SPECIAL MONTHLY COMPENSATION–WHAT IS IT?


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Member Carla writes and says “my husband has lost the use of his creative organ for all intents and purposes. They attribute this to his DM2. He was also blinded in one eye from shell fragments during a mortar attack in Vietnam during his tour. They were paying him Special Monthly Compensation (K). My question is simple. Can he have two (K) ratings at the same time? Our VSO says no and won’t file it. What’s the law?”

Well, Carla. Ratings accrue from 0% up to 100%. Certain parts and pieces we’re missing are remunerated slightly differently. Finally, if we are missing too many or some go bad, we advance up the ladder. SMC is awarded for “quality of life” issues above and beyond 100% disability.  At the end, when we are on our deathbed, we’re often actually entitled to SMC (r) (2) for that short period before we kick over assuming the proper, multiple causes are service connected (of course). Let’s look at this. Think of your husband as Mr. Potato Head for an example. Imagine him starting out complete. Now let’s start removing  eyes and arms and legs and see what happens. He has lost an eye so he gets SMC (K) number one. Ka-ching–$103.23/month. Your VSO representative is very wrong on the number of SMC Ks you can receive. Surprise, surprise , surprise, huh?

images (1)So now, you move forward and say Roger. Loss of, or loss of use of, a creative organ (we’ll forego illustrating this on Mr. Potato head in order for him to keep his dignity)–Ka-ching. SMC (K)– $103.23 more dollars a month. Each and every condition listed in 38 CFR §3.350 (a) Special Monthly Compensation  is a stand alone item worth the $103.23.

Obviously, this largesse hits a trip wire eventually. If you are 100% service connected for Hepatitis C and you have some of these items that are unrelated to the hepatitis, they are stand alone (K) ratings that qualify. If and when the aggregate total of these injuries meets or exceeds what you would be entitled to under SMC L, the gravy trains stops. There is no limit to (K) awards. One can see he/she would need all of them and an additional 60% such as needed for the SMC (S) to get into striking range of SMC (L). One can also see she/he’d need to have a complete complete Chelsey Manning makeover  to get all of them.

Here’s the criteria for (K) 

Mastectomy or even a partial one (see criteria)

Loss of testicle(s)

Loss of, or loss of use of use of, creative organ (male or female)

A foot; or

a hand

both buttocks (the Forest Gump injury)

totally deaf

Aphonia (loss of speech)

one eye

Extremely unfavorable complete ankylosis of the knee, or complete ankylosis of two major joints of an extremity, or shortening of the lower extremity of 3 1/2 inches or more, will constitute loss of use of the hand or foot involved.

Complete paralysis of the external popliteal nerve (common peroneal) and consequent footdrop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of this nerve, will be taken as loss of use of the foot.

SMC S

The next higher stand alone SMC is SMC (s). To be sure, you may collect the SMC (k) ratings above as well as SMC (s). By law, your SMC K(s) and SMC S cannot exceed the next higher rating of SMC (l). SMC (s) is called the housebound rating. If you are confined to your home because of medical conditions that keep you home, then you are “substantially” housebound. Another way to qualify for SMC (s) is to have a 100% schedular rating or TDIU and separate, additional 60% or more in combined ratings unrelated to the initial 100% qualifier. Those are the general parameters.

Now, I get asked this by every single Vet who finds out about this “secret” rating the VSOs never tell you about. “So I get the 100% check for$3,068.90 a month and I get the SMC (s) rate on top of that, right?” Negatory, fellers. VA is on a reduced bonus diet these days. They don’t hand out money like Mardi Gras beads on Fat Tuesday. Think of it like being promoted from PFC to Corporal. In this case, you get another $345 a month on top of the 100% comp. VA tells everyone we Vets call this our Corvette payment. Yeah, right.

And here, we enter a footnote -a very important one. Read the following decision on SMC S and what the VA Secretary says about it. The consensus precedent opinion  in Howell v. Nicholson says SMC (s) is not based on a medical consideration but a work consideration.

https://asknod.wordpress.com/2014/08/25/cavc-howell-v-nicholson-what-smc-s-really-says/

The regulation specifies that you must be either rateable at a combination of 60% or more above a TDIU (or 100% schedular rating) or with TDIU and with extraordinary conditions to be eligible. If you have one disease or injury rated at 100% and you are undebateably housebound in all but name only, they often grant. A letter from a doctor would be great help stating as much. SMC (S) is an extra $346.84 above the normal 100% rating of  $3068.90(with spouse) for a whopping $3415.74/month. A codicil to this is that each and every illness/injury has to be separate and distinct from your 100% (or TDIU item) to qualify. If you have peripheral neuropathy secondary to DM2, those are injuries/illnesses that are distinct and separate. Shell fragment wounds to several parts of your body (muscle groups) are all related to one injury or event and are not distinct and separate. VA will get down and dirty on this. Expect a lot of mistakes on what constitutes a “separate and distinct illness above and beyond the primary rating for the TDIU/100%”. They all have to be service connected, too. A complete, different illness separate from the rated one (like PCT),  secondary to the Hepatitis, involves a different element (the skin).  Much debate occurs on this and raters make much mistakes after much M 21.

And before we continue the alphabet disability parade, there are certain times you get a “bye” on a given SMC requirement and advance even higher. I discuss how to jump from L to N without being blind or suffering a single amputation in the last paragraph.

SMC L

The next big step up the ladder is the aforementioned SMC (l). The requirements of (l) will invariably include some of the (k) ratings because this is an incremental potato head game. (l) does not hinge on percentages. If you qualify for (l), it’s $3601.00/month in 2016 $ as a single Vet. The Forest Gump exemption is still there if you lose your buttocks. If you do, you get to throw in that SMC (k) and any others for $103.23/month each on top of (l) or (s). That’s not the end of (k)s because you can add them to (m) and (n), too. Oh, and you can keep the (K) for the loss of use of the creative organ too. The fact is, you can keep all your SMC (k) ratings  with an (l) rating as long as the combination doesn’t exceed what is paid for SMC (m).

SMC (l) is paid based on any of these:

Loss of one eye or blindness in both eyes with visual acuity of 5/200 or less

totally deaf

Aphonia (loss of speech)

loss of one hand and one foot or: loss of both feet

OR (notice the disjunctive)

Need for aid and attendance— The criteria for determining that a veteran is so helpless as to be in need of regular aid and attendance are contained in § 3.352(a).

Permanently bedridden–The criteria for rating are contained in § 3.352(a). Where possible, determinations should be on the basis of permanently bedridden rather than for need of aid and attendance (except where 38 U.S.C. 1114(r) is involved) to avoid reduction during hospitalization where aid and attendance is provided in kind.

The loss of, or loss of use of an extremity (hand, foot) is based on the SMC(K) rule (a)(2). This generally is an amputation or impairment closest to the first joint the extremity is attached to. The half steps are for amputation or loss closer to the trunk of the body. SMC P is a laundry list of odds and ends combined to instruct on all the possible combinations and the proper SMC rating for each. A lot of times the combination of disabilities doesn’t fit a (P) but VA errs on the side of a lower rating.

SMC L pays $3779.09/month with spouse, so this works out to  $710.19 more per month than a simple 100% rating.  The amount of SMC Ks added to the SMC L cannot exceed what is paid in SMC M-the next higher rate- unless it is described in SMC P.  Generally, someone who qualifies for SMC S eventually deteriorates over time and moves up to SMC L. Now, if you qualify for L as a stand alone rating based on one disability rated at 100% schedular, and you also had Hepatitis C for 100%, you would automatically advance to SMC (M). If you also have a 50% or greater rating on any additional disease/injury [regardless of whether the individual diseases, or injuries are of different etiology] and qualify for (L) as a stand alone, then you could advance with an additional bump to (M½). SMC (M½) pays $4,441.36/month. The rule is contained in 38 CFR §§3.350(f)(3),(4). If you have two separate and distinct, stand alone 100% schedular ratings, you get a bump from L to M, or M to N, or N to O. Under the same theory, you can have a bunch of 50% or more ratings (or combinations adding up to 50%) and get the 1/2 step bump for each one by VA’s current regulation. Remember its either conjunctively (and)- or disjunctively (or) phrased to understand it. If neither are there for clarification, the regulation or statute that grants the greater benefit is for application.  It’s an interesting codicil and one very few raters, let alone BVA judges are even aware of.

SMC M

The next step is  SMC (M). Mr. Potatohead is gradually losing his ability to ambulate and see. He is now wheelchair bound unless he’s very adroit with a bunch of prostheses. Here’s the next set of  required missing parts.

Anatomical loss or loss of use of both hands;

Anatomical loss or loss of use of both legs at a level, or with complications, preventing natural knee action with prosthesis in place;

Anatomical loss or loss of use of one arm at a level, or with complications, preventing natural elbow action with prosthesis in place with anatomical loss or loss of use of one leg at a level, or with complications, preventing natural knee action with prosthesis in place;

Blindness in both eyes having only light perception;

Mr. Potatohead on SMC (L)

Blindness in both eyes leaving the veteran so helpless as to be in need of regular aid and attendance.

Natural elbow or knee action. In determining whether there is natural elbow or knee action with prosthesis in place, consideration will be based on whether use of the proper prosthetic appliance requires natural use of the joint, or whether necessary motion is otherwise controlled, so that the muscles affecting joint motion, if not already atrophied, will become so. If there is no movement in the joint, as in ankylosis or complete paralysis, use of prosthesis is not to be expected, and the determination will be as though there were one in place.

Eyes, bilateral. With visual acuity 5/200 or less or the vision field reduced to 5 degree concentric contraction in both eyes, entitlement on account of need for regular aid and attendance will be determined on the facts in the individual case.

SMC M pays $4153.81/month-an increase up from  the $3966.07/month on (L½) or $187.74 more. SMC-M½ jumps to $4428.07/month and again requires shorter arms and legs,  eyes physically missing, poorly fitting prostheses, etc.

SMC N

Potatoheads on SMC (M)

SMC N  continues the parade of missing pieces. Mr. Potato head is now blind and immobile due to no feet down belooooow the knees. Actually he is without knees.Any of the conditions below qualify you for this. Also remember this is the last SMC chance to cash in the SMC (K) for the lost buttocks. Don’t forget it.

Amputation is a prerequisite except for loss of use of both arms and blindness without light perception in both eyes. If a prosthesis cannot be worn at the present level of amputation but could be applied if there were a reamputation at a higher level, the requirements of this paragraph are not met; instead, consideration will be given to loss of natural elbow or knee action.

Anatomical loss or loss of use of both arms at a level or with complications, preventing natural elbow action with prosthesis in place;

Anatomical loss of both legs so near the hip as to prevent use of a prosthetic appliance;

Anatomical loss of one arm so near the shoulder as to prevent use of a prosthetic appliance with anatomical loss of one leg so near the hip as to prevent use of a prosthetic appliance;

Anatomical loss of both eyes or blindness without light perception in both eyes.

SMC (N) pays out at $ 4540.89/ month- a sizable jump from M. I do not include the half steps as they simply add another few $ to the equation and a requirement for a few extra missing pieces or shorter ones.

SMC O

When we get to SMC O/P ($5,237.67) , Mr. Potato head is beginning to look just that- a potato. Here are the prerequisites to attain (O).

Mr. Potato Head in potato wheel chair.

Mr. Potato Head in potato wheel chair.

Anatomical loss of both arms so near the shoulder as to prevent use of a prosthetic appliance;

  Conditions entitling to two or more of the rates (no condition being considered twice) provided in 38 U.S.C. 1114(l) through (n);

 Bilateral deafness rated at 60 percent or more disabling (and the hearing impairment in either one or both ears is service connected) in combination with service-connected blindness with bilateral visual acuity 20/200 or less.

  Service-connected total deafness in one ear or bilateral deafness rated at 40 percent or more disabling (and the hearing impairment in either one of both ears is service-connected) in combination with service-connected blindness of both eyes having only light perception or less.

 Paraplegia. Paralysis of both lower extremities together with loss of anal and bladder sphincter control will entitle to the maximum rate under 38 U.S.C. 1114(o), through the combination of loss of use of both legs and helplessness. The requirement of loss of anal and bladder sphincter control is met even though incontinence has been overcome under a strict regimen of rehabilitation of bowel and bladder training and other auxiliary measures.

 Combinations. Determinations must be based upon separate and distinct disabilities. This requires, for example, that where a veteran who had suffered the loss or loss of use of two extremities is being considered for the maximum rate on account of helplessness requiring regular aid and attendance, the latter must be based on need resulting from pathology other than that of the extremities. If the loss or loss of use of two extremities or being permanently bedridden leaves the person helpless, increase is not in order on account of this helplessness. Under no circumstances will the combination of “being permanently bedridden” and “being so helpless as to require regular aid and attendance” without separate and distinct anatomical loss, or loss of use, of two extremities, or blindness, be taken as entitling to the maximum benefit. The fact, however, that two separate and distinct entitling disabilities, such as anatomical loss, or loss of use of both hands and both feet, result from a common etiological agent, for example, one injury or rheumatoid arthritis, will not preclude maximum entitlement.

 Helplessness. The maximum rate, as a result of including helplessness as one of the entitling multiple disabilities, is intended to cover, in addition to obvious losses and blindness, conditions such as the loss of use of two extremities with absolute deafness and nearly total blindness or with severe multiple injuries producing total disability outside the useless extremities, these conditions being construed as loss of use of two extremities and helplessness.

  Intermediate or next higher rate. An intermediate rate authorized by this paragraph shall be established at the arithmetic mean, rounded to the nearest dollar, between the two rates concerned.

Mr. P head on R2

Mr. P head on R1

SMC (O) is generally as high as you go unless you have two 100% disabilities distinctly different from one another and one of them is Aid and Attendance at the L rate.  A bright line rule when you get into the higher levels of SMC or leapfrog ahead under the §§3.350(f)(3),(4) codicils is to expect to have to meet stringent requirements. I’ve seen how VA treated one Vet in just the last year (2016). He was housebound, has grand mal seizures that put him in the hospital for two weeks at a time. He loses his recent  memory and has to “catch up” after each seizure. He can successfully transition from his bed to his wheelchair without falling so VA considers that proof that he has not lost the use of his lower extremities (entitling him to a jump from SMC P (M + K+K) to SMC R2). That took several doctors and employing the correct DBQ on the subject. They somehow disremembered they were not supposed to use the DBQ for Peripheral Neuropathy.

SMC P   and all its iterations

SMC P is what throws everyone. There is no set pay for SMC P so you have to retreat to §3.350(f)(1). Trust VA to try to envision every possible combination of a SMC L or M rating and begin adding on Ks and lengths of limbs capable of strapping prostheses to. Nevertheless, they did it. Check out all these myriad possibilities and see if you can squeeze in to one some day.

(1) Extremities.

(i) Anatomical loss or loss of use of one foot with anatomical loss or loss of use of one leg at a level, or with complications preventing natural knee action with prosthesis in place, shall entitle to the rate between 38 U.S.C. 1114(l) and (m).  L ½   $3,977.97

(ii) Anatomical loss or loss of use of one foot with anatomical loss of one leg so near the hip as to prevent use of prosthetic appliance shall entitle to the rate under 38 U.S.C. 1114(m).  M  $4,166.28

(iii) Anatomical loss or loss of use of one foot with anatomical loss or loss of use of one arm at a level, or with complications, preventing natural elbow action with prosthesis in place, shall entitle to the rate between 38 U.S.C. 1114(l) and (m).   L ½   $3,977.97

(iv) Anatomical loss or loss of use of one foot with anatomical loss or loss of use of one arm so near the shoulder as to prevent use of a prosthetic appliance shall entitle to the rate under 38 U.S.C. 1114(m). M  $4,166.28

(v) Anatomical loss or loss of use of one leg at a level, or with complications, preventing natural knee action with prosthesis in place with anatomical loss of one leg so near the hip as to prevent use of a prosthetic appliance, shall entitle to the rate between 38 U.S.C. 1114(m)and (n). M ½ $4,441.36

(vi) Anatomical loss or loss of use of one leg at a level, or with complications, preventing natural knee action with prosthesis in place with anatomical loss or loss of use of one hand, shall entitle to the rate between 38 U.S.C. 1114 (l) and (m).  L ½ $3,977.97

(vii) Anatomical loss or loss of use of one leg at a level, or with complications, preventing natural knee action with prosthesis in place with anatomical loss of one arm so near the shoulder as to prevent use of a prosthetic appliance, shall entitle to the rate between 38 U.S.C. 1114(m) and (n). M ½ $4,441.36

(viii) Anatomical loss of one leg so near the hip as to prevent use of a prosthetic appliance with anatomical loss or loss of use of one hand shall entitle to the rate under 38 U.S.C. 1114(m). M $4,166.28

(ix) Anatomical loss of one leg so near the hip as to prevent use of a prosthetic appliance with anatomical loss or loss of use of one arm at a level, or with complications, preventing natural elbow action with prosthesis in place, shall entitle to the rate between 38 U.S.C. 1114 (m) and (n). M ½  $4,441.36

(x) Anatomical loss or loss of use of one hand with anatomical loss or loss of use of one arm at a level, or with complications, preventing natural elbow action with prosthesis in place, shall entitle to the rate between 38 U.S.C. 1114 (m) and (n). M ½  $4,441.36

(xi) Anatomical loss or loss of use of one hand with anatomical loss of one arm so near the shoulder as to prevent use of a prosthetic appliance shall entitle to the rate under 38 U.S.C. 1114(n). N $4,717.07

(xii) Anatomical loss or loss of use of one arm at a level, or with complications, preventing natural elbow action with prosthesis in place with anatomical loss of one arm so near the shoulder as to prevent use of a prosthetic appliance, shall entitle to the rate between 38 U.S.C. 1114(n) and (o). N ½  $4,984.98

(2) Eyes, bilateral, and blindness in connection with deafness and/or loss or loss of use of a hand or foot.

(i) Blindness of one eye with 5/200 visual acuity or less and blindness of the other eye having only light perception will entitle to the rate between 38 U.S.C. 1114 (l) and (m).      L½  $3,977.97

(ii) Blindness of one eye with 5/200 visual acuity or less and anatomical loss of, or blindness having no light perception in the other eye, will entitle to a rate equal to 38 U.S.C. 1114(m).  M  $4,166.28

(iii) Blindness of one eye having only light perception and anatomical loss of, or blindness having no light perception in the other eye, will entitle to a rate between 38 U.S.C. 1114 (m) and (n). M½ $4,441.36

(iv) Blindness in both eyes with visual acuity of 5/200 or less, or blindness in both eyes rated under subparagraph (2) (i) or (ii) of this paragraph, when accompanied by service-connected total deafness in one ear, will afford entitlement to the next higher intermediate rate of if the veteran is already entitled to an intermediate rate, to the next higher statutory rate under 38 U.S.C. 1114, but in no event higher than the rate for (o).$5,253.39

(v) Blindness in both eyes having only light perception or less, or rated under subparagraph (2)(iii) of this paragraph, when accompanied by bilateral deafness (and the hearing impairment in either one or both ears is service-connected) rated at 10 or 20 percent disabling, will afford entitlement to the next higher intermediate rate, or if the veteran is already entitled to an intermediate rate, to the next higher statutory rate under 38 U.S.C. 1114, but in no event higher than the rate for (o).$5,253.39

(Authority: Sec. 112, Pub. L. 98-223)

(vi) Blindness in both eyes rated under 38 U.S.C. 1114 (l), (m) or (n), or rated under subparagraphs (2)(i), (ii) or (iii) of this paragraph, when accompanied by bilaterial deafness rated at no less than 30 percent, and the hearing impairment in one or both ears is service-connected, will afford entitlement to the next higher statutory rate under 38 U.S.C. 1114, or if the veteran is already entitled to an intermediate rate, to the next higher intermediate rate, but in no event higher than the rate for (o).$5,253.39

(Authority: 38 U.S.C. 1114(p))

(vii) Blindness in both eyes rated under 38 U.S.C. 1114 (l), (m), or (n), or under the intermediate or next higher rate provisions of this subparagraph, when accompanied by:

(A) Service-connected loss or loss of use of one hand, will afford entitlement to the next higher statutory rate under 38 U.S.C. 1114 or, if the veteran is already entitled to an intermediate rate, to the next higher intermediate rate, but in no event higher than the rate for (o); or

(B) Service-connected loss or loss of use of one foot which by itself or in combination with another compensable disability would be ratable at 50 percent or more, will afford entitlement to the next higher statutory rate under 38 U.S.C. 1114 or, if the veteran is already entitled to an intermediate rate, to the next higher intermediate rate, but in no event higher than the rate for (o); or

(C) Service-connected loss or loss of use of one foot which is ratable at less than 50 percent and which is the only compensable disability other than bilateral blindness, will afford entitlement to the next higher intermediate rate or, if the veteran is already entitled to an intermediate rate, to the next higher statutory rate under 38 U.S.C. 1114, but in no event higher than the rate for (o).$5,253.39

So, if you still find your self lost in SMC P’s possible manifestations, you now know how all those chuckleheads at the VARO feel when they get to figure it out. The general rule is you’ll be lowballed -especially on the effective date. Remember, in SMC world, it’s not the day you filed for it to get the entitlement. Whoa, Nelly. It’s the day you can prove you’re entitled. You don’t even need to have the proof in the VA’s constructive possession. If your medrecs show you were permanently bedridden in 2008, then by golly that’s your date of entitlement to SMC R2.

R1 and R2

R¹ ($7,436.95) and R² ($8,506.47) (married) are ratings for  extensive Aid and Attendance and are an extension of SMC (O). By this time you are starting to resemble a baked potato and any semblance to the Disney character is long gone. It seems sad when viewed in this context but a Vet has to almost be nigh on to Helen Keller in the disability world to get to N. Lt. Dan of Forest Gump fame would only qualify for M. My Uncle Jay with one foot destroyed (and amputated above the ankle) by a through and through GSW had 40% and two Ks, the other for loss of use of a creative organ before they caved in and gave him 100% P&T for PTSD. One thing is for certain in the Potato head game- know your regulation and which SMC you may qualify for because VA is not in the habit of researching it for you and including it in the next paycheck-most especially not the higher SMCs.

Mr. Potato Head at SMC R2

Mr. Potato Head at SMC R2

Higher Special Monthly Compensation is a benefit America accords its most damaged Vets. As you can see, Congress was might picky about how long an arm or leg had to be to get another $250.oo for it. VA sure wouldn’t want us gold diggers trying to game the system. I have visions of Spanish Inquisition torture devices to stretch a Vet’s arm or leg to get him on the wrong side of SMC N. I’m sorry. I’m jaded. They have hurt me so frequently I’m damaged goods and no longer trust them. But… I have two separate and distinct 100% disabilities and am looking forward to my wheelchair license and a bump to SMC M. Hell, if Winky quits working, I may get a K too which would take me up to P-something.

VA Range of Motion Improvement device circa 1395

VA Range of Motion Improvement devices circa 1395

A a matter for dissection, let’s look at my collection of disabilities. The moment I lose the use of my lower extremities, which won’t be long at this rate, I’ll advance from SMC S to L. Loss of use of lower extremities is an automatic 100% rating. Keep in mind that you do not take the SMC S and add it to SMC L. No way, GI. You leave it behind and matriculate to L. Having arrived, I will then exercise my extra rating for 100% for my Porphyria under §4.115a (dialysis). This bumps me up automatically to SMC M.  I also have a twenty-year protected rating for Hepatitis C which gives me another “bump” from SMC  M to N. In addition, I have two(2) ratings that are over 50% (Anemia @ 60%) and a combination of cryoglobulinemia and Fibromyalgia (40%) plus tinnitus(10%) yielding 46% rounded up to 50%. Those two individual ½-step bumps carry me from SMC N to N ½ and then to SMC O. We can ride this gravy train all the way to SMC O before they stop the “bump” avalanche. No VSO will tell you this. They wouldn’t know it could be done. That would be the difference between $3,790.43 a month versus $7,436.90 (married). Spooky, huh?

I can see the look of astonishment dawning on some of your faces when you think back to that VSO Rep from DAV saying there simply was no more dough after you get to 100%. Shoooo doggies. 100% is $2,915.55 (single) and SMC N is $4,554.51(single). You can see why this looks like the Mississippi River with all the possible combinations and switchbacks. SMC O purposefully allows the double counting (pyramiding of ratings) to get to R1 or R2. It’s the only instance of the violation of 38 CFR §4.14 in the entire CFR that VA sanctions. capture

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20 Responses to SPECIAL MONTHLY COMPENSATION–WHAT IS IT?

  1. ken suvanto says:

    I’m the victim of a racially motivated beating. They granted me 100% for PTSD but, did not take my physical disabilities into consideration. I think I’m entitled to SMC benefits due to the damage my body is experiencing. I do not know where to start. My rib cage was caved in and I cannot lay in bed without being in extreme pain. My feet hurt so bad 24/7 they feel like they are in a vice. My spinal cord is also a mess. Spondylitis throughout my spinal cord. I’ve had several operations to try and fix the damage. I’ve got screws and rods in my neck. They have done some surgery to release some of the pressure on my nerves. My doctor said I’m really messed up. This is an awesome post. Can you steer me in the right direction? Any help would be greatly appreciated!

    • asknod says:

      I doubt you’d be able to get any of the higher SMCs but you have to file to get the increase to even SMC S. I’d start by filing for all your injuries and make sure you specify they are SECONDARIES to the original injury. If they deny, then you get a doctor to state they are due to the beatings. If you did not have them before the attack, it’s a foregone conclusion they are part and parcel of the attack.

  2. BJ says:

    Hello I thank everyone who has contributed a story, question or provided a response or help in ones quest to navigate the muddy waters of the VA.
    To provide some context so this doesn’t quite sound way out there in the question realm I will give some details on medical disposition. I was medically retired for seizures; PTSD and TBI(to include..as part of the TBI findings with– Skull Fracture, Speech Impairment, slight Vision Deficit, slight right low level hearing loss, Memory Loss, Post-Concussive Headache Syndrome, Cognitive Impairment and a few others) The DoD rating started an evaluation of 80% and right out of the gate an easy sum calculation of VA 100% rating. After my final DoD “Temporary Retired Disabled List” period of evaluation had ended, it was concluded to a final score of “Permanent Retired Disabled List” DoD 50% rating. During that time in between i was through a complete and more extensive list of course for a VA rating, it still was at the total of 100% rating and of course has many more service connected disabilities rated. So as part of protocol if I have less than 20 years active and I am rated lower on DoD (medical retirement) rating than VA service connected benefit rating I will collect the pay of only the one that is the higher amount of the two. So I only receive the VA pay but still maintain all other DoD retirement benefits which is nice since i have family Wife and baby boy so the Tri-Care is a good benefit.

    So to circle back to where I am going with this is I am combat vet, medically retired due to a TBI, Seizures and PTSD resulting in an evaluation of no longer fit to continue service.
    The short question is, I was provided information, but I am unable to find anyone who really understands the extensive complicated process of Special Monthly Compensation and Aid & Attendance. I was given info and told if I find someone who understands it that I do qualify for 1) Aid & Attendance and 2) Special Monthly Compensation at the (r 1) or (r 2) level because of the service connected high rating i have for a TBI(Traumatic Brain Injury) w/ a high rating on the PTSD level.
    –And the reasoning he relayed to me is that “to qualify for SMC at the (r 1) or ( r 2)…I simply only have to merit 1 the basic need of “Aid & Attendance” and that it doesn’t matter if i still have all limbs and other parts in tact and functional its that the TBI rating is my qualifier” and he has mentioned its called a “T-rating” bringing me the benefit.

    -So the big problem with all of that is…there really isn’t any you know go by checklist or what forms or what items of history i need to present a case like this.

    -Any input comments from anyone would be so much appreciated.

    -So some points that do make my life difficult and what I see as an advantage and something to gain from Aid&Attendance and a SMC allotment is defiantly something I could really use. The VA has taken away my driving privileges and has made the Medical DMV office of my State required the report within I would say after my first couple months living back home( I totaled my wife’s vehicle and then also had 3 other car accidents in my vehicle) soooo driving is a no go here at home.

    The VA has been nice with the extensive care team i have two many doctors and care providers to count, having to usually come together for decision on certain aspects of my life when it comes to make adjustments of medications or care or extra services needed.
    I was granted SMT(status-special medical transport) which is simply a private EMT trained driver and wheel chair-bound vehicle that picks me up from my home and takes me to whichever VA facility I need to travel to for the specialist for care and then bring me home afterwards.
    I have so much weight for all my care needs and it puts out my wife heavy burden to have to be the only one who can drive any where to get anything done for everyday life. My wife has our groceries delivered to my house, all medications; goods; you name it amazon everything and such is all by mail to doorstep. My wife misses work and stays home if she needs to if I have fall, or server migiraine or a seizure like episode that requires watch for safety. She pre-preppes all meals that i need to eat. She supervises all my medication refill requests and per-filling for each week for my morning, afternoon, evening and bedtime doses. I currently do and am also receiving the “Family Caregiver Stipend” for the current Tier I am qualifying at which is a stipend for the level of care i require supervised and unsupervised, also requires quarterly reviews and annual and pop-in in-home re-assessments

    -Right now my Wife is still on maternity leave and she needs to return to the employer shes work with by next month and she has been home on unpaid maternity leave since October. So with only my Income i have coming in (from the VA and Social Security Disability) it is gradually getting harder to maintain house payments and diapers and all of what it takes to live. With her needing to return to Work the VA is already not feeling good about the fact I would be home with at at least some time of the day or portion of the week with out her to help care. And they are worried about a new baby at home and they want to ensure I have in home care for the baby or that is going to a day care facility. Otherwise we may have re discuss plans and they would have to by law notify CPS. Which as you can see would only make matters worse.

    So any help or suggestions would be great
    Thank you so much
    -BJ
    USN(FMF)(Ret.)

    • asknod says:

      I’m not sure what question(s) you need answered, sir. I could theorize and address innumerable paths to take. One thing you need to know is the SMC at the “T” rate is purely temporary. You will get dinged back to 100% plus SMC L if your wife goes back to work. No caregiver on 24 hour call equals no SMC T. That, I can guarantee you, will be the first big financial crisis. I’d try to go for the R2 rate which is the same as the top tier T rate based on what I read. Unless the TBI is your primary disability, you are eligible to take the SMC r (1) and r (2) path. Remember, this is the Mississippi River. Occasionally you’ll find the river flowing backwards. You need to know how this works. It took me a few years.

      I didn’t include the T tiers as they are not applicable to pre-2001 Vets. As most of the guys I represent before the VA are Vietnam era, I don’t represent very many of the newer Vets. Hence, I don’t do seminars on SMC T.

  3. joe says:

    confused this is what my ebenfits says help me understand please……You are receiving the following compensation Learn More
    SMC (L-1) Effective Date : 03/03/2017
    Entitled to special monthly compensation under 38 U.S.C. 1114, subsection (l) and 38 CFR 3.350(b) on account of being so helpless as to be in need of regular aid and attendance entitlement to continue while hospitalized at U.S. government expense from 03/03/2017.
    Rating Date : 02/13/2018 ok then it says this as pay…. VA Benefit Information
    Select All | None
    Summary of benefit information
    Include? Information Value
    Include the information in this row You have one or more service-connected disabilities: Yes
    Include the information in this row Your combined service-connected evaluation is: 90%
    Include the information in this row and the one below it

    Your current monthly award amount is:
    The effective date of the last change to your current award was:

    $3494.51
    February 01, 2018

    Include the information in this row You are being paid at the 100 percent rate because you are unemployable due to your service-connected disabilities: Yes
    Include the information in this row You are considered to be totally and permanently disabled due solely to your service-connected disabilities: Yes ………………..the pay for smc l is $3866.24…but the va is giving me this amount $3494.51…i dont understand????

    • asknod says:

      Not enough info to work from. Married? Looks like you were at SMC S (housebound) up until 2/13- then the SMC L kicks in on March 1st. Wait and see what they put in the bank next week. VA pays the month following your award. Hence when you die there will always be one more check coming.

  4. Jcp says:

    This website is so awesome. This information should be used on all websites. It is very user friendly. Thank you.

  5. Dave Copeland says:

    Hi, when the VA grants SMC (L) based on A&A, how do they determine a specific disability to use against that since there wasn’t something specific like loss of use of 2 feet or a foot and a hand, etc.
    I used a BVA Judge decision from 2012 that basically sets precedent for what minimum requirements for that A&A would be and I have a ton of individual disabilities that would give me 5 half steps and possibly 6 depending on what disability was used for the initial A&A.

    As a guide to what I’m looking at right now.
    headaches: 50%
    R shoulder: 20%
    L shoulder damage: 20%
    L shoulder ankylosis: 20%
    R wrist: 10%
    L wrist: 10%
    Lumbar DDD ROM: 40%
    L leg neuritis: 10%
    L knee: 10%
    L great toe: 10%
    R hip1: 40%
    R hip2: 10%
    R hip3: 10%
    R leg radiculopathy: 10%
    R knee: 40%
    R ankle: 10%
    Several scars at 0% each
    Pending secondaries:
    -R foot ORIF currently 0%
    -Facial spasms secondary to headaches pending
    -R foot metatarsalgia secondary to R foot residuals pending

    Let me know what you think…C&P for the 3 deferred contentions 8am tomorrow (Friday 12/29/17)

    • asknod says:

      Looks like you need to reread the regulation:
      (b)Ratings under 38 U.S.C. 1114(l). The special monthly compensation provided by 38 U.S.C. 1114(l) is payable for anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less or being permanently bedridden or
      so helpless as to be in need of regular aid and attendance
      Also remember that to get the 100% bumps from SMCs L to M, M to N and N to O, they must be for different body systems. The half steps authorized in §3.350(f)3) can be an amalgam of similar disabilities.

      .

  6. Ace says:

    I recently received additional benefits under 38 U.S.C. 1114, subsection (s) and 38 CFR 3.350(i) due to a total knee replacement. How long am I entitled to it?

    • asknod says:

      I’d say it was a permanent award based on one rating being totally disabled (TDIU) and one or more ratings in addition, adding up to 60% or more.

  7. Jamie frei says:

    Entitled to special monthly compensation under 38 U.S.C. 1114, subsection (s) and 38 CFR 3.350(i) on account of dizziness and lightheadedness, residuals of traumatic brain injury with cognitive disorder, short term memory losses/lapses, difficulty sleeping, problem solving
    with PTSD (to include cerebral contusion with diffuse axonal injury to bilateral frontal and temporal lobes) a single disability upon which a total individual unemployability rating is based and additional service-connected disabilities of tinnitus, scar tracheostomy due to ventilator dependence, left shoulder impingement syndrome with supraspinatus tendinitis (claimed as dislocation of left shoulder with popping), right foot strain (claimed as right foot contusion), independently ratable at 60 percent or more from 11/11/2016. What does this mean as far of which one I am entitled to?

    • asknod says:

      38 CFR 3.350(i) reads

      (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.
      You are entitled to SMC S.

  8. Kevin says:

    Thank you for defining the (SMC) so that we could better understand it’s meaning(s). I would like to ask you or anyone who is knowledgeable with (SMC’s) the following question’s please? I am receiving SMC-L for service connect seizures. I was wondering if I can apply for a higher rating as I do receive aid and attendance and am home-bound, and bedridden to to loss of use in both legs. I require the daily/nightly need of a person to assist me even with the simplest of matters as I live alone and have no family that can care for me. My son is on his 3rd tour in Afghanistan, and as we all know, the ARMY comes first. Is the $3602.02 per month I receive already inclusive of aid and attendance pay? My service connection(s) is 100% for seizures, and 20% for my lower back condition which worsened due to falls from seizures that have now left me incapacitated. Both leg’s are rated at 0%, but they were rated way back when, and perhaps now I should file a claim for a higher rating sense (A) caused (B)? I am just wondering if I can apply for anything else as my monthly expenses for my care eat up everything I receive? I look forward to anyone who could assist me with my question’s, and sincerely wish each of you a heartfelt thank you for your service to our great Nation.

    Thank you all in advance,

    ~Kevin

  9. Eve says:

    If you are TDIU for Major Depression, but I now have Chronic Pain Disorder from Lupus and Fibro, and I currently have a part time aid from the VAMC. I am pending a A&A claim rating. I am wondering, one, if they will rate my physical disabilities as secondary to the Major Depression /TDIU, since Chronic Pain Disorder would be the same as Major Depression (no pyramiding) and 2. if you are pending a SMC rating for A&A, and if you are awarded A&A do they offset the A&A against your TDIU comp? Thank you…..

  10. Kel says:

    You lost me at ‘loss of use of both buttocks’. I’ve never understood that. How can one have loss of use of both buttocks, yet retain use of lower extremities? I have a suspicion of what ‘loss of use of both buttocks’ is, but this is a family friendly site. Other then my conspicuous suspicions, how could one ambulate absent any use of the buttock muscles?

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