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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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Ward868

ptsd SMC-S, Filing Procedure, and Back Pay

Question

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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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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To add: 

https://www.va.gov/vetapp16/Files3/1624678.txt

This is an agoraphobia BVA award and reveals the rating schedule for agoraphobia:

“ORDER

 

Entitlement to a rating of 50 percent, and no greater, for agoraphobia prior to May 2, 2008 is granted. “

 

This was not a HB award however, because the veteran’s TDIU claim was not decided yet.

It shows how the veteran got to 50% for agoraphobia.

Also you could formally claim it but I could not find any specific form for HB.If the VA awards the claim, then it would not be too difficult to raise CUE at that point ,it is would warrant more retro.

I cant copy and paste from my M21-1MR,but you can google this:

M21-1MR ,Part III,Subpart IV,Chapter 6,Section B

For more info on what is an inferred issue.

Regarding the VA HB award statement in my Nehmer decision...that resolved my 2 CUE claims regarding SMC, .that was based on extensive documented evidence that my husband was housebound at time of the 1998 decision I CUed. I guess this is why they awarded the SMC CUE both ways.

Was there any other documented evidence in your VA med recs that would support the CUE for lack of HB consideration that indicates you are HB due to the agoraphobia?

 

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Thanks, Berta, for all, your input..To answer your question, ,... I don't if any other documentation exists in my records, claiming reference to agoraphobia, or housebound...The only thing I know for certain is, rating sheet  clearly stated diagnosis of ptsd, panic disorder w/ agoraphobia, major depressive disorder, severe...The va examiner noted you have total social, and occupupational impairment....               So that's all the evidence i have, for CUE, that smc-s, should have been inferred...after reading other posts, don't know if its enough, but i think I'm gonna try...Thanks, again...

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This clarifies everything :

"The only thing I know for certain is, rating sheet  clearly stated diagnosis of ptsd, panic disorder w/ agoraphobia, major depressive disorder, severe...The va examiner noted you have total social, and occupupational impairment... "

It looks to me that they included the agoraphobia within the 100% rating.I have seen that done before.

That is not a CUE.

The VA will only award one MH disability.

You can certainly claim it causes you to be Housebound, but with the 'rating sheet" statement above,I think the C & P examiner based that on symptoms you relayed to him/her

and it might be possible to get the HB award but you would need more evidence for it than what appears to already be considered by VA in the 100% rating.

This is the DBQ for both A & A and HB exams:

http://www.vba.va.gov/pubs/forms/VBA-21-2680-ARE.pdf

In this recent BVA case the veteran was found to be Housebound:

https://www.va.gov/vetapp16/Files3/1622748.txt

The BVA's explanation is this:

"In weighing the evidence the Board observes that the evidentiary information provided in October 2013 by Dr. D. S. as well as by the VA examinations addressed primarily the impact of the Veteran's service-connected disabilities with respect to the Veteran's ability to work. However, in the context of entitlement to SMC based on HB the essential matter is not the impact on the Veteran' ability to work but whether the Veteran is substantially confined to his premises. As to this, the Board observes that the June 2011 VA examination noted that the Veteran was not able to prepare his own meals and needed assistance in bathing and tending to other hygiene needs. Crucially, it was reported that he seldom left his own home and could only walk for less than one block. Dr. D.S. also maintained that the Veteran experienced pain that was intractable and virtually incapacitating. Physical activity, e.g., walking, standing, bending, stooping, and moving his extremities increased his pain to the extent that bed rest was necessary. From the foregoing, and after giving due consideration to the favorable resolution of doubt under 38 U.S.C.A. § 5107(b) and 38 C.F.R. § 3.102, the Board concludes that after May 1, 2011, the Veteran was so functionally impaired as to be substantially confined to his immediate premises due to his service-connected disabilities which remained throughout the Veteran's lifetime."

For my SMC Cue I proved the 100% plus 60% error ( My Husband was at that time 100% SC P & T plus 100% SC 1151 P & T ,as CUE but bolstered my CUE with significant medical evidence (in VA's possession at time of the 1998 CUE) that the veteran was also housebound.

Although he was 100% P & T for PTSD I could not rely on that, but could reply on his 1151 stroke (100% P & T)

BTW all, I am in the midst of my latest battle-3 CUE claims sent last week regarding the 100% P & T under 1151, who the director of my VARO (by ignoring my evidence AGAIN, insisted to me by phone,that their prior rating did NOT mean the veteran was 100% Permanent due to stroke under 1151 when he died.But that he was totally disabled by it.

I have 13 pieces of evidence ( one from a former VA Secretary) that says he was 100% P & T due to the 1151 stroke and three other VA doctors stated that as well.... at a C & P, plus his VOC rehab records, and his student loan waiver was signed by a VA doctor who also clicked on the P & T box on the form.

VA has to cough up their proof of their  "cure" for his 1151 Totally and Permanently disabled stroke- a cure that they never told the veteran about and caused the 1151 stroke in the first place so you would think they would gladly have let us know in the veteran's lifetime that his continuously totally disabled and permanent stroke , had in fact been " cured" because their recent HBP CUE award and that evidence ( From VACO -FTCA case)proves that VA did nothing at all to alter their medical errors to prevent the stroke, and covered up additional malpractice on the stroke and his AO IHD DMII and heart disease.

If you die with a continuous  total SC disability, and VA has not performed a miraculous cure for it, you have also died with a Permanent and Total SC  disability , because it Lasted your Lifetime.

I have never ever seen any decision at the BVA or elsewhere that ever has changed that established medical fact.

This is why you all need to get the spouse up to speed.

If a vet dies with a 100% P & T rating that has lasted ten years, can the VA say to his widow yeah he died with a 100% P & T total rating but it wasn't really permanent when he died.So No DIC for you.

If you die with a 100% P & T rating less than 10 years that VA continually ignores the evidence for, and says it was Total but Not Permanent, is you spouse fully prepared for that ridiculous battle over any accrued amount or potential DIC when you die?

 

 

 

 

 

Death makes a standing 100% award Permanent at death.

 

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Thx, again, berta...I value your opinion, and after reading your last reply, i guess I should forget about a cue, for smc-s...if you don't think its warranted, I'm not gonna drive myself nuts, pursuing it.. maybe, start a new claim, for smc-s, but no cue... appreciate, greatly, your help, and advice, with this matter...

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