SMC S1

[teacher1da]

I perused this site and found it informative and supportive.  I noticed on ebenefits under additional benefits that my husband is entitled to special monthly compensation under 38 U.S.C. 1114 subsection (s) and 38 CFR 3.350(I) from 8/31/2016 to 9/1/2016; rated date 2.4.2023.  Based on the information on this site, he has met the criteria regarding housebound (with my understanding for veterans who are unable to overcome their particular disabilities and leave the house in order to earn an income...) Senate Report No. 1745 June 27, 1960 .  And according to ebenefits, on account of bladder cancer in remission (Nehmer Granted) rated 100 percent and additional service-connected disabilities hypertensive heart disease s\p heart valve replacement, ptsd 70%-TDIU, independently ratable at 60 percent or more.  To my understanding, the bladder cancer rated 100% is temporary during treatment, the 100 percent evaluation decreased to 0 percent effective September 1, 2016.  As I investigated this further, I noticed the stated entitlement on a rating decision dated 1/20/22.  Note: a decision was made without a C&P examination.  Therefore, residuals were not taken into consideration.  Again, based on my limited knowledge on SMC qualifications, I assumed that my husband would qualify with ptsd tdiu and hypertensive heart disease.

I would like to take this case to the next level and file for SMC (s-1) since it was not awarded automatically.  I am not sure how to go about applying.  Do we need to provide a lay statement?  Do I provide copies of the C&P examination reports to show level of severity?  Please advise.   He has  gotten to 100% with many bumps on the road and we know VA does not always put us on a direct path.  We would appreciate any help to move forward.

Vietnam and Iraqi Vet

 

[broncovet]

Dont be suprised.  About 80% of VARO claimants are denied.  Of those where the Veteran appeals, about 2/3 of those are eventually awarded.  Of course, if you dont appeal, your decision will become final in one year.  

There are 2 types of SMC S.  

A.  Statuatory SMC S.  That requires a single 100 percent rating (tdiu counts) and additional combined ratings of 60%.  

B.  Housebound in fact.  This usually means your doctor makes a statment to the effect that you are "substantially confined to the premisis".  

In short, I suggest you appeal.  fill out a NOD form and send it in.  If you like a Veterans service officer may be able to help you.  

"IF" the VSO has VBMS access you could even view the file and see if there was evifence "already in your file" which supports an award of benefits.  (I have no idea what is in the file, you probably dont know either, until you look at it and review it.  Most people are suprised at stuff in their file).  ASK the VSO if he/she has VBMS access.  If he/she does not, I recommend finding one who has jumped through the hoops to obtain VBMS access.  

WITH VBMS acccess, and the decision in hand, you can craft an intelligent NOD, disputing their findings.  

Example:  While the VARO decision dated April 2, 2024 stated there was no evidence that you were substantially confined to the premisis, Doc. Jones, in an exam dated 11-18-2011 apparently disputed that finding, when he noted that the Veteran has agarphobia and almost never leaves the home except for doctors appointments.  

The VARO decision did not explain why this doctors finding was not considered in the decision.  

Then, include a copy of the 11-18-2011 exam with your NOD.  You can argue that 38 cfr 3.156 supports an effective date of 11-18-2011 or earlier, for smc s.  

[teacher1da]

I requested a copy of my husband's rating decision code sheet.  Is it a moot point if they state the following:  The veteran that was entitled to SMC, was only entitled to it for one day and is applying Omnibus, no additional benefits are actually payable.

[broncovet]

It would take a complete review of the file to know for sure, but this sounds like "just one more" bogus denial to me.  VA often denies for bogus reasons.  Please   Allow an example:

The US Supreme Court Justice, Roberts, was "suprised" to hear that the VA persues claims "against the Veteran" (from a legal perspective) that are "substantially unjustified" way more than half the time..  

I will explain.  At the CAVC (Court of Veterans Claims) level of appeal, Veterans are often represented by an attorney.  And, if the Veteran wins, or even gets a remand, the EAJA pays the VEterans attorney fees "if the VA took a position against the Veteran that was substantially unjustified".  This is most of the time!   Frankly, a Veteran can send a law firm a BVA decision and, if the law firm discovers an error (often) they will take the case "with no out of pocket money from the Veteran ever" because they know the VA often takes a "substantially unjustifed" (aka bogus) position agains the Veteran.  

The reason the VA does this is "because they can" and because it often works.  It works because many/most Vets dont appeal.  And, even among those WHO DO APPEAL, the VA delays it so long the VEteran often dies, or gets so sick he can no longer continue, or just plain gets frustrated and gives up.    Even when VA loses, They win.  Why?  because the VA has just gotten a 0 percent interest loan on the money.  I wish I could borrow money at zero percent interest!   

My advice is you probably need to appeal.  To appeal you begin by filing a Notice of disagreement.  https://www.va.gov/find-forms/about-form-20-0998/

[teacher1da]

Thank you.  I am gathering information from his case and from credible sources as suggested and writing a comprehensive report/argument.   Thank you.  I appreciate your service.  

Vietnam/Iraqi Vet

[broncovet]

I dont see how its possible "to only be housebound" for one day.  Specifically, housebound defination (per VA) is that you are "substantially confined to the premises".  

Further, VA has added that "substantially confined to the premises" means the Vetean cant leave the house except for doctors appointments.  

Using the definition of "housebound" VA uses, I dont see how one could only meet the criteria "for one day".  What day WAS that anyway?  Chrismas?  Most of us stay at home for CHRISTMAS!  

[Tbird]

Housebound References:

• M21-1 Part VIII Chapter 10 SMC S Housebound
•  38 U.S.C. 1114(s) 
• 38 CFR 3.350(i)