ptsd Diagnosed housebound in 2008 by VA; is med diagnosis binding?

[Cannabis]

Hi everyone!

I started going to VA in 2008. I just discovered in my medical file that psychiatrist resident, as well as the head psychiatrist approved her diagnosis that I am housebound. That's 2 doctors. Then, over the next 2 years or so, many details in med record support housebound.

Sep 09, filed disability. 50% granted. (ptsd, depression, cannabis dependence)

Approx. May 2015, filed for increase. 100% granted, same as above.

I filed NOD.

My question regards this newly discovered evidence of record that shows since 2008, i was diagnosed housebound.  I also have current evidence of housebound, it's no mystery around here that I don't go anywhere. And haven't for years.

Is the disability examiner bound by this diagnosis in 2008?  If so, then

1. if I am housebound per physician diagnosis in VA medical notes, then how can I be 50%? Wouldn't that defacto be 100%

2. any ideas on approach for this?  NOD with SMC S claim to date back to Sep 09?  Or CUE?  Help!?

Thank you and bless.

 

Edited March 26, 2017 by Cannabis

[Berta]

http://community.hadit.com/topic/51603-does-filing-for-smc-s-jeapordize-rating/

This is one of many CUE scenarios discussed in our CUE forum involving SMC.

A few posts into  that link,. I listed the exact legal evidence I used for my SMC CUE.

"So, this convo needs to move to CUE forum as that is what I am looking at here, CUE in the first decision."

That is where the CUE might lie,in your case.

They made 4 CUEs in the 1998 decision in the above link ,that they granted and I have one more pending.

All of the medical evidence had already been established.

 

Did they have medical evidence at that time that your rating should have been 100%?

If so that would be a valid CUE on that decision and then an additional CUE might kick in the proper SMC EED , as a CUE on the current decision.

What EED did they give you for the 100% in the recent decision?

And what medical rationale did they state for that?

 

 

 

 

 

Edited March 27, 2017 by Berta

[Gastone]

Before you leave, how about posting a redacted copy of the 50% Award Letter and the 100% Award Letter, including the Evidence Reviewed section.

Good luck on the CUE.

Semper Fi

[Cannabis]

Yes, Gastone, good idea. I'm living rough right now but i do have to get to copy/scan/fax soon, so maybe today later I can post it.  Thank you for your help, everyone.

[allansc2005]

Berta/Asknod,

Does the 60% that's needed to get SMC have to come from one condition, or a combination of conditions not included in your 100% scheduler or IU?

I was awarded SMC K-1, but am asking the question to help other vets.

Allan

2-2-0 HUAH!

[Berta]

Maybe this explanation from a recent BVA decision will help:

"A Veteran meets the statutory requirements for payment of SMC at the housebound rate when he or she has: (i) a single service-connected disability rated at

100 percent, and (ii) other service-connected disability (or disabilities) separate and distinct from the disability rated as 100 percent, and are rated at a combined disability rating of 60 percent or higher.  38 U.S.C.A. § 1114(s); 38 C.F.R. §§ 3.350(i).  A Veteran meets the criteria for payment at the SMC(s) rate when, as a result of a single service-connected disability rated as 100 percent disabling, he or she is permanently and substantially confined to his or her place of residence and immediate premises, or ward or clinical areas, if institutionalized.  38 U.S.C.A. § 1114(s); 38 C.F.R. §§ 3.350(i)(2)."

https://www.va.gov/vetapp16/files4/1627586.txt

My personal example also explains it.

Deceased veteran was 100 P & T SC for PTSD.

His posthumous ratings for a 1151 stroke ( a  disability distinct and separate from the PTSD) were combined and rated at over 60%. 100% SC PTSD plus over 60% 1151 CVA equals SMC S.

The decision however mentions he was also Housebound in addition to the 100% plus 60 criteria...because his service connected disabilities "permanently  and substantially" rendered him as "confined" to his home. They only pay for one theory of entitlement to SMC "s" but many vets probably fall into both criterias.

 

 

Edited March 27, 2017 by Berta

[Cannabis]

5 hours ago, Berta said:

http://community.hadit.com/topic/51603-does-filing-for-smc-s-jeapordize-rating/

This is one of many CUE scenarios discussed in our CUE forum involving SMC.

A few posts into  that link,. I listed the exact legal evidence I used for my SMC CUE.

"So, this convo needs to move to CUE forum as that is what I am looking at here, CUE in the first decision."

That is where the CUE might lie,in your case.

They made 4 CUEs in the 1998 decision in the above link ,that they granted and I have one more pending.

All of the medical evidence had already been established.

 

Did they have medical evidence at that time that your rating should have been 100%?

If so that would be a valid CUE on that decision and then an additional CUE might kick in the proper SMC EED , as a CUE on the current decision.

What EED did they give you for the 100% in the recent decision?

And what medical rationale did they state for that?

Yes, they had medical evidence in my file. Are doctors notes considered medical evidence? Are those notes prima facie evidence of what they state? If a doctor says "housebound" and the head doc agrees, and then the later doctor/psychologist appointments state circumstances that support housebound due to service connected depression, etc.

I'll look up the EED, but it was to the date I filed, around 2015 or so. All times I've filed they decide fast. This time, too, as I filed NOD and now, decision is in my mailbox but I can't get there, housebound, after all.  So I'm going to use this info you gave so far, and put together with NOD decision and give a timeline to you so you (and others ) can see a good timeline as reference and roadmap.  Blessed day, and love.