Question about opening a new claim

[toomnyhats]

I have a few separate questions.

I was granted 100% P&T, no exams required, along with the rest of the benefits (Chapter 35, Commisary, etc) based on cervical neck aggravation in service. We discovered later after discharge that I have a narrow spinal canal, I am now an incomplete tetraplegic with some remaining function in my left arm and not much in my right.  They granted 20% for neck with the following secondaries: 100% loss of use of legs, 70% Right Arm w/loss of use, 30% on left arm radiculopathy.  I also have an independent 60% on bladder granted almost immediately after filing my claim in 2015, because they found in my str where I had gone in for bladder spasms, however it is not listed as a secondary to the neck. I also have 10% tinnitus.

I had to have my colon removed and an ileostomy placed due to neurogenic bowel.  This was never addressed in the nod. When I mentioned it, I was told that they would see the secondaries automatically or we could file a new claim.   My neck claim never went to the board because I had two good letters (IME and IMO) stating that aggravation was more likely than not caused by service.  So after the Form 9 was filed, they eventually granted the items listed above.   My question is should I file a new claim for the neurogenic bowel.  I'm not looking at it from a monetary standpoint now, but looking at the future. If I were to get a bowel obstruction and die, my husband would not get anything since it's not service connected.  

Question number two relates to the bladder.  I'm am deteriorating in my hand and arm function to the point that it is difficult to intermittently cath.  My urologist thinks it is time to place a supra pubic catheter.  I saw somewhere that this is rated at 100%..does anyone know if that is correct? If so, then I assume the 60% for bladder would go up.  

Question 3 relates to the fact that I have loss of use of both legs, loss of use of both sphincters.  If they connect the neurogenic bowel, would that put me in the SMC O category?

And one last comment, I'm being urged not to rock the boat because there was no documentation regarding my neck, however the IMO did a great job documenting clearly why he would not expect me to seek treatment for neck pain because it typically starts at a low level (as mine did) and most people just treat it at home via OTC and heat.  There is also a steady stream of continuity of treatment starting 2 years after I was discharged.  He also specifically said that my degeneration occurred at a much more rapid pace than it would have had I not been doing the strenuous work I was doing.  I believe that, along with a great letter from my VA SCI doc plus full exam is what got me granted but I'm sure it was sitting on the fence and could have gone either way.  I am, of course very happy we avoided having to take it to the board of appeals.  So asking all the experts out there...would I be rocking the boat to request the connection of my neurogenic bowel?

Thanks much!

 

 

[broncovet]

Based on what you posted, as far as additional levels of SMC are concerned, I dont think additional SC ratings will increase your SMC except to the extent you can demonstrate "loss of use".  

Hopefully Alex will chime in here, but once you get to SMC L and above, you dont get the statuatory SMC S

(100 plus 60) because you already have a higher SMC and the statuatory SMC S becomes moot.  

Now, there are 3 levels of SMC L based upon the skill of the caregiver necessary.  If you just need A and A for "unskilled" aid and attendance, that is the lowest level.  "Unskilled" A and A means stuff like helping you get dressed, and stuff that does not require a nurse.  

If a nurse is required, such as if you are on IV's, (I dont know about catheters..I think that could go either way because people put in their own catheters and they are not doctors.  However, some require skilled nursing care)

So, especially if you have a "visting nurse" there to help you on a regular bases, you should be eligible for a higher level of SMC L.  

Further, you may be eligible for "Caregiver benefits", especially if your husband had to quit work to give you care:

https://www.military.com/benefits/veterans-health-care/new-va-family-caregiver-program.html