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SMC-S, Filing Procedure, and Back Pay

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Ward868

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100% p&t, since 2012... (ptsd)... I want to file for smc-s, but frankly, cant remember how to get the ball rolling... My c&p exam in 2011, clearly stated agoraphobia...Any suggestions, would be appreciated..Also, when approved, do you believe  retro will go back to 2012.. Thank you all, again, for your input, and advice... 

SEMPER FI

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I think we may need more details, but 100% for PTSD alone should infer SMC consideration. Agoraphobia is a cherry on top. If they didn't consider SMC when making your 2012 decision you may have a CUE case.

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Without reading your file, it does sound like a CUE, as VA is supposed to infer SMC S and adjuticate it whenever awarded a single 100 percent disability.  Did they deny it at your decision?  If so, you needed to appeal within a year.  

Just try first, a little sugar.  Apply for SMC S.   Then let em know it should go back to 2012, because you can count on VA to not read your file and see you were diagnosed with Agoraphobia.  

Maybe you wont have to fight the effective date, but VA fights me tooth and nail at every step, service connection, disability percenatage, and effective date every time.  I pretty much have to appeal every condition 3 times:  First for service connection, then disability percentage, then the effective date.  Its the way my RO works, they fight Vets for every nickel.  

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Thank you, for your insight.not sure what forms to file, for smc-s.. award letter never mentioned a word about smc-s, so therefore, i wasnt denied... honestly, didnt know at the time of my award, yhat there was such a thing, as smc-s... any other advice, or insight is greatly appreciated.. thank you !!

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File for SMC S like you would any other claim, using the FDC or intent to file.  It may generate a C and P exam to see if you are housebound "in fact".  Do you have 100% plus an additional 60 percent ratings, seperate and distint from each other?  If so, its a no brainer you should have been awarded statuatory SMC S.

There are 2 ways to get to SMC S. 

1.  Statuatory, that is 100 percent plus a combined 60 percent seperate and distint ratings.

2.  HOusebound "in fact".  This means a doctor would essentially need to certify that you are "substantially confined" to your home.  See Alexs post on SMC S. 

https://asknod.org/2014/08/25/cavc-howell-v-nicholson-what-smc-s-really-says/

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No, only rating is 100% ptsd... can you refer me to law that states, it should have been inferred, and adjuticated, from single 100% rating....i would like to include such law, in paperwork, in case I decide to CUE....Thanks, again...

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Someone at YUKU VBN gave the M21-1MR reference and some legal citations:

If your buddy was diagnosed with PTSD with acute agoraphobia (if that's the case) it's reasonable to argue that SMC-S may be inferred and therefore should have been awarded.

M21-1MR, Part III, Subpart iv, Chapter 6, Section B, 3,d Considering Subordinate Issues and Ancilliary Benefits
"IF a single 100 percent evaluation is assigned in a compensation or pension case, and A&A is not payable THEN ADDRESS ENTITLEMENT TO … Housebound Note: Do not address Housebound if the evidence does not show entitlement exists"

Sometimes raters either seem to skip this step or feel a high threshold exists for the evidence required.

Many vets have successfully responded with a NOD or request for reconsideration, but this would have to be done within the 12 month appeal period, best accompanied with new treatment notes or an outside medical opinion stating the vet is substantially and permanently confined to their home due to their service connected disability.

For purposes of housebound benefits, the Court has held that
being "substantially confined" to the home means an inability
to leave to earn an income. Absent a regulation by the Secretary
defining the term "substantially confined," the Court held that
the term may conceivably be more broadly construed. It found
that Congress intended to provide additional compensation for
Veterans who were unable to overcome their particular
disabilities and leave the house in order to earn an income, as
opposed to an inability to leave the house at all. Hartness v.
Nicholson, 20 Vet. App. 216, 220-22 (2006); cf. Howell v.
Nicholson, 19 Vet. App. 535, 540 (2006)

As Rotor points out, filing a new claim may be successful, but will also raise the possibility of a reduction. When dealing with someone with severe PTSD, it's important not to underestimate the potential adverse mental and physical effects from the stress and uncertainty of a long claims process.

http://vets.yuku.com/topic/121009/Help-with-SMCS#.WJ2gNzsrJhE

I won a SMC CUE but it involved 100% plus 60% yet my long decision (this was part of my Nehmer AO IHD death claim) yet the VA also awarded based on Housebound too but paid only for one SMC S which is correct.

The rating sheet ( a 1998 decision) contained the 100% plus 60 % rating evidence but the veteran was clearly housebound as well.

When I filed the CUE and sent in additional evidence, I worded the CUE for "lack of consideration"of the SMC regulations.My additional evidence had been established and was in V's possession at time of the CUed decision.

BTW-I don't quite agree with what "Rotor" said because if we all feared reductions we would never get what we deserve.

 "My c&p exam in 2011, clearly stated agoraphobia...Any suggestions, would be appreciated..Also, when approved, do you believe  retro will go back to 2012.."

The C & P exam was in VA's possession when they made the decision.

If the agoraphobia was at a ratable level in 2011, then it appears they made a CUE, and if they grant CUE it should go back to the 2012 decision. 

I am not sure if the VA will consider the C & P statement as a diagnosis.But it is worth trying to get SMC S.

The VA is mandated to infer SMC consideration in every case that warrants it by established medical evidence.

 

 

 

 

 

                              

 

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