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!

[pwrslm]

Secondary conditions can kill you. IF they are not SC, your spouse gets no DIC if you die. Pursue the secondary conditions. 

I am not really great on A&A, but the limitations leading up to A&A all have to be SC. If your secondary conditions contribute to your housebound condition, you need to get them SC to get A&A I think. If not the VA can claim the A&A is caused by non-SC conditions and you will be denied.

 

You already have 100%. TDIU is for those with less than 100% that brings them up to 100%. No need to worry about TDIU.

Edited December 5, 2021 by pwrslm

[broncovet]

You posted:

Quote

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.

With 220 percent, you should likely qualify under Statuatory SMC S,or above.   Key is DO YOU HAVE A SINGLE 100 percent.  If you read the regulations, SMC requires a single 100 percent.   The VA has a "duty to maximize your rating".  This means if you qualify for tdiu, and it results in you being qualified for SMC S, under Bradley vs Peake, then VA committed an error by NOT giving you tdiu, assuming you are unable to work due to sc conditions.  You may need to apply for tdiu, however, VA should have sent you the tdiu form and told you to apply, "if your file shows you told your doctor or the VA you were not working".  

I think there is a great chance you are due years of backpay..for SMC S..its about 370 per month.  But I would have to review your file to know, as well as Berta suggested your decisions.  

The first step, if you have not already done so, is to apply for tdiu and Smc s. (probably a supplemental claim).  

If denied, then we can give you advice on avenues of appeal, but you dont want to appeal something never applied for.  Its my "opinion", that, even tho its unnecessary for Veterans to APPLY for SMC, you should do so anyway, because many VA employees DONT consider you for it like they should.  

My advice:  Apply for SMC s and tdiu (unless you have been specifically denied for both). 

Given that you have 220 percent, you may well be eligible for a higher level of SMC....SMC L..for Aid and attendance.   Remember, the regulation clearly states that "a family member can provide A and A" and you still get the benefit.  

Example:  If this family member who is helping you, moved out, would you do ok?  In other words can you do everything yourself..remember your medications, cook, clean, dress yourself, feed yourself, bathe yourself, keep your home safe and in order, drive yourself to appointments, etc?  If a family member is doing one or more of these things, then you likely need A and A.  

    If in doubt, when you apply, ask for tdiu, SMC S, and a and A.  Let Va sort it out.  Dont limit yourself.  

Edited December 5, 2021 by broncovet

[scottinmt]

Broncovet, I do not have a single 100% rating.  My highest individual rating is 60%.  Thank you for the feedback and guidance.

Scott

[broncovet]

CCK law is the expert on SMC.  

Did you know "you dont have to hire them" for them to give you advice?  

Let me give an example:

Lets say you contact CCK law, send them access to your file, or relevant documentation, and they, after reviewing your info, say, "We think you are eligible for SMC K, SMC L, and (more)."  We will represent you if you sign a fee agreement form.  

Ok.  LISTEN carefully to what they say.  They may even tell you to apply for these, and, if denied, contact them again.  If they offer representation for, Say SMC L, then you are likely eligible and can take their advice, if you elect, and apply it on your own without an attorney.  Or you can hire them.  Your choice.  You are not under any obligation to hire them if they review your file, and give you advice.  Only if you sign a fee agreement with them, can they get paid from you.  

 

https://cck-law.com/practice-area/veterans-law/ 

In the upper right hand corner it says, "Free case evalution".  

OR an alternative.  

"If" you think you may need additional doctor statements (IMO), then consider Hill and Ponton instead. 

https://www.hillandponton.com/va-benefits-special-monthly-compensation/

Hill and Ponton has a reputation for "upfronting" the cost of an IMO, "if" they think it will be needed to win your claim.  (You see many Vets NEED an IMO to get benefits, but dont have the upfront money to pay for a sometimes costly IMO.)

To know whether or not you will need an IMO, will likely be based upon "whats already in your file".  That is, you may well meet the criteria straight away, without an IMO.  

Edited December 5, 2021 by broncovet

[Berta]

The info here is confusing to me , scottinmt-

You stated:

" I received my 100% P&T rating in the spring of 2016 backdated to the summer of 2015." And then:

"Broncovet, I do not have a single 100% rating.  My highest individual rating is 60%."

I am sort of assuming that you get TDIU based on this regulation:

"Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, the disability shall be ratable at 60 percent or more. If there are two or more such disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16 (a)."

https://www.va.gov/vetapp20/files1/20004635.txt (denial of a widow's claim for earier EED of TDIU as an accrued benefit.)

But then again you might have fallen into the last part of that regulation.

TDIU is paid at the same rate as 100%.

Certainly , if the MH disability can be linked to your service, you should claim it.

But the Rating sheet will reveal more info,and also their last decision will too,if you can attach here a redacted copy of thse documents.

 

[scottinmt]

Broncovet -  I contacted CCK Law.  I spoke with a case evaluator on the phone who thought I was most likely eligible for A&A.  As you stated however they wouldn't help until I applied and was turned down.

Berta, I am sorry if I confused you.  As I mentioned my brain doesn't process information well at this point and my ability to communicate thoughts is a bit...lacking.

Rated Disabilities:

60% Diabetes I

40% Neuropathy Right Upper

30% Neuropathy Left Upper

30% Intestinal Neuropathy

30% Neuropathy Incontinence

20% Neuropathy Right Lower

20% Neuropathy Left Lower

10% Diabetic Retinopathy

240% total

These per the rating table take me to 96%

Rated to 100% Permanent and Total per award letter