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SupermanCannedy

Appealing Denial for SMC T based on SMC R2 criteria

Question

Has anyone on this site put in a claim for SMC-t? Do you know of anyone who has been awarded it? I am the sister of a pre 9/11 veteran who has been rated at 100% for TBI P&T. I am his full time caregiver and have been appointed his fiduciary. I also have helped him with his claims...and have done well, until this one. I do my best to give him a high quality of life, but need to hire because his body is fit, but his memory and cognitive skills are in constant decline.

He is a textbook case for SMC T because, in addition to the first 2 requirements, his VA neurologist has also filled out the forms to state that "Without regular in home care the veteran would need to be placed in institutional care". That is a major requirement for an SMC T. We submitted the claim for an SMC T 2015 and they granted him A&A at the L 1/2 rating, which we didn't realize is also required to qualify for SMC t...actually SMC L or higher. We submitted the SMC t claim again April 2016 and they denied it based on R2 criteria. After not knowing what to do about that and not getting any help from the local VSOs (they aren't familiar with this SMC T) a pro bono attorney offered assistance, so we took it.

The decision board came back with a "We got your new claim...we can give you an answer within 30 days or you can have up to a year to submit more evidence." I have NO IDEA what that really means or what to do...So, I submitted for the extra time. Now, I need some guidance.

Should I have people we know write up some buddy letters to explain how much help the vet needs in his daily life? Should I hire one of those VA lawyer firms that take 20% of whatever award is granted? Do any of you know of anyone who has worked on an SMC t? The last report I read was from Dec of last year when the congressional coding was recommended to be changed in order to make the criteria more clear and the "open". The charts show that as of 2011, when the Fast Letter first went out, only 120 or so veterans have been awarded this SMC. So, that's why I am hitting brick walls!

We appreciate any help. Thank you!! 

 

 

 

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If you have the paperwork from the doctor I would personally go to your RO and they can help you file the right paperwork for his SMC. It may greatly increase the chance of getting it the first time around.

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We filed the original claim through the RO in Austin.  The rep was unfamiliar with the SMC-t, but so were all of the other VSOs I spoke with. I presented all of the documentation that I could gather, based on the information we had access to, and she filed it.  She was very unenthusiastic and told me two times that I should place him in a VA care facility.  When the claim was denied, she was "done". The denial letter states the reasons for denial as physical ones and noted other things that are required as criteria for r2....that's not the SMC we filed for. 

After asking for help from several VSOs in the area and one tried to explain the different choices I could make in the appeals process, but I couldn't get an apt to see them in person for awhile. I agreed to have the lawyers draw up the NOD because they could get me in to see them. Maybe that isn't even the step that we should have taken. 

So, go back to the RO?...don't be as concerned about finding a VSO who understands the SMC t, but rather one who is good at navigating us through the appeals process? 

 

Edited by SupermanCannedy

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Keep trying. I'm sure there is somebody out there that has more knowledge on SMC issues. You can try posting the denial letter and maybe it will spark someone's attention. Make sure you edit out private info i.e.: names, addresses, SS number...

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Could you post a redacted copy of the Denial Letter?

Semper Fi

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SupermanCananady:

    It looks like you have done your homework: You know the criteria for SMC T.  Dont overlook the basics, tho, the 3 caluza elements.   (I wish had a key on my computer that copied the Caluza elements of a)Current diagnosis, b)  in service event or aggravation and c) nexus or docs opinion that the previous caluza elements are at least as likely as not related.  

     Do not forget the basics.  VA wont.  

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