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cherry picker


Fellow Hadit members,

I am reaching out for advice in regards to an SMC-R1 exam appointment for 100% PTSD, bilateral sciatica (40% L, 40% R, and lumber50%) coming up in 2 weeks. I am filed for SMC INCREASE (+) TO SMC-R1 for A/A due to the ongoing deterioration of my conditions. The reason for the increased file is due to my bowl and bladder problem, the limited mobility of my legs (have fallen, unable to do any minor activity), and my ongoing PTSD which has gotten worse. 

My wife and sons are taking turns assisting me with the day to day tasks (bathing, dressing, standing, in/out of the vehicle) and need to observe/monitor me due to my PTSD aggressive reactions, loss of reality, etc. I have been absent from work more and more due to the worsening of conditions. 

Being this my first SMC-R1examination experience, I would like to prepare myself and show up to the exam (4hrs per VA) with the right information. 

 If it's not much to ask, please share your great advice in order to make this a successful outcome. 

1. According to the VA receptionist, this SMC-R1 is for my legs and bowl/bladder problems. I am baffled as to how they will evaluation my bowl/bladder condition??? 

2. Is this SMC-R1 exam the same as a physical C&P exam- the range of motion, PTSD symptoms,  etc? 

3. How can I prepare? What is expected during this medical exam? Do I need to take Lay letters, doctor's Opinion letters, my device that I use day to day to assist my daily activities?

4. Will it be recommended to have my wife or sons go with to the SMC-R1 exam as witnesses?

I would like to make this a successful outcome and not give the VA a room for doubt.


Thx all,





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1.  I have had C and P exams for SMC.  In mine, they simply asked me questions.  I suggest you simply answer them honestly.  

2.  The doc decides what kind of exam to give you based on VA's request(s).  Again, I expect they will simply ask you questions about your bowel and bladder habits, and maybe loss of use use.   Your level of SMC will likely be related to the "level" of care you need.  For example, if you need a full time nurse, your level of SMC will be higher than if you just need some help to get dressed, use the bathroom, etc.  This usually varies with your level of medical equipment.  For example, if you are on an IV, you need a nurse.  

3.  Remember the 5 P's.  Proper Preperation Prevents Poor Performance.  Read the criteria for SMC, and decide which you feel applies.  Then be prepared for evidence to support your position you feel you need (x) level of SMC:  https://www.law.cornell.edu/cfr/text/38/3.350   In other words, be prepared to show you have "loss of use" of your legs and or bowel bladder functions.  But, check the criteria first.  

4.  Probably.  It may raise a red flag if you go to a c and p exam, telling the doc you can not use your legs, but you drove there (and you dont have a handicap equipment on your vehicle).  

Dont give the VA a chance to catch you in a lie.   In other words, if you  could not use your  legs at all, then you would need to explain how you got to the VA on your own.  

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First, to get to R1, you will need two (2) conditions entitling you to a rate between L and N. One of them must be A&A. Loss of use of lower extremities must be diagnosed by a doctor, not just your say so. VA often makes the mistake of using a VAF 21-2680 when they should be using a VAF 383. If you have proof (not your spouse or children) that you are unable to bathe or feed yourself unassisted, then that would qualify as one SMC condition (SMC L or A&A). This includes being a danger to yourself or others. Loss of use of upper extremities would also be a condition. Needing A&A due to the loss of or loss of use of your lower/upper extremities will not qualify. Each condition must be due to a separate disability. You could be in need of A&A for PTSD and also due to loss of use of the extremities. Two A&A ratings qualify for R1 but you will need at least one of the SMC ratings between L and N due to A&A of another person. 

Just because the rater says you need R1 is not a winner. The M 21 states only a VA rater can award SMC L-O or R1/R2. 

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