SMC Questions

[scottinmt]

Hello All,

It's been a few years since I last signed on and it seems most of my data has been purged from my profile.  I received my 100% P&T rating in the spring of 2016 backdated to the summer of 2015.  My conditions have seemed to worsen over time and I am now considering applying for SMC for being both housebound and relying on my wife to care for me due to mental and physical issues.  I do not have a service connected mental health diagnosis but have seen VA Psychiatrists since 2011.  It appears that being housebound is a SMC S rating but I am unsure of where what I'm calling "aid and attendance" falls.  Any help would be appreciated.  Thank you!

[broncovet]

There are 2 separate criteria for housebound (SMC S).  I shall paraphrase the regulations:

1.  A "single" 100 percent plus a combined 60 percent seperate and distinct.  (Statuatory housebound)

2.  A single 100 percent and your doc saying you are "substantially confined to the home".  (Housebound in fact).  

      Bradley vs Peake shows us that TDIU can be used for a single 100 percent for the above.  (It is a little more complicated than that, tho, if you are tdiu, let me know). 

     The VA loves to deny housebound by requiring an exam, then, if you show for a housebound exam, they deny because you left the home for the exam, right?

     The VA can not do that any more.  SMC S, is not for Vets who cant leave the home "at all" but rather, who can not leave the home "for work".  See Howell vs Nicholson, which explains congress intended the above sentence.  

  The criteria for a and a is as follows:

       Your doc says you need the assistance of others for things like (and they give a bunch of examples).  eating, bathing, getting dressed etc...the daily life activities.  OR

       You be bed bound (confined to your bed).  '

       YES, the regulations permit you to get A and A, even if a family member provides care for you.  Its not required you hire "outside" help.  

https://www.law.cornell.edu/cfr/text/38/3.350.  Scroll down for housebound, and a and a.  

[scottinmt]

Hi Broncovet, LTNS.

I thought the requirements for receiving SMC S were either:

1. 100% on one specific medical condition/issue and an additional or total of all other medical issues being 60% rated.  or...

2. The actual merits of your condition that support you being "housebound" which can be physical or mental or both.

?

As for my rating, I have stand alones that amount to 220% the rating criteria takes me just over 96% which gave me a 100% P&T rating.  I have not asked to be TDIU but my conditions make it impossible for me to work.  I am 60 yrs old on top of that and have a SMC K award. I am also on social security disability.

Edited December 3, 2021 by scottinmt

[scottinmt]

This is what I am questioning:

38 U.S. Code § 1114 - Rates of wartime disability compensation

(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 $2,993.

 

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.

 

[Berta]

You stated:

"I thought the requirements for receiving SMC S were either:

1. 100% on one specific medical condition/issue and an additional or total of all other medical issues being 60% rated.  or..."

That would need to be one service connected condition rated at 100% and/or***

"2. The actual merits of your condition that support you being "housebound" which can be physical or mental or both."

***If the housebound evidence regards a service connected condition- or  a Section 1151 condition.

The rating sheet can reveal whether SMC S should be awarded but HB is diferent from SMC 100 plus 60 regulation.

Can you scan and attach here th last rating sheet you got from the VA?

Cover your C file #name, address prior to scanning it.

I applied for both theories of entitlement and was awarded (as an accrued benefit- I am widow of a veteran) under both theories but was paid properly only for one theory.

This was a CUE claim- searchable here- but my point is the last rating sheet on my husband was generated as an award of DIC about 3 years after he died.

The rating sheet attached to the award clearly revealed 100% P & T for SC PTSD and independently 80% (raised to 100%) for a Section 1151 stroke ( I had proven malpractice on that issue and other diabilities he had,-the 100% plus over 60% independent diability.)

I had to supply medical evidence of Housebound, and there was plenty of it in his medical records and within a statement I also made to the VA.

You also stated:

" I do not have a service connected mental health diagnosis but have seen VA Psychiatrists since 2011." Is it at all possible that the MH issue could be service connected? Did you try to get it service connected and they denied?

Nothing is impossible- I helped a vet years ago who continually prosecuted his claim for inservice bipolar depression for over a decade, and the BVA awarded it and he got almost 1/4 a million in retro.

If I still have the BVA case I will post it here.

 

 

 

Edited December 4, 2021 by Berta
added more.

[scottinmt]

Berta,

I haven't been online for a few years but you and Asknod really helped me with pulling together my 100% rating documentation, I will always be appreciative of that.

I will dig out the last rating and post to this string.

Scott

[scottinmt]

6 hours ago, Berta said:

You stated:

"I thought the requirements for receiving SMC S were either:

1. 100% on one specific medical condition/issue and an additional or total of all other medical issues being 60% rated.  or..."

That would need to be one service connected condition rated at 100% and/or***

"2. The actual merits of your condition that support you being "housebound" which can be physical or mental or both."

***If the housebound evidence regards a service connected condition- or  a Section 1151 condition.

The rating sheet can reveal whether SMC S should be awarded but HB is diferent from SMC 100 plus 60 regulation.

Can you scan and attach here th last rating sheet you got from the VA?

Cover your C file #name, address prior to scanning it.

I applied for both theories of entitlement and was awarded (as an accrued benefit- I am widow of a veteran) under both theories but was paid properly only for one theory.

This was a CUE claim- searchable here- but my point is the last rating sheet on my husband was generated as an award of DIC about 3 years after he died.

The rating sheet attached to the award clearly revealed 100% P & T for SC PTSD and independently 80% (raised to 100%) for a Section 1151 stroke ( I had proven malpractice on that issue and other diabilities he had,-the 100% plus over 60% independent diability.)

I had to supply medical evidence of Housebound, and there was plenty of it in his medical records and within a statement I also made to the VA.

You also stated:

" I do not have a service connected mental health diagnosis but have seen VA Psychiatrists since 2011." Is it at all possible that the MH issue could be service connected? Did you try to get it service connected and they denied?

Nothing is impossible- I helped a vet years ago who continually prosecuted his claim for inservice bipolar depression for over a decade, and the BVA awarded it and he got almost 1/4 a million in retro.

If I still have the BVA case I will post it here.

 

 

 

Berta, I looked through my award letter and never does it state anything regarding SMC other than an SMC K award I received back dated to 2004.

As for your question about mental health, no I never submitted a claim as I was already at 100% when I thought about it.  I do have VA psych notes and care back to 2011 and they did diagnose me with a major depressive disorder several years ago due to the impact of watching my physical health deteriorate and no longer being able to do the things I enjoy.  I have been on multiple anti-depressants for years.  I just didn't know if I should submit a claim for service connection at this time in order to get it documented.

I am also on social security disability and have been for a couple years now.  Should I also ask the VA to note me as TDIU using the SSD as support?

Lastly, my wife effectively provides aid and attendance for me, I don't know what I would do without her.  I only leave the home for medical appointments and the occasional haircut.  The reasons for both are due to limitations due to my service connected medical issues.

 

Thanks so much for everyone's help.  My brain doesn't function as it once did so please forgive me if I am unclear or seem thick.