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 (SMC) K. My question is simple. Can he have two K ratings at the same time? Our VSO says no and won’t file us for 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 beyond 100%. 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. Up until 1961, only those Vets who had served in a time of war qualified. Here are the SMC compensation dollar amount tables.

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). Sadly, since VA doesn’t keep its finger on your pulse, you need to file for these deficits even though the law says VA is supposed to “infer” it. If they can’t see you, they dang sure can’t infer you. Best to file a claim for this just so you’re covered as soon as you see it coming. Doing a verbal “informal” claim on VA’s Dial-a-Prayer/Prize Redemption Line (800 827-1000) is not advised. So, without further ado, let’s learn about SMC. I’m warning you ahead of time that this is probably the most confusing system in the VA’s repertoire. One of the highest SMC awards (T) is alphabetically after the second-lowest rating (S) above (K). Go figure.

In the course of this article, you will see the SMC rates expressed as lower case and upper case letters. Ignore that. It takes three strokes to parenthesize (s) versus S. I got lazy while doing this so you’ll see them expressed both ways. Six of one and half a dozen of another. You’ll also learn how to file for two A&A awards under SMC L because VA lets you pyramid your SMC. Interesting? You bet. Read on.

SMC K Awards

So… Carla. Think of your husband as Mr. Potato Head® for an example. Yeah, I know. In the new, woke world, Mr. P’s getting a lot of negative press. Let’s imagine him as a Veteran starting out complete. Now let’s start removing  eyes, arms and legs and see what happens. He has lost an eye so he gets SMC K  number one. Ka-ching–$118.33/month (2022 rates). But, your VSO representative is very, very wrong on the number of SMC Ks you can receive. In the immortal words of Gomer Pyle, Surprise, surprise , surprise, huh? The reason is simple. They don’t teach SMC to VSOs. I can’t tell you why.

images (1)So now, you move forward and say Romeo Tango (Roger That or R/T). Loss of, or loss of use of, a creative organ (we’ll forego illustrating this on Mr. PotatoHead™ in order for him to keep his dignity)–Ka-ching. SMC (K)– $118.33 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 $118.33. This set dollar amount is added to your current compensation check for your X% rating disability.

Obviously, this largesse hits a trip wire eventually. If you are 100% service connected for Hepatitis C and you have some of these items, 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 s/he would need all of them and an additional 60% such as needed for the SMC (S) to get within striking range of SMC L which is currently $4331.91. One can also see she/he, they, them, theirs would need to have a complete, and boy howdy do I mean a complete Chelsey Manning makeover  to get all of them. Nobody’s tried to lasso that one yet but I can conceive of it coming soon considering the VA is now offering gender reassignment surgery. In a world where men can become pregnant and become ‘birthing persons’ and ‘chest feeders’, I only strive for clarity here-no moral high ground. I really don’t care what your pronouns are. SMC, in the words of Robert Chisholm, is the art of the possible. It’s so nouveau and the case law is so sparse, that VA attempts to suppress knowledge of its existence, and when that fails, grant it to sweep it under the carpet. A VA Coach’s Prime Directive is to quash this in its infancy. If that fails and we win at the BVA, it’s time to sharpen the low ball knives and disremember how to program the VA’s “SMC Calculator”.

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 quintessential 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 foot drop, 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.


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 Ks and SMC S cannot exceed the next higher rating of SMC L. SMC S is sometimes called the housebound rating. If you are confined to your home because of medical conditions that keep you home, and your doctor will sign something that says so in no uncertain terms, then you will qualify as “substantially” housebound under §3.350(i)(2). The most common way most Veterans qualify for S  is to have a 100% schedular rating or TDIU for a singular disability and a separate, additional 60% or more in combined ratings (using convoluted VA math) unrelated to the initial 100%/TDIU qualifier. Those are the general parameters. VA strictly enforces the singular disability clause. However, one disease process such as Diabetes Mellitus Type II also includes secondaries like peripheral neuropathy and would be considered one disease process. Ditto Parkinson’s disease or IHD with hypertension etc. Now, when SMC S was instituted in 1945-ish, it was reserved for Vets who had served in a time of war only. You didn’t have to be an Eleven Bravo or in a combat theatre but just have served and be in possession of a National Defense Service Medal (NDSM). It’s open to all, now.

Other Veterans Help sites confuse SMC S with somehow being a form of aid and attendance. It isn’t. VA  merely uses the same form- the  21-2680- to determine whether you need housebound benefits or aid and attendance. The form asks certain questions. Depending on how you answer them will determine your eligibility. If you can’t remember to take your medications due to your condition, or you can’t prepare meals because of your condition, you need a&a. Here’s the form they use.

VAF 21-2680 Template

Now, I get asked this by every single Vet who finds out about this “secret” rating the VSOs never tell you about. “So, dude, I get the 100% check for $3,517.54 a month (2022) 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 a $345 raise per month up from what you were getting with the 100% comp. Think of SMC S as hostile fire pay or  flight pay add on. VA naysayers tell  everyone we Vets call this our ‘Corvette payment’. Yeah, right. $350/month won’t cover a Camry payment.

The Howell v. Nicholson  Argument (or not).

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. I no longer agree with others on this. My take on Howell is read the whole decision and it simply says if you are incapable of leaving the house to earn an income, you are entitled to SMC at the (s) rate based on being truly housebound. The VA likes to say if you can leave the house to attend a c&p exam then you ain’t very housebound. That’s the wrong legal standard of review.

The regulation(§3.350(i) specifies that you must be either ratable at a combination of 60% worth of separate and distinct disabilities (or more) above a TDIU (or a 100% schedular rating) or with TDIU alone and with extraordinary disability conditions to be eligible. If you have one disease or injury rated at 100% and you are undebatably housebound in all but name only, they may grant. A letter from a doctor would be great help stating as much. Download the 21-2680 form and have your doctor fill it out and then you submit it with a 526 claim form asking for SMC S. Do not let the doctor submit it. SMC S is an extra $397.58 above the normal 100% rating of  $3517.84 (with spouse) for a whopping $3915.42/month (2022). 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 but still can be used in combination to qualify for aid and attendance as part and parcel of a single disease process. 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 cirrhosis (DC 7312)),  secondary to the Hepatitis, involves a different element (the liver’s deterioration).  Much debate occurs on this and raters make much mistakes after smoking too much M 21. That’s why I write about this.

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. Remember, SMC allows you to pyramid certain ratings. Cool beans, huh?


The next big step up the ladder is the aforementioned SMC L. The requirements of L will invariably carry over some of the (k) ratings because this is an incremental potato head game. L does not hinge on percentages, per se. You need one index disease generally rated as 100% total but the definition of blindness can be argued. Now, I get in arguments with raters at  HLR hearings and they point to M 21-1 IV.ii 2.H.8.b.  That’s pure hooey. I’ve gotten Vets SMC L for a&a based on a 50% rating for PTSD. The trick is simple. You have to have “a factual need” under §3.351(c)(3)- read as a diagnosis- that you cannot accomplish one of the items on the list in §3.352(a).

If you qualify for L, it’s $ 4331.94/month in 2022$ as a married Vet. The Forest Gump exemption is still there if you lost your buttocks. If you do, you get to throw in that SMC (k) and any others for $103.23/month each on top of your L. 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 your 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:

  1. Loss of, or loss of use of both feet, or;
  2. one hand and one foot
  3. 5/200 visual acuity or less bilaterally qualifies for entitlement under 38 U.S.C. 1114(l). However, evaluation of 5/200 based on acuity in excess of that degree but less than 10/200 (§ 4.83 of this chapter), does not qualify. Concentric contraction of the field of vision beyond 5 degrees in both eyes is the equivalent of 5/200 visual acuity.
  4. Need for the aid and attendance of another
  5. Permanently bedridden

 Nota Bene…

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). But the regulation saying when you get it is listed under §3.351(c)(3).

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. But if you go for bedridden, it wipes out any chances of ever getting two aid and attendance ratings to get to SMC R. I strongly suggest you always fight for a&a.

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 such as above the knee or elbow. 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 $4331.91/month with spouse, so this works out to  $814.84 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 the SMCs to L or M.

The “Bump” Clause in §3.350(f)(3) and (f)(4)

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) See §3.350(f)(4). If you have a 50% or greater rating on an  a 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 theoretically advance with an additional bump to (L½). There is much discussion on this “bump” business. VA raters say the M 21 forbids both bumps. There is currently a case going up to the Fed. Circus on this subject which may settle the question forevermore. (They lost but it’s at the Fed. Circuit now). I had hoped to defeat that some day because §3.350(f)(3) is wonderfully ambiguous as to whether you can award multiple half-step bumps.   If you have a separate and distinct, stand alone 100% schedular rating with award of SMC L, you get a bump from L to M. But you could file for a separate SMC L for A&A for that too. If you had SMC M for LOU of the upper extremities and a 100%, you’d bump from SMC M to N. Under the same theory, you can have a 50% or more rating  (or combinations adding up to 50%) and get the 1/2 step bump  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. Well, yeah unless you look at it myopically as VA does who tries to minimize the grant.  It’s an interesting codicil and one very few raters, let alone BVA judges are even aware of. I’ve found several BVA decisions on this where both bumps- (§3.350(f)(3) and (4))- were awarded.

Here’s an interesting example of bumps. If you had LOU (loss of use) of the upper extremities, You’d be awarded SMC M. If you had another 100% schedular disability for IHD or Parkinson’s, you’d bump up to N. If the Courts allow the half-step bump up to N 1/2 as well, and you had a SMC K for LOU of a creative organ, then you get the big bump up to SMC O. Think Chutes and Ladders.

Obviously, the big banana is to go after two SMC Ls for aid and attendance to reach the higher tier of SMC R1. Most of you will never qualify due to your extremities still being in working order by VA’s estimation. This helps get you around that inequity. I will list these here for your education/edification but the discussion of R1 below is still pertinent.

Sometimes I cringe at the thought of publishing these tricks for fear that VA will just change the regs to forbid it. I guess we really don’t have to worry because it isn’t like hordes of VSO service officers are  likely to file their clients for SMC. Remember, they’ll argue you breathless that this SMC crap is just a fig newton of your imagination and doesn’t even exist.


The next step is  SMC (M). Mr. Potato Head™ is gradually losing his ability to ambulate and see. He is now wheelchair bound unless he’s very adroit with a bunch of prostheses. Or, if he has a SMC L for a&a and another 100% for IHD or Parkinson’s, he gets the §3.350(f)(4) bump up to M. Or, if he has SMC L for being blind, they bump him up to M if he needs A&A. Always remember this SMC game is like Chutes and Ladders.  Here’s the next set of  required missing parts if you go strictly by the way the regulation is written on losses of parts and pieces.

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. ( You Vets will probably be using this eventually).

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. In DickandJanespeak, this means you need to get an extraschedular rating for a&a first to get to the point where you can ask to be awarded the bump up to SMC M from L. It isn’t automatic.

SMC M pays $4,761.46/month-an increase up from  the $4,546.25/month on (L½).   SMC-M½ jumps to $4428.07/month and again requires shorter arms and legs,  eyes physically missing, poorly fitting prostheses, etc. Or, being sufficiently blind via a good medical nexus will accomplish this.


Potatoheads on SMC (M)

SMC N  continues the parade of missing pieces. Mr. Potato is now probably blind and immobile due to no feet down belooooow the knees. Actually he’s probably without knees if he’s even seeking SMC N. Or…. think about this. Johnny Vet is blind or nearly so as mentioned above to qualify for SMC M. Using the bump clause, he could get a 100% rating for Major Depressive Disorder (MDD) or even a 100% for IHD or Parkinson’s and then advance from M to N. This is legitimate. I’ve done it.   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/creative organs (or lack thereof). Don’t forget them.

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 $5390.95/month- a sizable jump from M. I did not include the half steps as they simply add another $200 to the equation and a requirement for a few extra missing pieces or shorter ones. And the last trick in this N gig is if you somehow had a N 1/2 and you drew to a SMC K for loss of use of a creative organ. Bingo! Chutes and ladders again. You get the ladder up from SMC N 1/2 + K to the maximum rate of SMC O.

Rarely are you going to get to N with bumps up from §3.350(f)(3)(4) past going from L to M. At this point, most arrive here totally blind with no light perception. This is not to say you couldn’t have a 100% for IHD and catch the full-step bump up to N and have no physical amputations as I mentioned above. SMC is like an endless river of combinations no one (even VA) could ever conceive of. In some respects, it’s uncharted and sometimes we get into unlitigated pastures never before dreamed of.

I’ve only gotten one Vet to SMC N to be truthful. I’ve always done the chutes and ladders game and advance to Boardwalk and R1 or R2/T. SMC N would be a case of you being amputated down to a torso stump but not needing aid and attendance somehow.  Or… if you’re blind, and have another 100% percenter separate and independent from the blindness, you’re in SMC N cotton. It’s really about as superfluous as SMC Q in this day and age. I’m guessing you could liberally count the SMC N Vets in the very low thousands- or even the top tier of the hundreds. These are legitimately Vets who can be bumped to O and thus to SMC R1. Hence the rarity.


When we get to SMC O ($5,237.67) via the standard methods of entitlement , Mr. Potato Head™ would look just that- a potato. However, as you know from the above, this isn’t always the case if you’ve been following some of my shortcuts. Here are the  prerequisites to attain (O) via a wheelbarrow of disabilities.

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); (the traditional way with the greatest level of success)

 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. (I win on this one a lot. Get a&a first for a set of disabilities (MDD etc.) and then get SMC L for loss of use of two extremities).

  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 R1). 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.

Here’s an interesting rating using SMC O and the addition of another A&A rating under L to get to R1.

SMC 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-more or less. Check out all these myriad possibilities and see if you can squeeze into 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 (2015)

(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 L for that particular  SMC facet.

R1 and R2

The easiest way to get to R1 is the most obvious- §3.350(e)(1)(ii). You start at SMC L. If you are entitled to Aid and attendance, you are awarded SMC L #1. If you should also lose the use of  both your lower extremities, or an upper and a lower extremity, you get another SMC L- #2. Two SMC Ls or any combination of of two Ls, Ms, or Ns gives you a bump to SMC O automatically. SMC N ½  with a K will advance you to O too. But-here comes the legal pyramiding- if you have two of any of the rates between L and N, with no condition being counted twice, and one of the ratings is for Aid and Attendance, you advance to SMC R 1 automatically. No VSO has a clue how to play SMC Chutes and ladders. It requires a lot of study to understand the myriad ways you can do this. It’s an art form building them and requires getting rated for the prerequisites, often in a carefully specified order) and then springing the trap on them before VA realizes they just handed you the Claymore to ambush them with.

I advise getting the A&A first. As previously mentioned, you can also get two A&A awards for separate disabilities that require A&A. This, too, will advance you to R1. You’ll actually find in practice that if you file for loss of use of extremities, they’ll default to SMC L  a&a in hopes of fencing you out of it. Cool beans. You then just get an IMO saying your legs are hors d’combat and get R1 that much sooner.

R¹ ($8499) and R² ($9721) (married 2022) are ratings for more extensive Aid and Attendance and are considered an extension of SMC (O). If you know how, you can attain this and still be “alive”-i.e., not a baked Mr. Potato Head™. It seems sad when viewed in this context but a Vet has to almost be nigh on to Helen Keller in the VA disability world to get to N. Lt. Dan of Forest Gump fame would only qualify for M for his two amputations above the knee absent IHD or full-blown Parkinson’s. 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 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. Considering most VSOs have never heard of R1, it behooves you to be acquainted with it if you’re using one to file for it.

The easiest way to make the jump to R 2 is to be seriously R 1 first. The added need for a higher level of A&A (R 2) is most easily accomplished if you-the caregiver or spouse-are officially “trained” by your supervising neurologist or Doctor to provide physical therapy and things like changing the undergarments due to incontinence. A candidate for R 2 must be so helpless that, without the help, he would have to be institutionalized in a hospital or nursing home. Personally, there are a large number of R 1s out there in VA Land who qualify for R 2 but lack the intricate knowledge I offer here free to argue it successfully. Rest assured that no VA examiner or rater can figure this out so they deny to avoid exposing their ignorance. VA has a “SMC Computer” where you put in the ratings and it spits out the magic SMC(s) entitlement. The problem is the input. I’ve only had two R 1s granted at the local level (Waco and Little Rock). A DRO in Ft. Hamilton, Montana told me they always send these to DC unless someone is bedridden and dying…and the conditions are separate and distinguishable.(Breniser v. Shinseki, 2011)

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 short an arm or leg had to be to get another $250.00 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 an SMC requirement. 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 thrown in too which would take me up to P-something.

VA Range of Motion Improvement device circa 1395

Early versions of VA Range of Motion Improvement devices circa 1945

A a matter for dissection, let’s look at my collection of disabilities. The moment I lose the use of my lower extremities due to my airplane crash, I’ll advance from SMC S to L for aid and attendance of another.  Please recall 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 or my under §4.115a (dialysis) or my 100% for Hepatitis C. This bumps me up automatically to SMC M.   In addition, depending on how they decide the multiple application of SMC half-steps under §3.350(f)(3), I have  ratings that combine to more than 50%- cryoglobulinemia/Fibromyalgia (40%) plus skin scarring (30%) and tinnitus(10%) yielding 62%. Those two individual bumps carry me from SMC L to M 1/2. No VSO will tell you this. Most probably wouldn’t know it could be done. That would be the difference between $4331 a month versus $5075 (married) in 2022 $. Spooky, huh?  As I mentioned above, the M 21 says you cannot use both a 100% bump and a 50% bump even if you qualify for each. This is not bright line law yet and ripe for an appeal to determine if it can be done. The regulation (§3.350(f)(3) and (4) are the pertinent authority and they leave it wide open. Not (f)(4) so much but certainly (f)(3). It’ll boil down to Chevron deference some day. Can VASEC interpret it his way or Congress’? That will be the argument at the Fed. Circus soon in Barry Vs. McDonough.

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 got to 100% and told you to go home and quit being greedy. Shoooo doggies. 100% is $3517 (married in 2022) and SMC S is $3915 (married). You’ll begin to 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.  From the number of comments I get on this blog, I apologize if I do not answer all of them. SMC is the most misunderstood system of entitlement in the VA system of compensation. It took me four years to say I have it somewhat memorized-both the regs and what they say. I pretty much have all the cites to Court precedence  memorized as well.  That really helps when you don’t have to keep looking down to recite stuff at a BVA hearing. You can look the Judge right in the eye and pin him like a deer in the headlights. I always catch the Judge digging into the 38 CFR Part 3 or 4 to check up on me during the hearing or writing/typing fast and furiously. Cool beans, huh? You need as much ammo as you can hump, folks. That’s it in a nutshell.

Always remember. Only the rater or a trier of fact (VLJ) can grant you R1.  see M21-1, IV.ii.2.H.1.b. It says the clinician cannot diagnose  loss of use of extremities even though I see it on a lot of DBQs. You’re wasting your time going out and getting your doctor to say your legs are toast. But, once they deny you, you can go out and get the magic DBQ saying you have LOU. 

Look at page 8 in Section X below. Right there it asks the clinician to determine that you have loss of use of extremities that would qualify you for loss of use of upper or lower extremities. As I like to point out to Judges, M21-1, IV.ii.2.H.1.b. doesn’t say you cannot rebut VA’s finding with your own diagnosis. I use the Caluza/Hickson/Shedden and its progeny to support the right of any Veteran to supply the three ingredients needed to prevail. VARO examiners have some unknown “higher level” legal standard of review on loss of use but cannot provide it at a hearing or HLR conference call. You almost always have to get the VLJ to grant because no one wants that on their resume when they’re going for the big jump up to GS 13, step 5.

Johnson DBQ 12-19-2017 8

P.S. The dollar rates  I listed for all these SMC Rates constantly change due to COLA rates increasing annually. I used to circle back and correct them to the current year but it’s too time-consuming now that I am accredited. Most of the rates advertized were for 2016. Obviously, SMC K is at $118.33 in 2022 now. Ignore that. The financial reward is immaterial to the discussion.

I don’t expect Joe Average Veteran to soak up this knowledge in one reading…or ten for that matter. SMC is antithetical to rational thinking when doing VA claims. Personally, I’d suggest any who try to do this get an attorney or agent who is well-versed in it. VA is vicious in this arena. They lie and misquote regulations. They add requirements that are not there. They ignore pathways to two a&a ratings and declare there’s no such thing. I tell my clients SMC is the art of the possible but most often requires appeal to the BVA to find a receptive ear and a keen legal mind-i.e., a lawyer/VLJ rather than a GS 13 VA examiner with a hardon for anyone asking for High SMC.

And that’s all I’m going to say about that.

Win or Die.


P.S. I wrote this in 2013 and have added, expanded and rewritten parts as the law changes. I became accredited in 2016 and learned even more about SMC from the owner of CCK. This represents the best knowledge I can provide to you, my Veteran brothers. I give it freely because no Veteran should have to pay to play this game. No pay walls. No inner sanctums. Getting the highest rating you are entitled to, especially the higher SMCs, requires a lot of specialized knowledge. I like to point to the analogy that just because you know how to drive doesn’t ensure you are Indianapolis 500 driver material. If this helps even one Veteran get to R2, then it was well worth my time invested in it. Best of luck to you all.

PPS. I promise to share my SMC T adventures here. It’s actually easier than getting R1. Time and my heart are my enemies.

About asknod

VA claims blogger
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  1. R.A. Chapman says:

    Thanks for sharing this again. I got SMC S last year in lieu of applying for A&A. Weird stuff as I have 100% SC for Crohns and another 150% for various stuff including Diabetes type 2, anemia. Post stroke headaches and neuropathy in both arms and legs. My bad record shows arthritis back in the 90’s. Also have to take B12 injections. Couldn’t get shit for constant ringing in ears, dizziness and balance issues. ED, nausea, and boat load of other stuff. Seems A&A would be in order but realize the folks at the VA are not trained to actually assist veterans. Someone should sue these MF’s for not assisting disabled veterans instead of fighting us and limit awards we earned the hard way! Maybe all disabled vets who have the facts they got screwed should pack the US courts with millions of TORT claims.

    Bless you brother! Appreciate all your hard work and especially the sharing of you knowledge.

    Semper Fi and Hooya! {ya I was in both}

  2. David T Pike says:

    I got 100% P&T SMC L1/2 A&A for cardiomyopathy(100%) and a couple smaller SCs (L) Now I just got “loss of use of both feet” 100%(L). They only gave me a 1/2 step to SMC M.

    The one L1/2 and the second L should qualify me for “O” and with the A&A it should automatically be bumped to R-1. Is that not correct?

  3. R. A. Chapman says:

    Excellent as always Brother. Your always spot on. I was 100% for a long time and then Diabetes and Anemia took over. Applied for A&A and got SMC “S”. So now I need to file for B12 dfeciency as I take shots every 28 days. Plus all the Neuropathy they gave me 10% and 20% legs/arms which with my 100% for Crohns/Colitis adds up to 250%….I will file for the B12 and A&A again. I hatre the rating being seperate for Crohns and Colitis. My Crohns occured on active duty and Colitis was many years later. They are 2 distinct seperate diseases occuring with Crohns in the small and Colitis in the large bowel. Also due to 4 rsections only have 120cm Small and 50% large bowel. Always runny and shit thru a goose…Not to mention the SC Scars they gave me SC 0%.

  4. Russell says:

    I am currently 100 percent for ptsd and I collect Smc s for 60 percent total for other ratings. I’m curious how do I get Smc L and if I do get Smc l would I paid at the Smc L 1/2 rate because I have over 50 percent in other ratings. Thank you p

    • asknod says:

      Without seeing your Code Sheet for your ratings, I hate to venture a guess. For A&A, you’ll need to present a factual need for one of the activities of daily living you are unable to accomplish (see §3.352(a)) or loss of use of hands, (or)feet or one foot and one hand. With a true 100% schedular for bent brain, it should be a cake walk to get a&a. You generally don’t need a nexus letter-just a properly filled out VAF 21-2680 stating you can’t do ____________.

  5. Pingback: VA Special Monthly Compensation (SMC) - For Veterans Who've Had it With The VA

  6. RickB says:

    Ok we spoke before in 2019, since then I have received additional ratings. I am @ A&A L 1/2 due to 100% COPD and 60% back . Raher than listing the new awards, I will list everything I am rated for; 100% COPD, 60% Asthma, 60% back, 60% left eye, 50% Apnea, 40% TBI, 20& r Knee arthritis, 20% Diabetes II, l0% left knee, 10% R knee limited flexion,10% rhinitis, 10% internal hemorrhiods, 10% Chronic Larygiitis w/dysphonia, and 5 0% ratings. As I said I am at L 1/2 and also have 2 k awards for loss of use of L foot, and Loss of use creative organ. I also have a TDIU from before the 100% rating, and without counting my lung disease ratings, I have an addition combined rating of 100% . Based on the above facts, am I entitled to a bump to SMC M.? Thanks

    • asknod says:

      Roger that. The TDIU suffices to give you entitlement to SMC L for A&A. The subsequent award of 100% for the COPD gives you the bump up from L to M under §3.350(f)(4). At present, you are receiving the half-step bump up to L 1/2 under §3.350(f)(3). Since VA won’t allow both, you are entitled to only one- the greater benefit. Getting them to “see” that will probably require a little bit of correspondence or a call to Dial-A-Prayer at 800-827-1000. Bon chance, monsieur.

      • Rickb says:

        Thank you for your comments, Does it matter that one of the reason I was awarded A&A was because of my COPD ( which is rated 100) while the TDIU A was based on a 60% rating for my back. It is my uinderstanding the VA must maximize my benefits regardless of when each disability was awarded. That being the case it should not matter to the VA how I get to SMC L, as long as I am entitled to it. Am I correct? thank you once again.

      • Rickb says:

        By the way I failed to mention that the loss of use of the foot, ( drop foot) along with sciatica was part and Parcel of the back injury.rated 60%. Don’t know if it matters or not.

        • asknod says:

          Look at you TDIU as the qualifier. Whatever provoked IU is a whole 100% disability. COPD is an entirely different beast involving pulmonary -not musculoskeletal. so a bump from L to M would be for application. Plus the 2 Ks. VA would call it SMC P (M+K+K)

  7. Bob Chapman says:

    Great site and appreciate all your professional insight! Thank you.
    I submitted a claim in October and have not received a reply accept tp say theu are working it and I had a C&P for PTSD on March 15th. In january i was hsopitalized for 3 days due to Post Stroke Headaches. I am 10% for strokes in 2020 (2 in 33 days). Laos diagnosed with Left Anterior Aterial Thrombus. Didnt get anything for that but we know it is sc to my Crohns (100%) and SC Diabetes II (sc 20%) and Iron difeciency SC 30%). When hospitalized in january i was also diagnosed woththe Post Stroke Headaches, Chronic Mircovascular Ischemic Disease, White matter Disease and Intercranial Atherosclerosis, hypothyroidism, hypertension, diabetic neuropathy, depression, insomnia, fatugue, and previosly Arthritis and Abdominal scar for 4 bowel resections. Should I file for all of these now or wait for the PTSD, B12 defeciency and A&A to be resolved ?? Dont want to get them confused…..Thanks Bob

  8. Robert Chapman says:

    I just had a C&P exam for PTSD. I applied for Aid and Attendance after 2 strokes in 33 days and now having post stroke headaches. I am alfready 100% for Crohns Disease, 30% for Iron defeciency, 20% for Type II Diabetes and 10% for Strokes. I applied for PTSD, B-12 Defeciency, A&A. So I went to the C&P Exam and the Dr says we will cover experience prior to service, in service and post service. After we discussed Pre=service and Post service he abruptly says OK we are done and walks me out. How can a Doctor evaluate my in Service PTSD if we do not discuss it? I have avoided the VA for many years due to the quality of care and this experience just reinforced my beliefs…Guess the Doctor got to the Magic time limit and said all done….I am sure that is not the protocal in the APA manula…….

  9. Alex Madrid says:

    My supplemental is waiting for Aid and Attendance in which forms were signed 3 times, backed by Nexus, DBQs and spouse FMLA papers.
    *denied at HLR and put as Housebound because they said it sounds lile I have a adjustment disorder instead. I am not Housebound, records and Dr’s. Specifically say I can leave but need spouse or family member or supervision for:
    Heart and Lung
    Vefyiho, falling down
    Sedation and dizziness medications
    Persistent danger self others
    Help daily tasks back and shoulders

    PTSD with Bipolar 100% service-connected with effective date 12/19/2020
    *Appeal in for effective date and combat code due to combat simulation with Nexus.
    3 DBQs
    Total S&O Impairment
    Persistent Danger to self and Others
    Same language in MEB before discharge

    Back says complete disibility needs help with most daily activities and neck severe disibility needs help with some daily activities.
    Setvice-connected 10% 08/31/10
    *C&P currently deferred with LHI exMs completed

    Shoulders new MRIs show 50% tears in both. service-connected left shoulder 10% 08/31/10
    *C&P Exam deferred no exams

    Heart, Afib- 8 procedures since Nov 2015 on heart. 2 Nexus service-connecting to PTSD with Bipolar for 3 years consecutive high stress and combat simulation.
    *C&P with 1151 currently deferred but LHI exams completed

    Pulmonary Vein stenosis in 3 of 4 veins with 3 stents and upper left said irreversible with Dr’s. Records stating secondary to Ablation conducted at Dallas VA
    *C&P exam deferred with

    Due to pulmonary vein stenosis upper left lobe on left lung died and scheduled to be removed.

  10. Pili davis says:

    Asknod thank you for your dedication to help out all veterans to receive highest possible compensation. I am currently trying to fight for my own smc rating.

    I was first awarded 70% ptsd 20% lumbosacral strain(secondary 10% R femoral nerve damage, 10% sciatica nerve damage) also left hip limitation right knee strain and left knee strain all service connected but at 0% this was awarded to me the date I got out of service 09/22/2017

    So as of now I am
    100% P&T for ptsd 07/22/2020
    50% sleep apnea 08/22/2020
    40% lumbosacral strain 10/22/2020
    2 secondary 20% for femoral and sciatica nerve damage same effective date
    10% left hip strain
    10% right knee strain
    10% left knee strain
    I know I am entitled to SMC (l) based on need for aid and attendance since my wife assists with everything around the house and also due to PTSD I cannot do much for myself or be trusted to do anything I’ve crashed cars almost burnt down the house plenty of things that are not good. I am just trying to figure out how to move up the ladder. And would I qualify for smc(r) based on need of A&A for my PTSD and for my Back pain? Also do you know anything about the caregiver process me and my wife are currently trying to get approved for that. And would caregiver affect smc?

  11. I was just rated at SMC-S effective 09/06/19. I read that there is no retro on the SMC portion is that correct?

    • asknod says:

      Wrong. SMC is due and payable the moment it can be ascertained that you are entitled to it. My record retro to date is going back to 1994 for SMC S through to 2016.

  12. Annie Pate says:

    Thank you for that information, I currently am receiving 100 IU PT and also smc (k) for loss of organ and also smc (s) for other disabilities rating over 50%. I’m going to have total knee replacement on my (r) knee which is service connected at 10% for osteoarthritis arthritis. I will later have the same done to the left knee as well, which is service connected as well at 10%. Will I qualify for another smc? My current VA rating is 90% plus 100% IU PT.

    • asknod says:

      If you had both knees done at the same time, VA would grant LOU of the lower extremities for six months following surgery. At that time, you would revert back to SMC S + K.

      • stef110568 says:

        Thanks for the response, but I wonder if I could possibly get closer to 100% service connected for I’m a total of 90% all around, not including my 100% IU PT.. I’m 10% in each knee for osteoarthritis due to shin splints, so I’m guessing that I will get 30% each after convalescent leave is over, which would give me 3pts each to add to my total 90% after all is said and done. This should give me a total of 96% which hopefully will push me to the 100% total service connected. What do you think?

  13. R.W. Carter says:

    Continued.. DDD, 10% L Wrist and 0% headaches. From what all I’ve read I should be entitled to (m), (o) or (r)(1). Any comment appreciated.

    • asknod says:

      Mr. Carter, something is missing. You state you are SMC S +K ( about $3,700.00 married) but then say “plus need for a&a”. A&A is awarded at the SMC L rate which is $4,083 (SMC L +K married). So, if you have loss of use of both lower or upper extremities, or loss of use of one upper and one lower extremity-and-are in need of a&a for another totally independent disorder or injury, then you would be entitled to SMC O. But if one of the two things that entitled you to O was A&A, then you advance to R1. This is like Chutes and Ladders with missing hands and feet.
      And then there’s the matter of all the other ratings. Were they awarded after you were entitled to SMC S? An additional 70%; 40%; 40% 40%; 30%; 20%;10% on top of a 100% schedular plus a 60% rating for something unrelated to the 100%? Unless you can qualify for SMC L, you’ll never get your foot in the door to other higher ratings.

      • R.W. Carter says:

        Thanks. For clarity I did get the (s) and (k). Three times now, approaching a 4th, this Thursday, have I had doctors acknowledge the need for a&a on 21-2680. I have a 24/7 of record caregiver. I had always believed that the (s) was for a&a although I too am housebound. Yes too on the next you asked. I was awarded the (s) and (k) prior to the other ratings. So perhaps this go around I can move up. I am hoping to this Mission Act of 2018 will kick in for all eras soon too as my caregivers car and insurance payments are coming out of my pocket since she quit her job 3 years back to take care of me. She is also my fiance of 4 years too. Lol. Thanks much for all your reseach above and your responses!

      • R.W. Carter says:

        Unmarried, Yes to add to the below; the rating of about a year ago were additional ratings after I was entitled to SMC(s). And they were too as you mentioned on top of the 100% and 60% rating unrelated to however, some secondary too the 100%. For example; the TBI was secondary to Meniere’s from a head injury from a fall. I had taken some meds last night trying to answer on my own and didn’t quite get finished answering. Thanks!

        • Richard Brooks says:

          Thank you for that information, I currently am receiving 100% Meniere’s disease 100% PTSD and 50% for vestibular migraines 30% MDD and 40% back 30% skin also an 30% sinus. I am currently filing a cervical diffusion c567 which I stems from a vechical accident .
          For example should I claimTBI be secondary to Meniere’s -vestibular migraines from a head injury stated Whiplash in the board’s denial in 1998 decision of the cervical claim prior to one year after discharge from the Army. My current VA rating smc m

          • asknod says:

            You have it backwards. TBI will always be the root rating for compensation purposes. Everything else is a secondary as listed in DC 8045. The PTSD or the Meniere’s has given you A&A. Likewise, either of the two is also the predicate for your bump up from L to M under §3.350(f)(4). Filing more claims for what you suggest above will not increase you towards the goal of R1 You need either blindness, loss of use of the upper or lower extremities or another rating for A&A for the other of your two 100% disabilities which is not being used for your current A&A rating. I’ve seen A&A for a 100% COPD plus A&A for PTSD granted in one decision on appeal. Assembling ratings for SMC is like Legos-everything has to fit perfectly.

            • Thank you for that information,so would it make a difference if I claim TBI as the primary and the secondary would be Meniere’s -vestibular migraines from a head injury from a vechical accident stated Whiplash by the BVA denial in 1998 decision of the cervical claim prior to one year after discharge from the Army. Evaluating TBI and co-morbid symptoms, see M21-1, Part III, Subpart iv, 4.N.2.i from the Army. My current VA rating smc m
              what do you think would like your input .

  14. R.W. Carter says:

    Trying again if it post later twice I’m sorry.
    I have been receiving SMC(s) and 1-(k) for a long time. (1-100% and 1-60% plus need for a&a). About a year I was awarded 70% MDD, 40% TBI, 40 DJD, 40% R shoulder strain, 30% L shoulder strain, 20% Cervical

  15. Rickb says:

    I have a 100% rating for COPD, and was awarded A&A back in 2007. I was also awarded a step increase since at that time I have an additional disability rated 50% or more ( 60% in my case ) for a back injury. since then I was awarded some additional disability when combined come to 60%
    ( and even then I have not counted a 50% rating for Sleep apnea that was combine with my COPD & asthma rating) Am I not entitled to an additional step increase from L 1/2 to M. or must I have an additional 100% rating to get to M. The way I read the rules I should have received the M step a long time ago? thanks

    • asknod says:

      When you say you got A&A, I presume you mean SMC L, correct? For some reason, some folks think SMC S (100% + 60% or more in unrelated disabilities) is a form of A&A. All step increases begin with an L rating or higher. I will be litigating this “bump” phenomenon shortly at the BVA. VA M 21 says you only get one 50% or one 100% bump but not both and certainly not more than once. I dispute that and read §3.350(f)(3)(4) to mean what it says. Each subsection is a stand alone entitlement separate from the other. I can’t find any case law that it has ever been argued.

      • Rickb says:

        Yes SMC L, A&A based on actual need, bumped to L 1/2 because of an addition separate unrelated 60% rating for my back. ( I realized it only required an additional 50% rating to get to L 1/2 ) to me the plain language says I am entitled to a bump each time I have a separate 50% rating which in my case can be as many as three bumps. I will be looking to hear about your litigation. thank you

        • asknod says:

          Roger on that. I read it the same as do many of my fellow NOVA litigators. We’re just looking for the proper vehicle. I have two currently. The problem with these is a lot of my clients graduate to R1 before they can litigate this facet.

          • Rickb says:

            If you need anything from me that might help you in the process … i am willing as I said, I may be entitled to as many as 3 bumps… based on my back rating – 60% , my sleep apnea rating 50% and a 40% TBI with 6 10% ratings…I have asked for the next step but the va seems to have ignored the request with no explanation or acknowledgement that I even submitted the claim.

  16. Cindy Carter says:

    Thank you for this. I have been using this site for a couple of years to help me understand how to do my husband’s VA benefits. With all the items wrong with him, it has been very helpful. My question is he has had 2 (two) Total knee replacements this year. One in February and one in July. The first was rated 38 U.S.C> 1114, subsection (s) and 38 CFR 3.350(i). I know this 100% rating is for 13 months only and then goes to 30% as of the 14th month for both knees. The SMC can it be collected for each knee at the same time? Meaning from July 2018 till April 2019 the SMC is doubled and then as of April 2019 it is back to one until September 2018 of which the SMC goes away. Unless we go back and have the knees re-evaluated, but they do not do motion testing after TKR, so it is usually not worth it. Thank you for your information

    • asknod says:

      You can only get one SMC S. Actually, no. I’ve had a client that qualified for SMC S on two counts but they only pay one. If you did surgery on both knees simultaneously, they can give you SMC L for loss of use of lower extremities under §3.350(b) for the surgical time you speak of.

  17. Jake says:

    I have been awarded smc s1,l1,p1. Some how they are paying l1/2. Is that correct? How if you are rated p1 do they get away with paying l1/2?

    • asknod says:

      P1 is a catchall. If you had loss of one foot and loss of one arm at the elbow, you’d get L1/2. It’s important to understand that SMC P is not higher than SMC O. SMC P, rather, is a way of rating you for a weird bunch of losses. If you get SMC S, then L, you have graduated from S. If you have a qualifier for SMC L and an additional 50% or more from a completely different injury unrelated to what you got L for, you get the 1/2 step bump under §3.350(f)(3). I tell folks to ignore the P designator.

  18. Douglas James says:

    Given my age at 75, a little confused. I am at 90% prior to having my right knee replaced. Filed for unemployable. Read online that I am 90%, granted early this year. Filed for unemployable, submitted Dr’s report, plus post operative report from May 29th 2018. I thought I might receive a temporary 100% based on my right and left knee, with many residual problems, would be granted. Not sure about it all. What is your concept of what happened? I thought I might get a SC, 38U.S.C.1114 sub section and 38 C.F. Thanks for your input.

  19. says:

    Given my age at 75, a little confused. I am at 90% prior to having my right knee replaced. Filed for unemployable. Read online that I am 90%, granted early this year. Filed for unemployable, submitted Dr’s report, plus post operative report from May 29th 2018. I thought I might receive a temporary 100% based on my right and left knee, with many residual problems, would be granted. Not sure about it all. What is your concept of what happened? I thought I might get a SC, 38U.S.C.1114 sub section and 38 C.F. Thanks for your input.

  20. 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.

  21. 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 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

    • 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.

  22. 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:

    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.

  23. Jcp says:

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

  24. 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.


    • N Shari says:

      Good morning sir,

      I have a question in need of your expertise advice for additional SMCs. Like the previous question, I am still puzzled about the ½ and full steps on the SMC chart.

      Injury Snapshot:

      I am currently 100% P&T, Car Grant recipient, HISA approved, SAH approved, Chap 31 ILP client for SEH rehab concerns, SSDI recipient, Medically Retired from work, and now SMC L ½ rated, effective 09/29/2021 due to all of my injuries. I just recently won a CUE for not rating my surgically repaired left hip replacement due to reevaluation of 90% after 1 year. They had to back date my CUE to 7/29/2019, which was the day that I was originally awarded the Aid & Attendance for the Left Drop Foot, along with the standard verbiage was, “In need of A&A of being so helplessness….”

      I have gone through the Pain Clinic, Spinal Cord Stimulator patient, RFA patient, Left Ankle surgery (2018), Botched VA Left Hip Replacement (2015), and 2 revision hip surgeries (2018). Diagnosed with Restless Leg Syndrome. And cannot performed a few of ADLs too.

      I have a chair lift in my home for stairs, ramp accessible, grab bars in shower and near toilet, ADA raised toilet with toilevator installed, about to get adaptable auto attachments, VA approved motor scooter, right ½ inch-built shoe due to left leg longer due to botched surgery, left shoe modified with AFO inserted into the shoe, due to I cannot put on myself

      I strongly feel that I have been short changed on my proper rating! I have listed my injuries below for a better visual.

      Current Disabilities:

      Left hip replacement: 90% (additional 2 resurface hip surgeries)
      Depression: 70%
      Radiculopathy of left lower extremity with drop foot: 60%
      Lower Back: 40%
      Radiculopathy of the lower extremity (femoral) with left drop foot : 30%
      DJD right ankle: 20%
      residuals of fracture of left medial malleolus: 20%
      Radiculopathy of the right extremity: 20%
      R knee: 10%
      R hip flexion: 10%
      R hip extension: 10%
      R hip abduction: 10%
      R wrist sprain: 10%

      L hernia scar repair: 10%
      L ankle scar repair: 10%
      L thigh myositis ossification: 10%
      L thigh ext: 10%
      L Ostemacia (soft bone): 10%
      Nonservice connected for Flat Feet: 0%


      1.) Do you think I am due the ½/ or full step in SMC lineage? The recent Decision Letter only showed rating rationale for the previous 2 (hip and right sciatica) injuries, but failed to mentioned their selected injuries and not mentioned of the other (right hip, knees, atrophy, and drop foot), It seems like they were just to make me go away?

      2.) I thought I should have been SMC N or at least M for loss of hips or loss of legs, which was not afforded to myself?

      3.) Should they have evaluated all of my mentioned injuries, since they were not the same/repeats?

      5.) Should I get a separate evaluation for calf atrophy for muscle injury? The DC code is 8520, but should be in the Muscle Injury DC range?

      thx in advance

  25. 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.

  26. 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.

  27. 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,


  28. 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…..

  29. 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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