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Housebound/SMC S question?

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TexasTweener

Question

I've been encouraged by a fellow Veteran and friend to apply for Housebound/SMC S.

I'm not sure I would qualify and don't want to tie up time and resources other Veterans need.

I'm TDIU P&T.

50% Depression

10% Right Shoulder

20% lower left leg radiculopathy

20% lower right leg radiculopathy

10% GERD

10 % Tinnitus

and a couple of 0% service connected.

Also I have/had non=service connected prostate cancer and I'm pretty much incontinent.  I do have a AUS but it's not perfect.

I've been TDIU for over 10 years at this point.

 

Due to my back problems I have problems standing and walking.  The time it takes to brush my teeth causes my back to start to spasm and hurt.  I can normally get around the house without a cane but it I try and walk 50 yards I must have the cane to prevent my back from spasming and my legs to hurt worse.  

My daily schedule is thus:

I get up in the morning, take the morning pills and make my way to my power recliner that I had to purchase with my own funds since the VA wouldn't provide one.  I'll sit in my recliner for 1-2 hours and get up to eat breakfast.  After breakfast it's back to the recliner.  I'll get up a couple of times during the day to urinate.  Once in a great while I'm able to help my wife with preparing dinner.  I have to do so sitting at the table since I can't stand long enough to do much of anything.  We're retired, no kids, so we eat dinner in the family room.

I'll maybe get up one more time between dinner and bedtime to use the restroom.

I spend around 11-12 hours a day in bed and the remainder in my recliner.  All total through the day I might walk 75 yards.  I only get out of the recliner for breakfast and head calls in a normal day.

In the past year I leave the house an average of three times per month.  One of those visits is my outside pain doctor since the VA quit prescribing opiates.  Usually one trip to Walmart with my wife, and one time a month for dinner out.

It's very hard for me to get around.  Carrying a gallon of milk for a short distance is about all I can carry.

My wife has to put my socks on and take them off.  She has to help me dress.  I'm of Scottish heritage so I've taken to wearing a kilt since I can get that on myself.  My wife has to help me bathe.  She does all the housework, almost all the meal prep.  She's a saint and I'd be lost without her.

I used to be pretty active.  I'd go fishing once or twice a week.  Go to the range once a week.  None of it was easy but it kept me active.   Now all that is a distant memory.

My friend and fellow Veteran tells me I am effectively housebound and that I should qualify for SMC S with no problem.

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Based on your answers, I suggest you apply.  "Housebound" (SMC S) and Aid and Attendance (SMC L) are usually applied for together.  

Remember, VA regulations permit you to get Aid and Attendance benefits "even when" the assistance is given by a family member.  

There are 2 possible ways to get SMC S, and you can qualify either way.  

1.  Statuatory SMC S (housebound).  This applies when you have 100 percent (yes, tdiu counts here) AND an additional 60 percent combined separate and distinct.

2.  Housebound "in fact".  This means you are "substantially confined" to your home.  

Some CAVC case law suggests congresses intended this to be for Veterans UNABLE TO LEAVE HOME TO EARN AN INCOME, as opposed to unable to leave the home at all.  

     While I have not reviewed your file, based on what you posted, I would suggest a better than 50 percent chance of getting at least SMC S, "provided that" you apply and are willing to do what it takes to appeal, since VA has been known to deny this to deserving Veterans requiring the Veteran to appeal.  

     You may well get either one or the other (Smc S or SMC L), but you will likely have to attend a c and p exam "unless" you meet the criteria for Statuatory housebound. (Possible, but not guaranteed...I dont know which conditions led to your TDIU, and, I have no idea which if any of your conditions are seperate and distinct. 

     My advice:  Apply.  Sooner is better than later, but be willing to attend a c and p exam if VA requests one.  

    

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Thanks for the reply.  

I believe all my conditions led to my TDIU.  I would have to dig out my paperwork and see.  I applied for TDIU because of the back and legs.

I have no problem attending a C&P exam.  

 

I was under the impression that aid and attendance was only for combat vets.

 

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No.  There is no restriction to "combat vets" for A and A.  The criteria for a and a follows:

Quote
3.352 Criteria for determining need for aid and attendance and “permanently bedridden.”

(a) Basic criteria for regular aid and attendance and permanently bedridden. The following will be accorded consideration in determining the need for regular aid and attendance (§ 3.351(c)(3): inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. “Bedridden” will be a proper basis for the determination. For the purpose of this paragraph “bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others.

To add, item "C" in this section explains that a relative may provide A and A, and the Veteran is still eligible for this benefit.  

Source:

https://www.law.cornell.edu/cfr/text/38/3.352#:~:text=The particular personal functions which,there be a constant need.

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The way I see it by your rating I don't see the 100/60 for smc s.

Housebound by fact my belief should be granted when a veteran is unable to leave there home to make a income.

That will be a fight. Believe me.

Smc l for aid attendance is based on the need of help if other. Bath cook dressing 

You don't need to need help for all things.

I would say educated your self on smc l a&a and do research. Before you apply.

I think that the best ave.

 

This all my opinion and is based off my understanding of smc.

 

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Try for Housebound in fact.  Statutory  needs total plus 60%. So I had TDIU and got an extra 60% for condition not included in the TDIU.  For "in fact housebound" you need to show by evidence that you are housebound.  Just go for all you can get, but prepare for a contest.  I know with the VA it is all about the money and the regs they use to deny or affirm your claim.  I would forget your going out to eat and trips to Walmart.

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