SMC S Etiology Question

[usarmyvet2]

Does anyone have experience with housebound regarding mental health?

I am diagnosed for anxiety but not receiving a VA rating for it and I am 100% for PTSD. 

To be awarded SMC-S one qualifier is 100% rating and a secondary rating of a separate etiology of 60% or higher.

If I get rated 60% or higher for my anxiety, will that qualify me for SMC-S?

Thanks.

 

Respectfully,

 

[brokensoldier244th]

Yes, I’m HB for depression, among other things.
 

 100+60 or over- that’s the statutory formula but it also depends on your symptoms overall, no pyramiding. I know lots of depressed people with high ratings that still function pretty well and aren’t HB. 

Edited April 19 by brokensoldier244th (see edit history)

[pacmanx1]

3 hours ago, usarmyvet2 said:

Does anyone have experience with housebound regarding mental health?

I am diagnosed for anxiety but not receiving a VA rating for it and I am 100% for PTSD. 

To be awarded SMC-S one qualifier is 100% rating and a secondary rating of a separate etiology of 60% or higher.

If I get rated 60% or higher for my anxiety, will that qualify me for SMC-S?

Thanks.

No, my understanding is that you can be rated for only one etiology in a category and since PTSD and anxiety both fall under the mental health category the VA would/will not give you a separate rating for it. Since you already have a 100% rating for PTSD, the additional rating or ratings could be a combined or a single rating of 60% or higher. 

Just to be clear, since you are already have a service-connected rating of 100% PTSD, any rating for anxiety would be pyramiding the same symptoms and would not be allowed. 

Edited April 19 by pacmanx1 (see edit history)

[broncovet]

I agree with Pacman.  If you read the criteria for Statuatory SMC S (my paraphrase) is that you need a single 100 percent rating "plus an additional 60 percent combined which are seperate and distinct.  

    While no one can accurately predict "what VA will do" especially when it comes to interpreting its own regulations, my guestimate (unsubstantiated) is that Va will consider anxiety and PTSD "NOT" seperate and distinct.  But, dont take my word for it, it would certainly not be the first time VA did something I did not think they would do.  

    In fact, I think I can say with about 95 percent certainty, that everytime I got a VARO decision, I was surprised, as I did not think it would be that way.  

    For me, VA seems to have a habit of denying stuff that should be a no brainer, and, rarely, awarding stuff I never considered.  

[broncovet]

For the reasons I posted above, my advice is to review your file, and see if there may be additional things which could be SC, such as back, knees, high blood pressure due to toxic exposure, hearing loss, etc., that is "seperate and distinct" from PTSD.  

"But also (and this is a big But)", remember, case law suggests congress intended for SMC S to be for Veteran's who cant leave the home for work, (as opposed to not being able to leave the home at all).  (Housebound in fact).  Regulations use the term "substantially confined to your home".  

Remember there are 2 roads to SMC S:  Statuatory (first paragraph, above) and Housebound in fact,second paragraph.  

Finally, when you were rated 100 percent for PTSD, if you look at their criteria, it says, "Total occupational and social impairment".  Its not a "stretch" that if you are "totally occupationally impaired" you can not/do not work outside the home.  So, my speculative guess is that you are NEITHER working, nor are you leaving your home FOR WORK.  

There has been much much discussion on SMC S involving "not leaving the home for WORK", and, VA law is in flux.  

There fore, if you are NOT leaving your home for work, then I dont see a good reason why you would not apply.  You can search BVA CAVC case law on this to support your postition, but VA does not hand out SMC S like candy at a parade, so you will likely have to fight for SMC S, most likely like you had to fight for the rest of your ratings.  

VA fought me for every inch, for decades.  

Its sort of like football, when you are 1 inch from the goal.  There is going to be a "whole team" of VA lawyers and employers whose job it is to make sure you dont gain that last inch.  

But, the good news is you, too, can assemble a team to help you push that last inch.  Sometimes it takes a STRONG lawyer, sometimes you can do a quarterback sneak, or, you can "pass" on the lawyer, and get hadit, your VSO, and maybe even others to help.  

(Football huddle). "Ok, we only need one inch.  We need someone real strong, or very fast, or someone who can really catch the ball.  I will "audible" the call when I see their defense.  On 2!  Lets go!"  

[broncovet]

For the reasons I posted above, my advice is to review your file, and see if there may be additional things which could be SC, such as back, knees, high blood pressure due to toxic exposure, hearing loss, etc., that is "seperate and distinct" from PTSD.  

"But also (and this is a big But)", remember, case law suggests congress intended for SMC S to be for Veteran's who cant leave the home for work, (as opposed to not being able to leave the home at all).  (Housebound in fact).  Regulations use the term "substantially confined to your home".  

Remember there are 2 roads to SMC S:  Statuatory (first paragraph, above) and Housebound in fact,second paragraph.  

Finally, when you were rated 100 percent for PTSD, if you look at their criteria, it says, "Total occupational and social impairment".  Its not a "stretch" that if you are "totally occupationally impaired" you can not/do not work outside the home.  So, my speculative guess is that you are NEITHER working, nor are you leaving your home FOR WORK.  

There has been much much discussion on SMC S involving "not leaving the home for WORK", and, VA law is in flux.  

There fore, if you are NOT leaving your home for work, then I dont see a good reason why you would not apply.  You can search BVA CAVC case law on this to support your postition, but VA does not hand out SMC S like candy at a parade, so you will likely have to fight for SMC S, most likely like you had to fight for the rest of your ratings.  

VA fought me for every inch, for decades.  

Its sort of like football, when you are 1 inch from the goal.  There is going to be a "whole team" of VA lawyers and employers whose job it is to make sure you dont gain that last inch.  

But, the good news is you, too, can assemble a team to help you push that last inch.  Sometimes it takes a STRONG lawyer, sometimes you can do a quarterback sneak, or, you can "pass" on the lawyer, and get hadit, your VSO, and maybe even others to help.  

(Football huddle). "Ok, we only need one inch.  We need someone real strong, or very fast, or someone who can really catch the ball.  I will "audible" the call when I see their defense.  On 2!  Lets go!"  

"If you walk away and forfeit the game, not even trying anything, then you will lose".  If you try something and it does not work, you still have more "downs" to go.  Its first and goal at the one inch line.  You can probably make that last inch with 4 tries.  "  Dont forefeit, keep trying no matter what.  

[brokensoldier244th]

Anxiety is not separately rateable if there is PTSD or other MH rating. It is usually subsumed under the claimed condition rating due to avoiding pyramiding.