Do I qualify for SMC? Is it automatic?

[LKF050813]

Hi all,

I was originally awarded 80% rating upon medical retirement. Recently filed for an increase and just received the notification letter. I’m at 100% for mental health, and then I have combined ratings for other things that total another 90%. Do I qualify for SMC-S? If so, do I have to file for it or is it added automatically because of my rating?

[Tbird]

https://www.ecfr.gov/current/title-38/chapter-I/part-3/subpart-A/subject-group-ECFR6477ad08d327384/section-3.350

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.

 

[broncovet]

We dont know if your ratings are "seperate and distinct" or not, a requirement for SMC S..statutory.  We also dont know if you are "substantially confined to your premisis" to qualify you for SMC S (housebound in fact).  If you can answer those questions, we can give a better answer.  

The answers to the above questions are often (but not always) found in your medical/cfile.  In all cases, you can/should apply for SMC S, and, probably dispute VA's findings if you disagree.  

The good part of smc is that, if awarded, regardless of when you apply, you should get retro "back to the date" when you first met the criteria for smc S.  Example:  You apply for smc S, on June 15, 2024, and you eventually get awarded benefits back to the date your doctor says you were substantially confined to your home, in a medical exam in April 2022.  Your effective date should be april, 2022.  

[Vync]

6 hours ago, broncovet said:

The good part of smc is that, if awarded, regardless of when you apply, you should get retro "back to the date" when you first met the criteria for smc S.  Example:  You apply for smc S, on June 15, 2024, and you eventually get awarded benefits back to the date your doctor says you were substantially confined to your home, in a medical exam in April 2022.  Your effective date should be april, 2022.  

I wish the VA disability compensation would also award benefits back to date of diagnosis like they do for SMC...

[LKF050813]

On 6/12/2024 at 4:11 PM, ShrekTheTank said:

 

Edited June 14 by LKF050813

[LKF050813]

On 6/13/2024 at 8:33 AM, broncovet said:

We dont know if your ratings are "seperate and distinct" or not, a requirement for SMC S..statutory.  We also dont know if you are "substantially confined to your premisis" to qualify you for SMC S (housebound in fact).  If you can answer those questions, we can give a better answer.  

The answers to the above questions are often (but not always) found in your medical/cfile.  In all cases, you can/should apply for SMC S, and, probably dispute VA's findings if you disagree.  

The good part of smc is that, if awarded, regardless of when you apply, you should get retro "back to the date" when you first met the criteria for smc S.  Example:  You apply for smc S, on June 15, 2024, and you eventually get awarded benefits back to the date your doctor says you were substantially confined to your home, in a medical exam in April 2022.  Your effective date should be april, 2022.  

My 100% rating is for mental health. The other 90% are made up of various physical conditions, like bilateral knee problems, bilateral foot problems, lower back problems, TMJ, etc. The VSO I was referencing seems to think he sees the code for SMC-S1 on my file, but I can’t see that yet because my notification letter is still not showing up online. I asked him if I was P&T and he said he believes so because I’m getting educational benefits. I asked if I’m P&T for everything or just for mental health and he didn’t know.

Just wish this was all less confusing. I’ve been rated on all of these conditions since 2011 and never had a reassessment. I’m very grateful for my updated rating and just want to move on from this without having to look over my shoulder for the boogie-man. The process of applying for increased benefits was mentally and physically exhausting and I need a break from worrying for awhile. 

[pacmanx1]

40 minutes ago, LKF050813 said:

The VSO I was referencing seems to think he sees the code for SMC-S1 on my file, but I can’t see that yet because my notification letter is still not showing up online. I asked him if I was P&T and he said he believes so because I’m getting educational benefits.

Here is the thing, if the VA recently granted you an increase in your rating, you need to wait to see what actually changed. It makes absolutely no sense in you filing any claim and or appeal until you get your notification letter. It is very possible that the VA included SMC-S in your newly decided award and your new notification letter will explain that. Keep an eye out for any direct deposit retro payment. But for now, the only thing you can do is sit back and wait for your decision letter. You can ask your VSO to send you a copy of your decision if it is ready or you can call the 1 (800) 827-1000 number to see if they can email you a copy if it is completed and ready but that is just about it. CH 35 DEA Education benefits come with P & T and not being rated 100% so, if your records show you are getting CH 35 DEA that means the VA has awarded you P & T.

SEE VA FORM 21-8760 for ADDITIONAL BENEFITS FOR P & T.

VBA-21-8760-ARE.pdf (va.gov)

Edited June 14 by pacmanx1