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Do I have a chance at R1 or R2?

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USMC EOD

Question

I received my approval for 100% T&P back in May 2014. Like many Veterans, I perceived the 100% rating as the end of the line. Although I thoroughly researched the 38 CFR, I neglected to consider filing a NOD, review the SMC and other benefits. I just assumed that 100%was the highest level of compensation available.

My question is this, Do I qualify for the SMC R?

At present I am receiving SMC (K-1) on account of loss of use of a creative organ. Additionally, my cervical spine condition has worsened. Presently suffering from loss of feeling and strength in my right arm and constant lower back pain. Receiving weekly treatment from a Spine treatment specialist through Tri-Care. Does this show cause to file for SMC R1?

After reading these posts I am also sick over my having followed the advice of my VSO on not filing a NOD for conditions I was treated for while on AD.

Please advise, your assistance is greatly appreciated.

Semper Fi!

70%=

PTSD

50%=

Sleep Apnea

40%=

Lumbar Spine

20%=

Hematochezia

20%=

Right ankle arthritis

20%=

Cervical spondylosis

20%=

Radiculopathy, right upper extremity

10%=

Tinnitus

10%=

Radiculopathy

10%=

Left wrist tenosynovitis

10%=

Left ankle arthritis, status post fracture

10%=

Right elbow olecranon bursitis

10%=

Deviated septum, traumatic

10%=

Painful scar of right axilla

0%=

Right hand DeQuervain's tenosynovitis

0%=

Erectile Dysfunction

 

Not Service Connected=

Renal cyst

Not Service Connected=

Right knee patellofemoral syndrome

Not Service Connected=

Hypermetropia

Not Service Connected=

Migraine headaches

Not Service Connected=

Left shoulder acromioclavicular

Not Service Connected=

Left knee condition

Not Service Connected=

Right wrist condition

Not Service Connected=

Epididymal cyst/spermatocele

Not Service Connected=

Right shoulder rotator cuff impingement

Not Service Connected=

Bilateral hearing loss

Not Service Connected=

Bilateral cubital tunnel syndrome

Not Service Connected=

Traumatic brain injury

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The very first prerequisite for R-1 is to obtain a "O" rating. Read CFR 3.350 - 3.352 for eligibility rules.

You don't mention anything about SMC "S" that you should qualify for, and you might qualify for regular A&A, depending upon your individual circumstances.

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I think you might qualify for "L", (might) only because of this BVA decision that makes it clear that "L" can be awarded even if the 100% disability is not for one specific disability:

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp16/Files3/1624771.txt

But it pays to read the SMC info carefully here and even in BVA decisions because it can be confusing.

 

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10 hours ago, USMC EOD said:

I definitely do not qualify for "S", but after further review, I think I qualify for "L".

OIG Investigation at various RO's have found that if you are rated 100% PT; you are  entitled  to SMC "S"  BUT the RO's are failing to award based on thinking you need an additional 60%.    If you do not leave your house for "work", you should be awarded SMC "S".

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32 minutes ago, THOMAS89031 said:

OIG Investigation at various RO's have found that if you are rated 100% PT; you are  entitled  to SMC "S"  BUT the RO's are failing to award based on thinking you need an additional 60%.    If you do not leave your house for "work", you should be awarded SMC "S".

 Hold on here Hoss

How long ago was this? I mean if they are suppose to give the SMC -When I veteran gets P&T  And usually the only way to get P&T IS TO BE RATED 100% or TDIU.

I have been rated TDIU P&T the last 13 1/2 Years concurrently and never was awarded the SMC-S???during this time

I get it now only b/cLast year I filed a PTSD Claim and got 70% on top of my TDIU P&T And that's a mandatory rating  b/c the criteria was met for the SMC-S

When or where do the CRF'S Mention a veteran gets P&T  Then he should also qualify for SMC?

I need to know this  hell I might ask them hey where is my SMC BACK PAY THE LAST 13/1/2 YEARS.

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Buck, maybe this will help....

 

23Share Receive Updates Gov bubble 20px
 

Review of VBA’s Special Monthly Compensation Housebound Benefits

Veterans Affairs Office of Inspector General (OIG) sent this bulletin at 09/29/2016 03:20 PM EDT

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You are subscribed to Oversight Reports for Veterans Affairs Office of Inspector General (OIG). This information has recently been updated, and is now available.

09/28/2016 08:00 PM EDT
 
We conducted this review to determine whether the Veterans Benefits Administration (VBA) properly granted entitlement to all statutory housebound special monthly compensation (SMC) benefits for living veterans with a single disability rated as 100 percent and one or more disabilities independently rated at 60 percent. This review focused on whether VBA failed to pay or delayed paying any of these benefits. We also assessed the accuracy of SMC evaluations for veterans receiving compensation at the housebound rate, including statutory housebound, and housebound in fact, as well as SMC that had been incorrectly coded as housebound benefits. We conducted our review from March 2015 through February 2016. Our first review objective focused on a population of about 186,000 living veterans’ cases nationwide that at some point were entitled to statutory housebound SMC benefits based on a single disability rated as 100 percent and one or more disabilities independently rated at 60 percent as of March 10, 2015. To address our second objective, we reviewed a population of about 98,400 veterans’ cases nationwide receiving compensation at the housebound rate for any reason as of March 10, 2015. To accomplish our objectives, we reviewed applicable laws, regulations, policies, procedures, and guidelines. We also interviewed appropriate VBA management, employees, and other officials. We conducted onsite interviews with VBA management and staff at eight VA regional offices from September through November 2015. The VA regional offices in Atlanta, GA; Cleveland, OH; Lincoln, NE; Nashville, TN; Saint Petersburg, FL; Seattle, WA; Waco, TX; and Winston Salem, NC, were selected based on having the most cases in our samples. We reviewed a statistically selected random sample of 250 cases with eligibility to statutory housebound benefits, based on veterans having a single disability rated as 100 percent and one or more disabilities independently rated at 60 percent as of March 10, 2015. We also reviewed a stratified random sample of 247 cases of veterans receiving compensation at the housebound rate and grouped according to their combined evaluation. We reviewed the claims folders and electronic records for each of the cases and sought to determine whether they had been accurately worked. For more information on the scope and methodology of this review, go to Appendix B. We identified errors in 45 of 250 cases (18 percent) in which veterans were entitled to statutory housebound benefits based on having a single disability rated as 100 percent disabling and one or more disabilities independently rated at 60 percent or more. Errors included failure to grant housebound benefits, failure to pay housebound benefits that had been granted, and prematurely reducing housebound benefits. We also found errors in 127 of 247 cases (51 percent) in which veterans were being paid compensation at the housebound rate. In 10 additional cases, we could not determine whether housebound in-fact benefits were accurate because VBA’s eligibility criteria were unclear. We identified different error rates within each group of our stratified sample. As a result, we estimated an overall error rate of 10 percent for veterans being paid compensation at the housebound rate, and a 27 percent error rate for veterans with combined evaluations that were 90 percent or less. Generally, the inaccuracies we identified involved housebound benefits for unemployable veterans, entry of SMC codes into the electronic system, and housebound benefits on an in-fact basis. Generally, VBA staff failed to grant statutory housebound benefits because they overlooked the issue, and VBA’s electronic reminder was ineffective. Errors for veterans being paid compensation at the housebound rate were due to ineffective training and a multi-step process for entering temporary housebound codes in the electronic system. VBA staff were also confused as to the requirements for use of the SMC Calculator. Finally, VBA has not clarified the meaning of “substantially confined” for housebound in-fact determinations. Veterans entitled to statutory housebound benefits did not consistently receive correct benefits decisions. Based on sample projection results, we estimated errors in 33,400 of 186,000 cases. We estimated that these errors resulted in veterans being underpaid $110.1 million through February 2015, and receiving recurring underpayments of $1.8 million per month as of March 2015. In addition, we estimated that VBA staff delayed paying veterans $54.3 million. Errors for veterans receiving compensation at the housebound rate also resulted in incorrect benefits decisions. Based on sample projection results, we estimated errors in 2,600 of 9,800 cases for which veterans’ combined evaluations were 90 percent or less. We estimated that these errors resulted in veterans being overpaid $44.3 million through February 2015, with ongoing overpayments of $1.1 million per month as of March 2015. These overpayments included $21.4 million in benefits that were improper, which were ongoing at a rate of $678,000 per month. The remaining overpayments of $22.9 million were not supported by adequate documentation and were ongoing at a rate of $427,000 per month. Veterans’ monthly recurring overpayments generally continue for at least 5 months. We recommended the then Acting Under Secretary for Benefits establish plans to update the electronic system, conduct reviews of cases in which housebound benefits are being paid, provide updated training, remind staff to use the SMC Calculator in all SMC cases, and clarify the meaning of “substantially confined.” The Principal Deputy Under Secretary for Benefits concurred with our recommendations and stated that VBA will conduct an annual review of SMC housebound benefits with the initial review in October 2016, and then, each October thereafter. Compensation Service has provided business requirements for changes to the Veterans Benefits Management System Rating application to prevent staff from completing a decision without considering potential eligibility to statutory housebound benefits any time a veteran has a single 100 percent evaluation and to add a requirement to discontinue temporary housebound benefits when a veteran no longer meets the criteria. VBA has required decision-makers to use the SMC Calculator and to include the worksheet results in the claims folder. This requirement is included in updated mandatory training for all Rating Veterans Service Representatives and Decision Review Officers. Furthermore, VBA has initiated a working group to clarify the statutory term “substantially confined” to ensure consistent application of this benefit. VBA plans to complete these actions by December 2016. Finally, the Principal Deputy Under Secretary for Benefits stated that VBA has identified approximately 11,600 veterans being paid compensation at the housebound rate with a combined evaluation of 90 percent or less. VBA will review the cases and certification will be provided to the OIG. The target completion date for these actions is April 2017. The Principal Deputy Under Secretary for Benefits’ planned corrective actions are responsive to the recommendations, and we will follow up as required. To address Recommendation 1, VBA released VBMS 11.0 on June 17, 2016, which included new functionality that prevents staff from completing decisions without considering potential eligibility to statutory housebound benefits any time a veteran has a single 100 percent evaluation. Therefore, we consider Recommendation 1 closed and we will follow up as required.

Update your subscriptions, modify your password or e-mail address, or stop subscriptions at any time on your Subscriber Preferences Page. You will need to use your e-mail address to log in. If you have questions or problems with the subscription service, please contact subscriberhelp.govdelivery.com. All other inquiries can be directed to vaoig.reportsstaff@va.gov.

This service is provided to you at no charge by Veterans Affairs Office of Inspector General (OIG).

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