PTSD increase A&A added

[taylor88be8]

I have been TDIU P&T for over 6 years well since I medically retired from the Army for PTSD on June,26,2012 (PDRL).  

My current ratings are 70% PTSD. ,30%Migraines  30% Gerd 10% Tinnitus 0% ED  combines total of 90%

 

I was awarded VA Caregiver from 2012-2014 until my wife left me them I lost Caregiver 

 

question is if apply for a increase in my 70%PTSD and I have a DBQ signed rom a medical doctor stating “Total Occupational and Social Impairment”  and the same MD filled out the VA Form 21-2680 A&A Form stating I need it.

 I’m also on SSDI since 2012 for PTSD as well   

I already have SMC-S and SMC-K

 

What are my chances for any of this?  

 

Thanks 

 

Edited March 26, 2018 by taylor88be8 (see edit history)

[FormerMember]

Sure, Gastone. I just read his first post at the top. His wife left. Sayonara SMC (t). No caregiver = no dice. So... He says he is currently SMC (s)with a K-about $3380/mo. I could see him maybe being entitled to a 100% schedular for the PTSD but you have to be prepared to go up to the BVA to win it and especially any A&A. VA is going to choke and puke. Most guys work with VSOs and most VSOs would refuse to file it because they are good buddies with the raters and were taught never to help a Vet do this. Most don't even know what SMC is. Most attys. would shy away because he already has P&T- there's no money in it. There are about 800 Vet attys. you can turn to and 350 of us agents. That's a whole lot of you folks chasing good legal help.  I have clients literally show up dying and asking me for help who have already been waiting at the BVA two years. Their VSO forgot to ask for advancement and never filed a Waiver of Review in the First Instance to prevent a remand.

With the above disabilities mentioned, even if, arguendo, he got the 100 for the bent brain, he still has to show he meets the requirements of §3.352 regardless of what kind of fiction the good doctor writes on the 21-2680. VA wasn't born at night. They'll ask for a c&p. Does PTSD prevent you from feeding yourself? Does the MDD prevent you from attending to the wants of nature? If so, who changes your diaper? Bedridden? Can't dress yourself because your brain isn't working right? Can you heat up a Hot pocket in the microwave? Need help bathing yourself in the tub/shower? If all you can rustle up is you may be a danger to yourself or others, VA would have you declared unable to manage yourself or your affairs and assign a fiduciary to "be your financial caregiver". There are a lot of possibilities at play here. Pick the wrong one and you'll wish you hadn't. You can't recall a bullet... or a VA claim.

If you are living all by yourself and asking to be rated essentially as burnt toast and need A&A, VA is going to ask themselves if you are playing fast and loose with the dictionary.  To get into A&A, the very essence of it is what it means-AID & ATTENDANCE. If you have no Attendee to perform the Aid, how is it you could even make it to the doctor to have him fill out the 2680?  Forget that 100% homie, it's time for domiciliary care.That's VAspeak for nursing home. My advice is to get married again pronto and only then mount up the posse and file for the (t). In cases like this the r(t) caregiver stipend is the greater benefit than SMC (l) for Aid & Attendance and already a proven need. Never try to reinvent the wheel.  

[FormerMember]

There are four flavors of A&A. One is the first tier or SMC(l). Next comes r(1), then r(2).  Last  but not least is SMC r (t). It is staged into several tiers with the highest equaling the payment of r(2). Because the Veteran is from whom the entitlement flows, all funds are paid to him for disbursement unless he has a fiduciary. With a divorce, his ex-spouse loses her spousal entitlement. With no caregiver living in the home, Mr. 88 loses the smc r(t) and drops back to SMC (s). If the caregiver were someone other than the spouse, the $ would be paid to him/her directly.

Buck is correct. If a new caregiver was found who could live there 24/7 and be trained by VA to provide the function, he would be entitled to the smc r(t) again. It would not require a relative but that would be optimal here probably. Again, VAF 21-2680 is rather pointed in what constitutes the requirements to attain A&A and especially any A&A at the higher tiers. CAVC precedence says you have to have "most but not all" of these problems listed in order to get the $. But if you only have one risk, it almost always has  to be bedridden or blind. VA is pretty sticky when handing out these big ticket SMCs. I'd say there are less than 5,000 r (1) & (2) ratings out there. One thing no one discusses is r(t) is considered "transitional" as in 'you're going to get better some day and won't need it.' I've never done a r(t) yet, just a couple of r(2)s and and 3 r(1)s. I aced them all.

With the PTSD rated for over 5 years, it's "substantially protected" but that's no guarantee. One thing I've found is the more screwed up you are, the less chance of getting dunned by a c&p and reduced. I did see a Vet get whacked at 19 years and 4 months. He fought to the BVA and got it overturned. These guys are vicious. Remember that.

[FormerMember]

It's better to research something before opening the piehole and making pronouncements that others may follow to their own detriment. The Google Search bar, or any search engine for that matter, gives you a wealth of information. In fact, Hadit has numerous discussions that encompass SMC in all it's iterations. Search and ye shall find. Or, you can be lazy and misinform others.  Remember, a forum model like this has no filter to erase misinformation.  You must be responsible. If you do not know the answer, it's best not to hit the reply button and expose your ignorance or harm others. Here's a quick study on SMC that will hopefully help newcomers to better understand the ins and outs of SMC. It is one of the most absolutely misunderstood subjects in VA law and takes several years to wrap one's noggin around. More errors are committed by VA raters  on this one subject than any other.    https://asknod.org/2013/02/27/special-monthly-compensation-what-is-it/

[taylor88be8]

         So for the ones that said I wouldn't be approved for A&A,    I was approved for  ( SMC-L 1/2)  Based on Aid and Attendance.               The (1/2)  step came from my additional ratings totaling (60%) that were not used on the award of (SMC-L).                                                                                                                                                                                                                                                                      So I was (70%) (PTSD TDIU P&T)   I asked for a Increase of the( PTSD) and received the bump to (100%)  PTSD and awarded A&A .   I'm not sure how the TBI got so confused,  at no point did I say or ever claim TBI or A&A Based on a  TBI.                                                                                                                                                                                                                                                                                                          I was not given a C&P for the (PTSD) Increase or the A&A Claim either i was approved just off my medical records and doctors notes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Thanks again

Edited May 3, 2018 by taylor88be8 (see edit history)

[broncovet]

Based on what you posted, your chances are good.  Im a little unclear of your motive, tho.  Since you are already at 100 percent with TDIU, it doesnt seem likely that an increase in PTSD to 100 percent, even if it happens, will increase your compensation.  

Of course, if you meet the criteria for SMC S, housebound (100 percent plus an additional combined 60 percent), that could result in an increase, as could your A and A that you applied for.  

The housebound, however, would be moot if awarded A and A.  A and A and housebound are mutually exclusive to each other.  You dont get a and a and housebound, at least not if I get that correctly.  I have read the VA regs and it certainly would appear you get EITHER A and A  OR housebound, but never both.  

Due to the fact you are not apparently working, then you probably should get housebound, according to this:

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

[taylor88be8]

1 hour ago, broncovet said:

Based on what you posted, your chances are good.  Im a little unclear of your motive, tho.  Since you are already at 100 percent with TDIU, it doesnt seem likely that an increase in PTSD to 100 percent, even if it happens, will increase your compensation.  

Of course, if you meet the criteria for SMC S, housebound (100 percent plus an additional combined 60 percent), that could result in an increase, as could your A and A that you applied for.  

The housebound, however, would be moot if awarded A and A.  A and A and housebound are mutually exclusive to each other.  You dont get a and a and housebound, at least not if I get that correctly.  I have read the VA regs and it certainly would appear you get EITHER A and A  OR housebound, but never both.  

Due to the fact you are not apparently working, then you probably should get housebound, according to this:

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

I forgot to add that I already have SMC-S and SMC-K.  I was told you need one Disability a straight 100% not TDIU to receive A&A 

[Buck52]

 Taylor88be88

If you are 100% or IU there's actually no difference in benefits at that point once a Veteran reaches the 100% level any other S.C. Conditions will be considered to meet the criteria for SMC Depending on the severity of his/her S.C. Disabilities.

IMO,  a 100% or IU  Veteran should file on any condition that he thinks should be S.C. if he feels up to dealing with the VA?

it could quite possibly be a good thing later on down the road.

Two main reasons why

1. To be service connected incase this condition worsens and takes the life of the veteran for DIC Purposes his spouse will get some help.

2. In case the Veteran gets a proposal  reduction letter JUST OUT OF THE BLUE on his present S.C. Conditions  having extra S.C. Conditions will help him not go below the 100%

I am guilty of not filing more claims that I could get .S.C. but I am just getting to old to be dealing with the VA and the stress.

[vetquest]

One reason I believe you should file for 100% disability is that the government has already once stated that they might reduce TDIU veterans once they reach retirement age.  This did not happen but it may rear it's ugly head again.  

[john999]

I agree with what Buck is saying about filing even if you are 100% or TDIU.  I got an extra 60% after I was TDIU and then got HB which meant another $300 a month.  It is really not chicken feed since it is tax free money.  I now make about as much in tax free money as I did when I retired from the USPS with a taxable income.
 

[broncovet]

The criteria for A and A, are here:

https://www.law.cornell.edu/cfr/text/38/3.352

and, briefely, here:

https://www.law.cornell.edu/cfr/text/38/3.350

It does "not" state you have to be 100 percent to get a and A.  (TDIU will suffice).  

[Gastone]

How about posting a redacted copy of your Dr's A & A Questionnaire? With the SC's you list above, I don't see how you qualified for SMC S or S (1). Your IU is based solely on your 70% PTSD, correct?

What makes you think the PTSD rates a bump to 100%? There's always a possibility of a Reduction.

[taylor88be8]

10 hours ago, Gastone said:

How about posting a redacted copy of your Dr's A & A Questionnaire? With the SC's you list above, I don't see how you qualified for SMC S or S (1). Your IU is based solely on your 70% PTSD, correct?

What makes you think the PTSD rates a bump to 100%? There's always a possibility of a Reduction.

I’ll let you know how I qualified.   My PTSD 70% TDIU P&T since I was put on IU P&T based off the PTSD they consider that a 100% Rating for SMC-S purposes the other 60% came Migraines 30%.    Gerd 30%. Tinnitus 10%.  There is my rounded up to 60% combined to satisfy the SMC-S Housesbound Statutory.   

Maybe you misread it, or you don’t know how there are 2 ways to get SMC-S  and being on unemployability 

[Gastone]

It's not unusual for Vets filing for IU to list their PTSD SC  as well as their Migraine SC as the cause of their claimed IU. When the Award is generated, the inclusion of the Migraine SC eliminates it from the SMC S (1) 60% calculation. You indicated an SMC S, not an S (1) Scheduler. Not a big deal.

Are you now filing for a PTSD SC Increase to 100%?

How does your Dr's New A & A 21-2680 comport with the original 2012 A & A  2680?

I'm sure you are aware that PTSD and other MH Conditions are all viewed by the majority of both Private and VA MH Clinicians to be treatable, with expectations of marked improvement over time.

An IU Award, T & P No Future Exams Scheduled, has been known to give Vets a false sense of security in the permanence of the Rating.

[taylor88be8]

1 hour ago, Gastone said:

It's not unusual for Vets filing for IU to list their PTSD SC  as well as their Migraine SC as the cause of their claimed IU. When the Award is generated, the inclusion of the Migraine SC eliminates it from the SMC S (1) 60% calculation. You indicated an SMC S, not an S (1) Scheduler. Not a big deal.

Are you now filing for a PTSD SC Increase to 100%?

How does your Dr's New A & A 21-2680 comport with the original 2012 A & A  2680?

I'm sure you are aware that PTSD and other MH Conditions are all viewed by the majority of both Private and VA MH Clinicians to be treatable, with expectations of marked improvement over time.

An IU Award, T & P No Future Exams Scheduled, has been known to give Vets a false sense of security in the permanence of the Rating.

The PTSD DBQ states “Total Occupational Impairment, I was already approved for the VA Caregiver from 2013-2015 for PTSD but when my left me and she was my caregiver the caregiver stopped and I never followed back up with it.  Like I said I’m SMC-S.    If that’s different from S1 then I have just SMC-K & SMC-S.   

I was approved for social security disability in 2012 as well for PTSD and Migraines and then I was medically retired from the Army Permantly (PDRL)  with a 100% PTSD Rating from the Army and 100% CRSC I was injured in a roadside bomb and Purple Heart And we lost 17 guys, so my records reflect we were in the middle of a very Violent area of Afghanistan.  

[Gastone]

You have the SMC S (1), your (2) 30% + the 10% get to 55.-- gets you to the separate CSC 60% to qualify for the S (1) Scheduler Rating.

You lost the A & A shortly after the X bailed, how have you managed to date? Has someone replaced her services?

[taylor88be8]

On 3/28/2018 at 6:06 AM, Gastone said:

You have the SMC S (1), your (2) 30% + the 10% get to 55.-- gets you to the separate CSC 60% to qualify for the S (1) Scheduler Rating.

You lost the A & A shortly after the X bailed, how have you managed to date? Has someone replaced her services?

 

On 3/28/2018 at 6:06 AM, Gastone said:

You have the SMC S (1), your (2) 30% + the 10% get to 55.-- gets you to the separate CSC 60% to qualify for the S (1) Scheduler Rating.

You lost the A & A shortly after the X bailed, how have you managed to date? Has someone replaced her services?

  What do you mean how have I managed to date?  Has someone replaced what service’s? 

[FormerMember]

Whoa there, cowboys. What's a SMC (s)(1)? Last I checked, there's one SMC (s) authorized by Congress https://www.law.cornell.edu/uscode/text/38/1114

(s)

If the veteran has a service-connected disability rated as total, and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or, (2) by reason of such veteran’s service-connected disability or disabilities, is permanently housebound, then the monthly compensation shall be $3328.70 For the purpose of this subsection, the requirement of “permanently housebound” will be considered to have been met when the veteran is substantially confined to such veteran’s house (ward or clinical areas, if institutionalized) or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout such veteran’s lifetime.

 

You see? There's only one (s). There is no new, improved secret (s)1. The statute is unambiguous on its face. SMC (s) = $3,328.70 for a single guy or $3,494.51 if you are married. The conjunctive is "and". You need 100% (or TDIU)"and" 60% or more. The disjunctive is "or" as in "Or" you need a permanent housebound profile for the rest of your life to qualify without that extra 60% or more.

 

The next step up from SMC(s) is SMC (l). That is more commonly known as the first tier of the Aid & Attendance ratings.  It's followed by (r)1 and (r) 2.

 

(l)

if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, with 5/200 visual acuity or less, or is permanently bedridden or with such significant disabilities as to be in need of regular aid and attendance, the monthly compensation shall be $3700.43

 

 

 

 

Edited March 30, 2018 by asknod (see edit history)

[Gastone]

Nod, sounds good to me. Then again, I have to ask myself where the hell did I come up with the SMC S (1) idea, possibly in a dream? I'd been aware that there were (2) ways to qualify for Housebound but never paid much mind to it until I got the Award in 2015 after a single SC 100% Rating Increase.

As I understand your post, you've never seen the Single 100% SC with the additional SC's at 60% CSC referred by the VA as Scheduler SMC S (1)? At this point, I stand corrected.

[Buck52]

Gastone I am not sure and Alex knows what he is talking about here and with those regulation he put up  ..we got to go by those.

But as I understand what your meaning..I was 90%   S.C. combined Rating  and on TDIU P&T , then I was granted 70% for Chronic PTSD and that changed my ratings from the 90% to 100% to become a  a final degree  and the PTSD Rating met the criteria for SMC S 1 H.B. According to the SMC Special pay table.

I read this off my Award letter

[Gastone]

NOD & Buck, as much as I hate to reverse my earlier (this am) statement regarding the SMC S (1), I absolutely do.

Just did a couple searches regarding SMC S (1) and I've decided to continue using both SMC S (1) and SMC S (2) terms when discussing the SMC S Housebound Rating.

For those interested, the basis for my decision is the following. 1. BVA Decision 14 - 2272 02/2016 Gazelle V McDonald refers to both SMC (S1) and SMC (S2).  2. Ben Krause VA Lawyer article 12/30/14 addressed SMC S (1) & (2) and linked to Cornell Law LII article addressing 38 US Code - Rates of wartime Vet comp, where again both (S1) and (S2) are addressed.

Then comes the last but not the least reason, I checked my own E-Ben page, and there it was.  Listed under Benefits - Special Monthly Compensation Benefits, SMC (K-1) and SMC (S-1).

With that said, I will continue to address Scheduler Housebound as SMC S (1).