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#1 believe

 
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Posted 14 September 2012 - 07:51 PM

My C&P exam records show that the doctor listed me as homebound. Do I have to still apply for homebound or could I be awarded that when a decision is made on my claim without ever applying for it?

#2 jbasser

 
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Posted 14 September 2012 - 09:02 PM

Housebound is listed under special monthly compensation S scale
You either meet the percentage requriements or are housebound.

The RO will most likely ignore it.

J

#3 believe

 
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Posted 14 September 2012 - 09:21 PM

I am homebound which is why the doctor stated that in my records. If I dont meet the percentage requirements is it possible to still get homebound rating because of my records even though I didnt apply for homebound?

Youre saying the VA does ignore some C&P exam records?

#4 believe

 
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Posted 14 September 2012 - 09:23 PM

My nexus letter and C&P exam states that I am homebound.

#5 carlie

 
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Posted 14 September 2012 - 11:54 PM

My nexus letter and C&P exam states that I am homebound.


Welcome,
It's obvious you have a claim in for VBA benefit issues or a
C&P exam would not have been scheduled.

At this point your profile shows zero percent of SC.

The criteria for housebound (SMC - S) is SC at total plus 60 percent
and there are a couple of other things that might help get it too,
although not done very often.

What issues do you currently have claims in for SC ?
Please copy & paste exactly what your "nexus letter and C&P exam"
state and better answers / guidance can be provided.
Do not post something personal like name, claim #, SSA #, address, etc...

#6 believe

 
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Posted 15 September 2012 - 07:05 AM

I had my exam but I have not recieved a letter with the decision yet is why I am still at 0 percent.

PTSD chronic and unremitting
Panic disorder with agorophobia

Social alienation, housebound, limited access to healthcare
Unable to leave home unless for extreme cases
Occupational and social impairment with deficiencies in most areas
The 2 mental disorder can not be differentiated because the 2 mental disorder developed at same time
All of the top boxes are checked for the criteria used for establishing PTSD except for burst of anger. 20 boxes checked
Symtoms listed as .. depressed mood, aniety, suspiciousness, panic attacks that occur weekly or less often, near continuous panic or depression affecting the ability to function independently, appropriately and effectively.
Chronic speep impairment
Memory loss for names, relatives, ownoccupation or own name
Disturbances of motivation and mood
Difficulty in establishing and maintaining effective work and social relationships
Inability to maintain effective relationships
Suicidal ideation
DIfficulty in adapting to stressful ciscumstances including work or worklike setting
Extreme agorophobia

My nexus letter is not as thorough as the C&P exam records but it states Chronic PTSD and severe agorophobia. My nexus is more about my extreme agorophobia.

The doctor wrote about 2-3 pages worth of notes. Nothing to hurt my claim.

Edited by believe, 15 September 2012 - 07:52 AM.


#7 carlie

 
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Posted 15 September 2012 - 12:13 PM

believe,
MH disability's get one rating even tho most are co-morbid
with additional MH diagnosis.
The info I already posted addresses SMC - S - housebound.

The C&P looks to be in your favor in relation to percentage evaluation,
but I did not read anywhere as to what the examiner's opinion is
of what your MH conditions are a result of.

That's the very first step in all VBA claim issues, is getting
SC granted first of all.
If the examiner opined your MH condition/s were more than or
at least as likely as not related to something on
active duty and this can be substantiated then at least
SC should be granted - that's step one.

#8 believe

 
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Posted 15 September 2012 - 01:57 PM

I have proof and evidence of a stressor which is in my records. I thought I listed that the doctor said this but I guess I didnt. It does state that the disability PTSD and panic disorder with agorophobia is as least as likely as not caused by or a result of assualts. So I wasnt really concerned about step 1 because I knew I needed that and had that. I was trying to figure out if I could get housebound since the doctor stated that. What kind of percentage should I be looking to get?

#9 jbasser

 
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Posted 15 September 2012 - 11:12 PM

The criteria for Housebound or SMC S is 100 or Iu for 1 condition plus an additional 60 percent. this is called statutory housebound,
The other requirement is to actually be housebound and agoraphobia is a very good reason for that.

Hang in there.

#10 broncovet

 
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Posted 16 September 2012 - 05:08 AM

Ok. To clear this up there are actually two "housebound's"

One is SMC "housebound". The criteria for it are to have a single 100 percent disability and additional disabilities of 60% or more OR
being housebound "in fact", that is, if your doc says you are housebound. This is for disabled Vets and there is no "means test" that is, you dont have to have limited income or assets. Its a service connected compensation Special Monthly Compensation.


The other is SMP "housebound". This is part of a pension program and requires eligibility for "pension". Pension eligibility has strict income and net worth guidelines. You also must have served "during time of war" to be eligible for pension. The advantage of SMP "housebound" over SMC is that you do not have to have "service connected" to qualify. You could be housebound because you got old and your joints are worn out. You dont have to be wounded in the war.

I think the VA lumps these two VA programs together, in part, to confuse Vets so many do not apply. Some think they dont qualify because they make or have too much money. This is true with pension but not true with compensation. Others think they have to have been injured in the war and have to be service connected to collect housebound. This is true with SMC housebound but not with pension housebound.

Edited by broncovet, 16 September 2012 - 05:12 AM.


#11 believe

 
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Posted 16 September 2012 - 07:01 AM

Thanks for all the help. I am definitely housebound and it is pretty bad the severity of my case which I have plenty of evidence to prove that claim. I'm not getting into to specifics but my agoraphobia is extremely bad. I came so close to not going to that C&P exam. How often is that required if you are awarded compensation? I just don't know if I can go back there and especially on a regular basis.

Also no1 has said if housebound is something that I have to apply for even though the doctor has me listed as housebound. Does any1 know the answer to that?

#12 broncovet

 
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Posted 16 September 2012 - 10:25 AM

Yes, apply pronto!

While there are some circumstances when the VA is supposed to "infer" housebound, dont bet the farm on the VA doing that. Instead, go ahead and apply, and after you get it, you can challenge the effective date on the basis that VA was supposed to infer it. Otherwise, the VA can blow you off indefinately. Just because you go to the doc, this does not mean the VA takes everything the doc says as a claim. The VA says you have to "show intent" to apply for benefits and they automatically assume when you go to the doc that you are seeking "treatment" not benefits from the doc.

#13 john999

 
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Posted 16 September 2012 - 11:20 AM

Pete53 knows about HB for panic disorder and agoraphobia. I got mine for TDIU plus 60% and I had to file a CUE claim to get it. Actually, I just asked for it and the VA called a CUE and awarded it to me. If I had not claimed it I never would have got it even with Bradly vs Peake. If you claim HB for a medical condition you probably will have a C&P exam for it. If it is statutory then the VA should infer it and no exam. However, as others have said if you don't claim it you probably don't get it. I got two years retro. Any PTSD or mental health vet with a 100% should claim it. VA is supposed to consider it and if they don't I think that is a possible CUE. Remember every dime you get from the VA will go into making any cola's larger for you.

#14 believe

 
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Posted 16 September 2012 - 05:48 PM

My claim is in the authorization stage. Would it still be a good idea to apply for housebound now or should I wait until I receive the decision in mail?

Edited by believe, 16 September 2012 - 05:50 PM.


#15 carlie

 
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Posted 16 September 2012 - 06:08 PM

My claim is in the authorization stage.
Would it still be a good idea to apply for housebound now or should I wait until I receive the decision in mail?


At this point
NO
do not call or submit absolutely anything at all to va.
Doing so could easily throw the brakes on everything.
Wait the time out for your decision.

#16 believe

 
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Posted 20 September 2012 - 05:51 PM

I got a white envelope today. It said 100% :) They did not award housebound. So what should I do now? Just call and ask for it? The VA doctor and my personal doctor clearly states that I am housebound.

#17 believe

 
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Posted 20 September 2012 - 10:23 PM

Is there a thread for CUE letters. I guess I will have to write 1. Any help?

I just realized there is a CUE forum.

Edited by believe, 21 September 2012 - 01:57 AM.


#18 carlie

 
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Posted 21 September 2012 - 02:41 AM

Is there a thread for CUE letters. I guess I will have to write 1. Any help?

I just realized there is a CUE forum.


I replied to your CUE forum post but you will do better keeping it all in this topic for now.
Please post the decision - without info like name, claim #, etc...

#19 carlie

 
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Posted 21 September 2012 - 03:29 AM

I got a white envelope today. It said 100% :) They did not award housebound.
So what should I do now? Just call and ask for it?
The VA doctor and my personal doctor clearly states that I am housebound.



Again -

1) DO NOT SUBMIT ANYTHING ELSE TO VA YET or call 800 or send an iris
inquiry about this SMC/S issue.
2) At this point you have absolutely no grounds to file a claim for CUE.
3) Please post the decision.
4) What is your current age ?

Here's something else to consider.

http://ecfr.gpoacces....67.144&idno=38

Below is the exact criteria for SMC/S.

(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
You have met the above portion of the criteria for SMC/S - but there is still more criteria to meet.

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,
You definitely don't meet the criteria of the portion above.
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.


In that rating decision I'm asking you to post, it will be important to see if permanent is
mentioned anywhere - or if the C&P examiner or provider that wrote your nexus, states
this will more likely than not last throughout your lifetime, and/or if they provided full
medical rationale to support the opinion of "extreme agoraphobia".

In reply to something else you posted,
"I came so close to not going to that C&P exam.
How often is that required if you are awarded compensation?"

Just so you know - there are many, many claimants that come real close to not going to their C&P exam.
Not attending a C&P exam that has been scheduled is pretty much felt to make for an
automatic denial.
Believe me - NO ONE usually wants to go OR looks forward to a C&P exam.

Now, onto your question regarding how often it's required to attend a C&P exam
if you are awarded compensation?

True answer: ANY and EVERY time one is scheduled.
Even if the VBA adjudicates you to be P&T - if a C&P is scheduled
DO NOT miss it.

It takes 20 full years of a continuous evaluation for a given disability
until the evaluation is protected from reduction (absent a finding of fraud).

It takes a full 10 years of a continuous evaluation for a given disability
until the evaluation is protected from severance (absent a finding of fraud).

#20 broncovet

 
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Posted 21 September 2012 - 04:57 AM

Welcome back Carlie

If you think you are eligible for housebound, and the VARO decision did not award it, you have one year to appeal, or the decision becomes final.

There are 2 ways to get "housebound". One way is the "Statuatory" housebound, that Carlie Posted. The other way is HOUSEBOUND in FACT. If you meet the criteria for statuatory housebound, you need not get a doc's statement that you are housebound. However, if you do not meet the statuatory housebound critera, you still can use evidence from your doctor to obtain "housebound in fact".

#21 believe

 
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Posted 21 September 2012 - 06:54 AM

I guess this is what you are asking for ..

Decision

Service connection for PTSD and panic disorder with agoraphobia (previously referred to as unspecific mental condition) is granted with an evaluation of 100 percent effective July 28, 2010.

It does also state in the reason for decision that since there is a likelihood of improvement, the assigned evaluation is not considered permanent. I just looked over my C&P exam records again and the doctor said several times that my condition is severe. Obviously I can't type all of what the doctor said but here is a little more to add that I believe supports my claim for extreme agoraphobia ..

Rarely interacts with family, rarely leaves home, avoids family reunions, no social contacts. Veteran acknowledges some reduction in anxiety over the years (yet I still have a diagnoses of extreme agoraphobia). Sense of a foreshortened future (does not expect to have a career, marriage, children, or a normal life span).

I can add more but with the information I have provided so far, what do you think about a CUE case now?

Im 29

Edited by believe, 21 September 2012 - 07:20 AM.


#22 Berta

 
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Posted 21 September 2012 - 09:06 AM

I agree with Carlie, this is still not a a basis for a CUE claim.

CUE claims and their criteria is all explained in our CUE forum here.

I am concerned about one thing.

http://www.craigbashmd.com/helpful

At Dr. Bash's site, that popped up when I tried to find more info regarding the lack of SMC,

he shows a separate diagnostic code for panic w/ agorahobia, under the PTSD info.

How did the VA rate your disability on the rating sheet. All under 9411 PTSD ,or part under 9412?

And what were the %s for each?

But then again ,it might not even matter because the entire decision could reveal that everything was considered within the 100% award.

If you feel you should appeal the decision, by all means file a NOD and tell them why you feel they are wrong.

#23 broncovet

 
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Posted 21 September 2012 - 09:57 AM

Beleive

Berta and Carlie are correct. Cue applies only to UNAPPEALED decisions that have became final. You simply appeal and dont worry about CUE when your decision is within a year.

#24 believe

 
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Posted 21 September 2012 - 10:34 AM

It wasnt clicking in at first. I understand now. Instead of CUE I need to appeal because its within a year. So now the question is .. do I have a case for housebound? If I do, should I appeal (I never filed out housebound form) or should I file a new claim for housebound?

I didnt have any assistance with DAV but maybe I should get 1 now because Im starting to ask a lot of questions.

#25 broncovet

 
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Posted 21 September 2012 - 11:32 AM

Yes. If you think you have the evidence for "housebound in fact", then certainly you should appeal. I did not read your docs report, but if you think so that is all that matter. Carlie pointed out you probably do not qualify for "statuatory housebound" because that is when you have a minimum of 100% plus 60%.

#26 believe

 
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Posted 21 September 2012 - 11:45 AM

Ok thanks. Just to make sure .. this appeal will not affect my current pay rate at 100% correct?

#27 broncovet

 
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Posted 21 September 2012 - 01:45 PM

No. Your decision remains in effect until the appeal is settled.

Remember, the VA can not appeal a RO or BVA decision. Any issues you do not appeal become final in a year and cant be revised except for CUE.

#28 john999

 
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Posted 21 September 2012 - 03:07 PM

If you are 100% and the VA did not consider you for HB I would appeal. If they did consider you for HB and denied you I would appeal with more evidence.

#29 believe

 
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Posted 21 September 2012 - 03:10 PM

No. Your decision remains in effect until the appeal is settled.

Remember, the VA can not appeal a RO or BVA decision. Any issues you do not appeal become final in a year and cant be revised except for CUE.


Sorry Im a little confused. Don't I just send a notice of disagreement to my local VA office to appeal?

#30 broncovet

 
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Posted 21 September 2012 - 03:11 PM

Yes. You send a NOD to the Regional Office.

#31 carlie

 
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Posted 21 September 2012 - 06:27 PM

I guess this is what you are asking for ..

Decision

Service connection for PTSD and panic disorder with agoraphobia (previously referred to as unspecific mental condition) is granted with an evaluation of 100 percent effective July 28, 2010.

It does also state in the reason for decision that since there is a likelihood of improvement,
the assigned evaluation is not considered permanent.
I just looked over my C&P exam records again and the doctor said several times that my condition is severe.
Obviously I can't type all of what the doctor said but here is a little more to add that I believe supports my claim for extreme agoraphobia ..

Rarely interacts with family, rarely leaves home, avoids family reunions, no social contacts. Veteran acknowledges some reduction in anxiety over the years (yet I still have a diagnoses of extreme agoraphobia). Sense of a foreshortened future (does not expect to have a career, marriage, children, or a normal life span).

I can add more but with the information I have provided so far, what do you think about a CUE case now?

Im 29


This is absolutely nothing for a claim of CUE - just forget that part totally.

I do not see where you meet the eligibility criteria for SMC/S under any of the regs
that provide this additional benefit.

1) Your rated 100 percent - you are not rated total plus 60 percent - so this way is a denial.


2) "It does also state in the reason for decision that since there is a likelihood of improvement,
the assigned evaluation is not considered permanent." and this way is a denial.

To me - it is NOT AT ALL "Obviously I can't type all of what the doctor said . . ."
along with exactly and all of what the decision states.

How can you possibly expect to get the best guidance when only posting
partial answers.
Severe now does not equate to permanently - for life, especially if the mental health
providers statements / opinions are not supported with full medical rationale.

You are 29 yrs old - a decision maker would have a difficult time due to your age
in my opinion.

Are you familiar with the reg criteria for a 100 percent evaluation for mental health ?



Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name..100

From what I have read in the topic postings so far - personally I would leave SMC/S alone.

Even tho you posted how difficult attending the C&P exam was for you - -
I highly suggest being in some kind of mental health treatment program on a fairly regular
basis (at least 6 times a year) because you will for sure be getting scheduled for a re-exam
sometime down the road.
This most likely won't happen for a few to several years - - - but at sometime - - - it will happen.

Maybe I'm the only nay-sayer on this one but this is what I see.

#32 believe

 
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Posted 21 September 2012 - 09:16 PM

I guess I could have typed the 2-3 pages worth of personal notes the doctor wrote himself. So me saying obvious was wrong to do. Sorry. Some others said I should send in a NOD with the partial information that I provided. Sorry I thought the information I provided was enough for you all to say yes I have a case for SMC-S. Pete53 makes it seem like I should ask for it. If I get it or don't, I will update this thread. Thanks for all of the help on this thread.

1 other thing I didnt mention. I have had this condition for almost 10 years which is stated in my records. So I waited a long time before I applied for compensation.

Edited by believe, 21 September 2012 - 09:19 PM.


#33 carlie

 
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Posted 21 September 2012 - 11:54 PM

I guess I could have typed the 2-3 pages worth of personal notes the doctor wrote himself. So me saying obvious was wrong to do. Sorry. Some others said I should send in a NOD with the partial information that I provided. Sorry I thought the information I provided was enough for you all to say yes I have a case for SMC-S. Pete53 makes it seem like I should ask for it. If I get it or don't, I will update this thread. Thanks for all of the help on this thread.

1 other thing I didnt mention. I have had this condition for almost 10 years which is stated in my records. So I waited a long time before I applied for compensation.


Hey - please don't get me wrong here - you can submit a claim for ANYTHING,
it's just that with the basics you posted - I personally don't see SMC/S happening.
You want to request SMC/S then request it.
But another thing to consider is that if your decision does not state SMC/S or housebound
is denied - then you wouldn't file a NOD on the issue.
A NOD is filed on an issue that has been adjudicated.
You would request an increase in benefits to include housebound or SMC/S
and be sure to have the correct medical documentation to support the claim.
JMHO

#34 broncovet

 
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Posted 22 September 2012 - 05:07 AM

I am including the cfrs for smc and housebound, with my highlights, noting that you need not meet the "100 plus 60" criteria if you meet the "or" criteria, highlighted in bold, below. In other words, if your doc says you meet the criteria for housebound, below, then you are housebound:


Title 38 - Pensions, Bonuses, and Veterans' Relief


Volume: 1Date: 2008-07-01Original Date: 2008-07-01Title: Section 3.350 - Special monthly compensation ratings.Context: Title 38 - Pensions, Bonuses, and Veterans' Relief. CHAPTER I - DEPARTMENT OF VETERANS AFFAIRS. PART 3 - ADJUDICATION. Subpart A - Pension, Compensation, and Dependency and Indemnity Compensation. - Ratings for Special Purposes.


§ 3.350
). 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.
[26 FR 1587, Feb. 24, 1961, as amended at 27 FR 4739, May 18, 1962; 28 FR 1587, Feb. 20, 1963; 28 FR 5671, June 11, 1963; 40 FR 54245, Nov. 21, 1975; 45 FR 25392, Apr. 15, 1980; 46 FR 47541, Sept. 29, 1981; 48 FR 41161, Sept. 14, 1983; 49 FR 47003, Nov. 30, 1984; 54 FR 34981, Aug. 23, 1989; 60 FR 12886, Mar. 9, 1995; 67 FR 6873, Feb. 14, 2002; 68 FR 55467, Sept. 26, 2003]

Edited by broncovet, 22 September 2012 - 05:37 AM.


#35 believe

 
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Posted 22 September 2012 - 05:13 AM

Hey - please don't get me wrong here - you can submit a claim for ANYTHING,
it's just that with the basics you posted - I personally don't see SMC/S happening.
You want to request SMC/S then request it.
But another thing to consider is that if your decision does not state SMC/S or housebound
is denied - then you wouldn't file a NOD on the issue.
A NOD is filed on an issue that has been adjudicated.
You would request an increase in benefits to include housebound or SMC/S
and be sure to have the correct medical documentation to support the claim.
JMHO


I already submitted the NOD. The letter was a NOD and a request for increase. What should I do now?

#36 broncovet

 
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Posted 22 September 2012 - 05:25 AM

After you submit a NOD, the ball is in the VA's court. Carlie is right in that it would be fruitless to appeal if you dont have the evidence. If you do have a docs statement, or can get one, then you are justified in persuing your appeal.

It will delay your appeal if you do not specify whether you want a DRO or not, and whether or not you want a hearing.

They will likely send you a letter and ask you if you want to appeal via the traditional method (BVA) or if you want to appeal via a Decision Review Officer, and whether or not you want a hearing.

If you specified in your NOD that you elect a DRO review, then a Decision Review Officer will redo your case and he is supposed to either "grant your benefit" or send you a Statement of the CAse. A SOC means you have been denied again. If you get the SOC, then you have 60 days to file an "I9" to "perfect" your appeal before it will normally be certified to the BVA (Board of Veterans Appeals).

There the BVA will decide if you are granted your benefit, denied it, or if it is "remanded".

Right now, you wait, and you will be doing lots of that.

Edited by broncovet, 22 September 2012 - 05:29 AM.


#37 broncovet

 
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Posted 22 September 2012 - 05:44 AM

I will add that, if you have evidence of housebound, and the VARO decision failed to adjuticate (your eiligibility for SMC) then your remedy is to file a NOD, because SMC is "inferred" automatically, and when the RO neglects to "infer" it, you can file a NOD.

#38 broncovet

 
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Posted 22 September 2012 - 06:01 AM

M21 manual says that whenever a single 100% disability is awarded, there is an inferred claim for SMC:


[DOC]
Part III, Subpart iv, Chapter 6, Section B. Determining the ...




page 5b and 6b
M21-1MR, Part III, Subpart iv, Chapter 6, Section B

Edited by broncovet, 22 September 2012 - 06:09 AM.


#39 believe

 
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Posted 22 September 2012 - 07:05 AM

Thanks broncovet. I do have evidence. My C&P exam doctor has me as housebound in my records. I also haven't had a job outside my home since getting out the military. Tax returns prove that.

Edited by believe, 22 September 2012 - 07:09 AM.


#40 believe

 
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Posted 21 January 2013 - 12:26 PM

The VA housebound decision states that there is no evidence to show that I am in fact housebound. Im confused, Are they looking for a different type of evidence?

 

My C&P exam states "Psychosocial and Environmental Problems (describe, if any): social alienation, underemployment, "housebound", limited access to health care.

 

The VA decision also states that the housebound form submitted does not show that my current impairment is likely to be permanent and no subsequent medical evidence has been submitted for review.

 

My psychologist sent additional evidence a month after the housebound claim was opened and the VA verified that it was recieved. Part of the statement from my doctor says that I am "permanently and substantially confined to my home".

 

Also just to clarify, none of the doctors Ive seen said that my condition is likely to improve. It only said that on my decision letter.