smc SMC S/L A&A if not now, then what to keep track of for the future?

[averagejoe]

Greetings,

I have been battling with the VA since early 2017 with my disability claim(s). In September 2021, I filed a supplemental claim due to the presumptive condition changes for OEF/OIF/OND and burn pits / particulate matter exposures. They followed through and rated me at 100%, but I then filed for a higher level review because they put effective dates in October (the date of my LHI exam, and not the effective date of change in law or date filed for disability). It is still on-going, and they did a partial grant. I didn't ask for a CUE claim, but they found several CUE claim issues upon that higher level review. So sleep apnea, IBS, hemorrhoids, and etc are being addressed because the VA failed in their duty to assist. They sent my records to an LHI contracted physician (one I saw back in October and she had favorable findings for me then). Presently, I have a combined disability of 100% P&T. And for now (I'm 39), I have gainful employment at a decent salary.  Miraculously enough, PTSD and mental health are not among my medical conditions or concerns, even after 20 years in the USAF/ANG.

 

As I go through life, I am finding it more difficult to do tasks independently. My wife cuts my toenails because it is hard for me to reach my toes and use clippers (right hand dominant), and I usually end up cutting too much and/or getting an ingrown nail. I also have one of those as seen on TV gizmos to help put on my socks. So, needless to say, managing my feet is rather difficult for me (and balancing on 1 foot in the shower to scrub them with soap is nearly impossible). The VA has provided me with special shoes and cork inserts to help with the flat feet. I wear collared shirts for work, and it is difficult to do the buttons on the collar as well as the cuffs. I almost always have to have my wife do those for me. I have about 20 medications that the VA has prescribed to me for all of my medical conditions and issues. And my wife is quite persistent about me keeping track of my medications. She bought me one of those medication holders that has a tube with 4 spaces (breakfast, lunch, dinner, bead) for each of 30 days. Just filling those sometimes is an awful pain in the ass with my hands and fingers.

 

I have tried several times to get the VA to consider flare ups in the rating for my cervical spine and knees. Each time it has failed. So now, I have the DBQ's printed and on file with my PCP. The next time I have a flare up, the PCP will see me that day or next day and go through the DBQ's. Then I'll file for an increase, and I may try to file for an earlier effective date as I have not run out of appeals/reviews and I'm still within a year. And my flare ups

When my neck gets tweaked, it is nearly impossible to turn my head left or right, my head is pretty much frozen at a slight rightward angle and limited ROM. This usually results in my right shoulder having a flare up as well. 

When my right shoulder goes wonky, I have severe pain and need to wear an immobilizing brace.

And my my lower back will go out with shooting pain from lower back to my feet, unable to walk long distances, and if I pick up my son or dog, I will lose feeling and fall to the floor, so I don't do that when my back is flaring up. And sometimes lifting my younger son or dog will cause this problem. 

For my knees, these usually go out when I'm deep in the woods walking on uneven terrain, and braces/K-Tape don't seem to prevent the knees from becoming nearly impossible to use and they are in such pain that I can't flex them. It can take me several hours to walk/limp even 3 miles back to the truck when my knees go out. So now, I don't go as far out into the woods if it is an area that has zero cellular service.

 

I also have problems with both wrists, and I have to sleep with braces on to keep them from curling my hands inward at night. So trying to manage a CPAP or even the buttons on my pajamas to take a piss gets very irritating and frustrating at night. I am to the point where I don't drink anything after 7pm so that I don't have to get out of the bed at night to relieve myself in the bathroom.

 

To what degree is loss of use considered for extremities? And to what degree is A&A factored into basic tasks of hygiene and grooming and medication management? At least once per day, my wife does help me with something related to personal hygiene or dressing. If I'm not quite at the point for SMC type benefits, what should I be documenting and keeping track of, and where? Do I schedule more frequent appointments with my doctor? I have a community care provider as the local VA and CBOC's are well over an hour away from me.

 

Also, is SMC paid in addition to, or in lieu of scheduler VA disability payments?

 

I have an upcoming appointment with my doctor to discuss ED related matters, and it appears that several of my medications for service connected issues (arthritis medications, sinus medications) have ED listed as a potential side effect. So, I will be working on an SMC-K package for that.

 

Lastly, I have tried and failed in regards to an earlier effective date for tinnitus, hearing loss, and rhinitis (all rated back in 2017 with an adjustment in 2018 for rhinitis). When I got off of OND/OIF orders in 2011, I went to the VA in 2012 for those issues. I was told that I should go see the VA and they'll take care of you. But nowhere did anyone offer any assistance or direct me towards a formal disability claim. Could it be seen or considered an informal claim (under those old rules) by having sought a VA diagnosis and/or treatment within 1 year of release from Active Duty? Should I try a formal CUE claim on this issue, or just accept defeat? Who knows, maybe 21-432 ARELLANO V. McDONOUGH might help with this if SCOTUS affirms for the petitioner.

 

I do have a digital and electronic copy of my C-File from 2017-2018. I haven't requested an updated copy recently. But the last copy I got was over 1800 pages of documentation. 

 

I'm also looking forward to HR 3967, if that passes, the effective date for my sinusitis and migraine headaches could be back to my initial claim in May of 2017. But with that said, if it passes, and I file a supplemental claim for sinusitis, migraine headaches, and sleep apnea (if they grant it) will they review the present rating tables, or the rating tables at the time of the application? The VA published changes to the rating tables for ears, nose, throat, sinus, sleep apnea and etc on Feb 15th in the Federal Register.

 

 

Thank you,

 

 

Disability	Rating	Decision	Related To	Effective Date
chronic strain right thumb (previously evaluated under DC 5224)	10%	Service Connected		5/7/2017
shoulder condition, right	20%	Service Connected		5/7/2017
radiculopathy of the right upper extremity	20%	Service Connected		10/11/2018
radiculopathy of the left upper extremity	20%	Service Connected		10/11/2018
internal derangement of the left knee	10%	Service Connected		2/24/2020
internal derangement of the right knee	10%	Service Connected		2/24/2020
radiculopathy, right lower extremity involving the sciatic nerve	10%	Service Connected		10/12/2021
radiculopathy, left lower involving the sciatic nerve	0%	Service Connected		11/10/2020
internal derangement of the right ankle (claimed as ankle condition, right)	10%	Service Connected		5/7/2017
left ankle strain	10%	Service Connected		10/30/2017
bilateral flat feet (pes planus)	30%	Service Connected		9/12/2019
lumbosacral strain	10%	Service Connected		11/10/2020
cervical strain with degenerative arthritis of the spine (previously rated as musculoskeletal - neck/upper back (cervical spine) (to include neck condition))	10%	Service Connected		10/7/2019
rhinitis with eustachian tube dysfunction	10%	Service Connected		10/11/2018
sinusitis	50%	Service Connected	Gulf War Presumptive 3.320	8/5/2021
tinnitus	10%	Service Connected		5/7/2017
bilateral hearing loss	0%	Service Connected		5/7/2017
migraine headaches	0%	Service Connected	Burn Pit Exposure	8/9/2021

[jbasser]

To get aid and attendance, a veteran must have loss of use of both feet or 1 hand and one foot or be blind in both eyes or be so helpless that the veteran requires the assistance of another person for daily activities. This is explained in 38 USC 1114. Focus point on ADL's for A&A.  

[broncovet]

Its paid "in lieu of".  This means a "net increase" for SMC S of about $370 per month, and SMC L is about double that.  

 

[jbasser]

In order to qualify for SMC S one has to have a single 100 percent disability and a separate and 60 percent disability or be housebound,