Respiratory Cancer, AO presumptive

[RockyA1911 1]

Hi all,

Been a while since I have been on here.  I had a lung resection on Valentines day and have had a long recovery.  After removal of tumor it was later diagnosed with Stage 4 Squamous Cell Carcinoma located in my pleural cavity.  I am treated every 21 days with infusion of Keytruda, an immunotherapy drug.  I will have to have the rest of my life.  I filed a new claim today for Cancer, Respiratory....Presumptive Agent Orange Condition.  I have been SMC-S housebound award since 2008.   My question is.....while undergoing treatment for service connected AO presumption condition, the VA rates that condition 100% and since what I have is debilitating condition that will require treatment rest of my life it is likely to be one more condition that is permanent 100%.  Since I already have a service connected condition rated at 100% alone and others that are 70%,70%, 50%, 10%, 10% that is the SMC-S...…..is there any other SMC that would increase due to TWO SEPERATE Conditions each stand alone 100% each with others totaling 60% or more?

[broncovet 4,246]

The way I read it, yes.  But you read it yourself:

https://cck-law.com/blog/special-monthly-compensation-explained/

 

[Richard1954 254]

11 hours ago, RockyA1911 said:

s there any other SMC that would increase due to TWO SEPERATE Conditions each stand alone 100% each with others totaling 60% or more?

Under Housebound there is only one level 

You should apply for Aid And attendance 

2 -100% ratings would  entitle you to Aid and Attendance at the M level  the  new rate is       $ 4265.31 a month for just veteran or $4438.49 with spouse

 

https://www.benefits.va.gov/COMPENSATION/resources_comp02.asp

Edited December 11, 2019 by Richard1954

[RockyA1911 1]

Thanks. I researched the M SMC but it appears it is a RAMP type that extra 100% moved from L to M. The problem I see with me is that I am SMC-S and nothing above that, so no SMC beyond the S to RAMP up to.  I have Hospice/Palliative care VA contracted for.  I guess we will see, it will be up to VA to determine if there would be a change in SMC and which one.  VA is now paying for me to have my every 21 day infusions of Keytruda locally near my home instead of having to drive to Iowa City every 21 days.  In fact all my oncology the VA has transferred to Genesis Cancer Center, 4 miles from home.  My current SMC-S below, not including recent pending claim for Respiratory Cancer AO

1. Head Neck Cancer AO - 2008 - 100%
2.  TBI -- 70%
3.  PTSD- 70%
4.  Skull Loss - 50%
5.  Hypothyroidism - 10%
6.  Scar on head - 10%
7.  Tinnitus - 10% 

[Richard1954 254]

3 hours ago, RockyA1911 said:

he problem I see with me is that I am SMC-S and nothing above that, so no SMC beyond the S to RAMP up to. 

This is exactly why I told you in my previous post that you need to apply for SMC Aid and attendance.... It seems to me you would qualify for Aid and Attendance based on what you have said here if you get the respiratory cancer service connected.  It also looks to me like you qualify for Aid and attendance right now at L 1/2 based on the fact you have at least one separate  condition rated 60 %  or more in addition to your 100% rating, And you need  and have actual assistance right now. Have your doctor fill out the application form for Housebound/Aid & Attendance, noting that you should be on aid and attendance.

Edited December 11, 2019 by Richard1954

[toddt 114]

https://asknod.org/2015/02/19/smc-kevin-asks-the-big-question/

[RockyA1911 1]

I looked up 38 USC 1114 and what I copied below I have found the below.  It only states one full step increase for additional 100% condition, but lists paragraphs I thru o.  I am not missing extremities to qualify for the others.  So, the remedy it says for all others would be the VA Secretary would have to establish the increase amount not to exceed $4667 per month compensation.  Could be a precedence for those that are SMC-S, 100% with 60% combined conditions

 

Determine if the veteran qualifies for: An Increase due to Additional Independent Disabilities.

Additional independent 50 percent disabilities. In addition to the statutory rates payable under 38 U.S.C. 1114 (l) through (n) and the intermediate or next higher rate provisions outlined above, additional single permanent disability or combinations of permanent disabilities independently ratable at 50 percent or more will afford entitlement (increase 1/2 step) to the next higher intermediate rate or if already entitled to an intermediate rate to the next higher statutory rate under 38 U.S.C. 1114, but not above the (o) rate. In the application of this subparagraph the disability or disabilities independently ratable at 50 percent or more must be separate and distinct and involve different anatomical segments or bodily systems from the conditions establishing entitlement under 38 U.S.C. 1114 (l) through (n) or the intermediate rate provisions outlined above. The graduated ratings for arrested tuberculosis will not be utilized in this connection, but the permanent residuals of tuberculosis may be utilized.

Additional independent 100 percent ratings. In addition to the statutory rates payable under 38 U.S.C. 1114 (l) through (n) and the intermediate or next higher rate provisions outlined above additional single permanent disability independently ratable at 100 percent apart from any consideration of individual unemployability will afford entitlement (increase full step) to the next higher statutory rate under 38 U.S.C. 1114 or if already entitled to an intermediate rate to the next higher intermediate rate, but in no event higher than the rate for (o). In the application of this subparagraph the single permanent disability independently ratable at 100 percent must be separate and distinct and involve different anatomical segments or bodily systems from the conditions establishing entitlement under 38 U.S.C. 1114 (l) through (n) or the intermediate rate provisions outlined above.

 

SMC-S

Total plus 60 percent, or housebound; 38 U.S.C. 1114(s)

The special monthly compensation provided by 38 U.S.C. 1114(s) is payable where the veteran has a single service-connected disability rated as 100 percent and,

(1) Has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or

(2) Is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime.

INSTRUCTION: If either of the above checked AND a SMC Level has not been selected yet from the Other SMC Level drop-down select below, then select "SMC-S".

NOTE: The compensation for rate SMC-S is less than for rates SMC-L through SMC-R (except SMC-Q).

[RockyA1911 1]

Hey Berta!

How say you in regard to a current SMC-S:

100% - Larynx cancer

70% - TBI

70% - PTS

50% - Skull Loss

10% - Scar on head

10% - Tinnitus

10% - Hypothyroidism

The larynx cancer AO and treated back in 2008 an due to Edema and voice, it was made 100%P&T.  The new cancer is AO also, lung cancer stage 4, I filed claim last week as an increase.  I can feed and bath myself  etc. and am not permanently  physical housebound, and I do not have any amputations.  I know the USC says  each additional 100% rating gets a full step increase from I to o etc.  What about SMC-S, I would have two 100% conditions with others combined totaling 60%? Have you run into this stuff before.

 

[Richard1954 254]

On 12/11/2019 at 2:12 PM, RockyA1911 said:

Could be a precedence for those that are SMC-S, 100% with 60% combined conditions

 

The rules are very clear.. it has nothing to do with precedence. I  have SMC Aid and Attendance at the L 1/2 level.    That means I have an additional separate 50% or more rating to get to the  step of L 1/2.

If you have two 100% ratings (not combined 100% ratings) you would qualify for the M Level 

Again based on what your original post indicated you should be eligible for SMC Aid & Attendance at L 1/2 right now, and you should apply for it. If you do get an additional rating of 100% later, the VA would be required to boost you to the M Level.

This is a cut and dry situation,  doesn't take anything more that a completed application for the SMC from one of your doctors, or make a claim and  then go thru a C/P exam.... 

23 minutes ago, RockyA1911 said:

What about SMC-S, I would have two 100% conditions with others combined totaling 60%? Have you run into this stuff before.

Again there is no additional compensation at SMC S, for those that have more than one 100% rating..... 

[Berta 4,215]

That is how I understand it ,per Richard's reply.

[RockyA1911 1]

There is something terrible wrong then! I just got decision and the craziest explanation I ever saw.  Keep in mind the diagnosis for stage 4 lung cancer of lower right lobe with resection surgery and metastasized to lower right pleural cavity on 14 Feb 2019...….The 100% Head Neck Larynx cancer diagnosed 19 Oct 2007 and treated in 2008 has remained cancer free but still edema.

So VA service connected the Lung Cancer due to agent orange and just put it there in place of the already permanent 100% and back dated the effective date of the lung cancer back to 19 Oct 2007.  Stating Stage IV Lung Carcinoma lower right lobe w/ resection surgery and metastasized to lower right pleural cavity and Larynx cancer from 19 Oct 2007.....

So it is an additional 100% for lung cancer on top of my already SMC-S (S-1), but no increase in pay

Still SMC-S and no additional increase for the additional 100% that the U.S.C. said I was supposed to get.