Effective Date for SMC S?

[jdman]

I was told by my DAV Rep that my claim for Major Depression increased to 100% and I qualify for SMC S Homebound status. When is the effective date of this? When the claim was filed or when the condition worsened to award me 100%. 

[broncovet]

Lemeul:  You posted:

Quote

Which means my effective date will depend on when my nursing home care began, not on when the delayed primary care physician wrote the consults for assessment.

Not necessarily.  It would take a review of your file to know that.  More precisely, Im with you.  "When treatment" began, aka nursing home care, is not the criteria.  You could well have a condition for decades, and, your doctor could note the symptoms, but he may try a variety of differing treatment plans to treat you, which should not affect your benefits.  Some times doctors elect a treatment plan which is "wait and see", and sometimes that is the best plan, too.  Some conditions will heal up on thei own.   

Example:  You are 100 percent PTSD on Buprprion.   Your doc switches you to a different med.  This, in of itself, does not equate to your symptoms improving.   He is simplying trying a different treatment plan.  I would consider appealing this one, especially in the appeal period.  If out of the appeal period, you could apply for a supplemental claim for that period.  Again, I have not read your file, so IDK.  

As far as spousal SMC, and her passing before it was finished, my first thought was to file a substitution of claimant:

https://www.vba.va.gov/pubs/forms/VBA-21P-0847-ARE.pdf

This form is for "substitution of claimant", not for "substitution of Veteran".   This would allow you to step 

into your spouses place to continue her claim to get all the benefits.  You must do that within a year.  Like everything with VA, we have all these time limits, while VA can take 2, 4, 10, 20 or more years to process our claims with no penalties for them.  Indeed, there is a financial incentive for VA to delay our claims, and they will continue to be delayed as long as there is a financial incentive for them to delay.  

If you could delay paying your electric bill for 4, 6, 10 or 20 years, without penalty, and without interest AND your heirs would not even have to pay when you died, would you not delay paying your bill?  I would.  I would never pay my electric bill or any other bills that I could delay forever like va does, without interest and without penalty.  

[Lemuel]

Thanks for the input, Bronco.  Got my first wheelchair in 1975 in DC.  Got a better one in 1976 at Long Beach.  While I have had one ever since, I did not need it from 2003 until last year.  Only used Canadian crutches. (forearm crutches)  So my record is a mixed bag.  Treated for epilepsy with Keppra began in 2015.  Was confirmed and mistreated with Tegretol in 1990.

Was not so much that I needed observation to keep from having falls and being a mark for theft and being conned out of money.  It just happened.  No getting it back or getting those years back.  And now I am worse since falling in December of 2021.  Stayed in and let my wife keep tabs on me.  Now she is gone.  But nursing care began last July when she was no longer able to pick me up when I was down.  But they were not, and are not, there when I need them.  So much for directed care.

But may have an improvement.  Liv Health is directed care that allows you to hire your caregiver.  So will hire my sister who is bigger than I am.

[broncovet]

SMC S is for housebound, and is a much lower level than nursing home care.  You should be at a much much higher level.  

You can get Aid and Attendance "even when a family member" provides the aid.  

Quote

(h) Special aid and attendance benefit; 38 U.S.C. 1114(r)—(1) Maximum compensation cases. A veteran receiving the maximum rate under 38 U.S.C. 1114 (o) or (p) who is in need of regular aid and attendance or a higher level of care is entitled to an additional allowance during periods he or she is not hospitalized at United States Government expense. (See § 3.552(b)(2) as to continuance following admission for hospitalization.) Determination of this need is subject to the criteria of § 3.352. The regular or higher level aid and attendance allowance is payable whether or not the need for regular aid and attendance or a higher level of care was a partial basis for entitlement to the maximum rate under 38 U.S.C. 1114 (o) or (p), or was based on an independent factual determination.

(2) Entitlement to compensation at the intermediate rate between 38 U.S.C. 1114 (n) and (o) plus special monthly compensation under 38 U.S.C. 1114(k). A veteran receiving compensation at the intermediate rate between 38 U.S.C. 1114 (n) and (o) plus special monthly compensation under 38 U.S.C. 1114(k) who establishes a factual need for regular aid and attendance or a higher level of care, is also entitled to an additional allowance during periods he or she is not hospitalized at United States Government expense. (See § 3.552(b)(2) as to continuance following admission for hospitalization.) Determination of the factual need for aid and attendance is subject to the criteria of § 3.352:

(3) Amount of the allowance. The amount of the additional allowance payable to a veteran in need of regular aid and attendance is specified in 38 U.S.C. 1114(r)(1). The amount of the additional allowance payable to a veteran in need of a higher level of care is specified in 38 U.S.C. 1114(r)(2). The higher level aid and attendance allowance authorized by 38 U.S.C. 1114(r)(2) is payable in lieu of the regular aid and attendance allowance authorized by 38 U.S.C. 1114(r)(1).

(i) Total plus 60 percent, or housebound; 38 U.S.C. 1114(s). The special monthly compensation provided by 38 U.S.C. 1114(s) is payable where the veteran has a single service-connected disability rated as 100 percent and,

(1) Has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or

(2) Is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime.

(j) Special aid and attendance benefit for residuals of traumatic brain injury (38 U.S.C. 1114(t)). The special monthly compensation provided by 38 U.S.C. 1114(t) is payable to a veteran who, as the result of service-connected disability, is in need of regular aid and attendance for the residuals of traumatic brain injury, is not eligible for compensation under 38 U.S.C. 1114(r)(2), and in the absence of such regular aid and attendance would require hospitalization, nursing home care, or other residential institutional care. Determination of this need is subject to the criteria of § 3.352.

(1) A veteran described in this paragraph (j) shall be entitled to the amount equal to the compensation authorized under 38 U.S.C. 1114(o) or the maximum rate authorized under 38 U.S.C. 1114(p) and, in addition to such compensation, a monthly allowance equal to the rate described in 38 U.S.C. 1114(r)(2) during periods he or she is not hospitalized at United States Government expense. (See § 3.552(b)(2) as to continuance following admission for hospitalization.)

(2) An allowance authorized under 38 U.S.C. 1114(t) shall be paid in lieu of any allowance authorized by 38 U.S.C. 1114(r)(1).

Your sister can get paid for helping you.  That is, you would get paid, and you can pay her.  It does not matter that a and a is provided by a family member.  You should apply for the max level, then appeal if denied.