bob Smith

I'm fairly positive it is an "s" award. If you go to the US code, 1114(s) covers 100+60 for housebound. That's why it's called an "s" award. You state you're 100%+50% or is that an error? Housebound for a single vet is $295 and that's the housebound rate. All the letter ratings are found in US code 1114. jmo

pr

[Dorothy Kansas]

The independent 50 or 100 rule only apply when rated L or higher.

You can not build on the housebound rating and its less than the "L" award.

[Philip Rogers]

The independent 50 or 100 rule only apply when rated L or higher.

You can not build on the housebound rating and its less than the "L" award.

Dorothy - I looked thru 38 USC 1114 and don't see any mention of "the independent 50 or 100 rule," only the 100+60. My USC is the 2000 edition. Is this a more recent change?

pr

[sixthscents]

. However under USC CFR 38 3.350 Paragraph (3) the following applies:

(3) Additional independent 50 percent disabilities. In addition to the statutory rates payable under 38 U.S.C. 1114(l) through (n) and the intermediate or next higher rate provisions outlined above, additional single permanent disability or combinations of permanent disabilities independently ratable at 50 percent or more will afford entitlement to the next higher intermediate rate or if already entitled to an intermediate rate to the next higher statutory rate under 38 U.S.C. 1114, but not above the (o) rate. In the application of this subparagraph the disability or disabilities independently ratable at 50 percent or more must be separate and distinct and involve different anatomical segments or bodily systems from the conditions establishing entitlement under 38 U.S.C. 1114(l) through (n) or the intermediate rate provisions outlined above. The graduated ratings for arrested tuberculosis will not be utilized in this connection, but the permanent residuals of tuberculosis may be utilized.

PLEASE NOTE THE FOLLOWING: the disability can be single or a combination adding up to 50%..That’s what “additional single permanent disability or combinations of permanent disabilities independently ratable at 50 percent or more” means…

OK so for all of you confused... you can take an SMC and go to the intermediate rate with additional 50% ratings. I am sure of this since the VA recently approved my claim... but

I am actually 170% scedular...

Now housebound is a seperate rating... it has to be in excess of L1/2... I mean it really must, and the guidance for it is 100%+ 60%, or 100% and a doctors statement showing why you are housebound etc. This statement is NOT needed for someone who has a 100% rating and a combination or individual rating equal to or in excess of 60% which derives from different injuries, systems or illnesses.

Again my question remains... what is the SMC rate... it almost cant be less than L1/2, that makes no sense...well it could I suppose but.. I cant find anywhere that it states the rate. While USC 39 does say (s), its at the ens of a sentence and does not say smc (s) etc. The housebound rate is to pay for the additional care necessary... hence my belief that its R1 or R2.....

[Pete53]

My Gatekeeper Doc at VA called me this morning and has completed the physicians statement required for A&A. She said she would mail it today. I plan to apply as soon as I get the Doc's Statement.

If I get the award I plan to Appeal and request that I be awarder back pay to the time I was originally declared 100% because the VA did not look into it although my diagnosis included agoraphobia.

[sixthscents]

OK, after more than a little research... I am left with the following conclusion. Housebound rate of s is lower than L1/2. Nope it makes NO sense but... thats the case. Title 38, section 1114 (s) is clear on it, and I followed the historical path backwards thru the comp rates to 2002. So I am actually being paid More $3,473 at L1/2 than I wouls be under (s)....

Makes no sense.. but go figure.

[john999]

Peter

I think you have a good shot at HB because you are 100% schedular.

[Dorothy Kansas]

Sixthsense, once you qualify for "L" or higher the housebound rating becomes a moot issue. just like if you special adative housing grant and special adapted housing. If you get the special adapted housing the grant is moot. I MUST REMIND EVERYONE THAT YOU CAN NOT BUILD ON THE HOUSEBOUND RATING.

[Berta]

Thanks for making that point Dorothy-

You and Rich are sure our SMC experts -as well as others here-

I am glad you reminded all-

SMC "S" is not part of the "building block" potential of other SMC awards.100% for one SC and then 60% or more for additional independent SC (including "as if" SC under 1151) is the "S" award.

The VA could try to award me SMC on my CUE claim accrued for Rod and never considered-

100% under Section 1151 Plus 100% under SC PTSD-they could try to say it is the "s" award but I told them I won't accept "S".

The med evidence reveals well over 100% catastrophice disability that VA already admitted they caused -as well as Rod's death.

Anyone with both SC and Sec 1151 awards should not overlook the fact that Section 1151 disabilities can become part of an SMC award.

I have specific M21-1 regs, a GC pres Op, and four or five BVA decisions that prove that point if anyone needs-

Edited December 19, 2006 by Berta (see edit history)

[Philip Rogers]

Sixthsense, once you qualify for "L" or higher the housebound rating becomes a moot issue. just like if you special adative housing grant and special adapted housing. If you get the special adapted housing the grant is moot. I MUST REMIND EVERYONE THAT YOU CAN NOT BUILD ON THE HOUSEBOUND RATING.

Couldn't you get an "L" award and an "s" award? I think you can get a "k" award, with another SMC award, so why not an "s" award?

pr

[sixthscents]

No, you cannot build upon the s award... essentially how SMC works is the lowest award k is rated, and then built up level by level depending upon the circumstance. What I have learned and has been shown here is that the smc rating of s is not a "buildable" rating. Once you hit the L rating, the money is greater than the s rating, so it becomes a "moot" point as stated by another post.

I am not sure what was meant by the adaptive housing grant/ vs adaptive housing. I have the adaptive housing grant, and the adaptive vehicle.... but what is the adaptive housing that was referenced earlier? The only other grant that I know of is HISA, and that CAN be added to the adaptive housing grant. Further, under the new law, the adaptive housing grant can be splint into three uses, combined which are not to exceed the 50K limit.

Is there some fund that pays to rent adaptive housing etc.? If so its the first I have heard of it.

Thanks for the help.

Bob Smith

[Dorothy Kansas]

The special adapted grant is the smallest I believe 11,000 it is given to blind veterans. The adapted housing is 50,000. If you arer awarded the big one the little one becomes a moot issue. You can use HISA anytime it is not included in the SAH or grant.

[shag]

OK, after more than a little research... I am left with the following conclusion. Housebound rate of s is lower than L1/2. Nope it makes NO sense but... thats the case. Title 38, section 1114 (s) is clear on it, and I followed the historical path backwards thru the comp rates to 2002. So I am actually being paid More $3,473 at L1/2 than I wouls be under (s)....

Makes no sense.. but go figure.

see the following quote

Vike,

Thanks for firing this right back. I appreciate it. To some extent you have answered my question. Nevertheless, everybody I talk to at the VA seems to have each his or her own translation of the regs.

Yep. What Dave said was pretty straight forward. But, how is the SMC computed? One argument with VA is that the Congress would not give authority for each person handling a claim to arbitrarily assign an amount to SMC. The rate is and has always been set in statute extending back to 1925. Now considering that the system, according to the experts in this, has not been altered in its essence (i.e. there is the schedular system, the (added) Special Monthly Compensation system, and what has now become an SMC but is the A&A/Housebound Rate.). For instance, there is there is a specific amount provided by the Schedular Rate Table (the 0 - 100% scale) for each 10 percent increment of disability. The same holds true for the Special Monthly Compensation Rate Table. Each sub-paragraph (lettered K-S) has a specific amount of compensation assigned to it. Now, the problem is this. VA reps seem to be trained to subtract the schedular rate from the SMC rate in order to come at the amount of SMC. After MUCH research, it is impossible to find where that formula might be found. What can be found is this from the VA 2004 Legislative Study of the Comp System. The study was done for

VA Office of Policy, Planning and, Preparedness

"Benefit Amounts and Disability Rating Schedules

Over the years, one of the best indicators of the intent of Congress regarding the purpose of disability compensation has been how it sets compensation. The following section shows how compensation rates for specific disability percentage ratings have changed over time.

In August 1939, Congress published a rating schedule that was to become the basis for future increases in the rate of compensation to disabled veterans (Pub. L. No. 76-257). One of the most striking features of this schedule was its perfect linearity, beginning at $7.50 per month for a veteran with a 10% disability, increasing by $7.50 for each additional 10 percent, and topping out at $75 per month for a 100% disability rating.

Even though basically linear, certain kinds of disabilities received additional compensation. For the loss of the use of an eye, foot, or hand, monthly compensation was $18.75 per month. For loss of the use of both hands, both feet, or some combination thereof and in need of “regular aid and attendance,�� the monthly amount was $112.50. At the high end, for severe disability, monthly compensation was $187.50.

Although for losses such as those indicated, there were increases in compensation, as shown in Figure 4, the basic linear model persisted until 1957. Beginning in 1957, Congress introduced differentiation for veterans who were 100% disabled. This may be a response to the Bradley Commission report, which showed, among other things, that veterans’ median

annual earnings were substantially lower for those rated at 100% disabled."

Thus, it would seem that once the 100% schedular rate has been reached, (the compensation table does not convert, nor does it disappear, rather it becomes a given). Then, the Special Monthly Compensation is added to that (100% schedular) by the specific amount stipulated by the SMC letter designation.

To further expound on this. When looking at the way the rate tables were set up initially, it is not hard to notice that the schedular scale was and is separate from the SMC scale. For instance, to get to the $187.50 amount mentioned earlier, the 100% schedular rate of $75.00 was added to the Special Monthly Compensation amount $112.50. What follows is another quote from the same study:

"Congress could have built these exceptions into the rating schedule itself but did not. For example, if losing the use of an eye, hand, or foot is to be compensated an additional amount per month, one approach would be to build the additional compensation into the rating itself or similarly specify that a given disability rating be increased by 20 or 30 percentage points to achieve the desired level of compensation. For reasons not evident in the legislation nor in testimony and reports reviewed, Congress instead chose to provide

explicit enhancements above and beyond the percentage disability schedule. Although Congress did not state it directly, it is reasonable to infer that Congress’ intent was to compensate for loss of quality of life."

What say ye

I am sorry, but you are advising vets in error. This has been going on a long time from what I gather