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Aid & Attendance: SMC Benefits Beyond 100% – From Hill and Ponton by Kirsten Hirt, Claims Advocate

VA Disability

Originally appeared on Hill and Ponton Blog
When dealing with VA claims, the topic of conversation generally revolves around obtaining a rating of 100%.  However, even if you are rated 100%, you could qualify for additional benefits beyond the 100% schedular rating (but do not need to be rated at 100%).  These additional benefits are referred to as Special Monthly Compensation (SMC) benefits.

There are various kinds of SMC.  The basic levels range from SMC(k) to SMC(s).  If you qualify for the lower level SMC benefits, then you could potentially be considered for the higher levels which are SMC(l) to SMC(o).
Unlike the typical VA disability ratings, which focus on employability, SMC benefits deal with non-economic factors.  If your case is being reviewed for SMC, the VA will look at the personal inconvenience, social inadaptability, or the profound nature of a disability.
It is important to keep in mind that, when dealing with SMC for anatomical loss or loss of use, the loss does not need to be the direct result of an injury or illness during service.  Whether you experienced an injury during service that caused the loss of use of your foot or it is the result of your diabetic neuropathy, both cases are equally entitled to benefits for loss of use.

  • One of the most common types of SMC benefits is aid and attendance (A&A).  A&A benefits can be awarded to veterans needing daily assistance in reference to the following:
    • Inability to dress/undress
    • Inability to maintain personal hygiene
    • Inability to feed oneself
    • Inability to prevent oneself from hazard/danger

Special monthly compensation (SMC) is available when, “as the result of a service-connected disability,” a Veteran suffers additional hardships above and beyond those contemplated by the rating schedule. Breniser v. Shinseki, 25 Vet. App. 64, 68 (2011); see also 38 U.S.C.A. § 1114(k)-(s). A Veteran is presumed to be seeking the maximum benefit allowed by law or regulation, and such a claim remains in controversy, even if partially granted, where less than the maximum benefit available is awarded. AB v. Brown, 6 Vet. App. 35, 38 (1993). Therefore, a claim for increased disability compensation may include the “inferred issue” of entitlement to SMC even where the Veteran has not expressly placed entitlement to SMC at issue. Akles v. Derwinski, 1 Vet. App. 118, 121 (1991).

The daily assistance provided to the veteran does not have to be from a medical professional in order to qualify for A&A.   But if the level of need does require a medical professional, or under the supervision of a trained health care professional, a higher level of A&A may be warranted to award increased compensation.
If your caregiver assists with health care services by following a regimen or instructions provided by a licensed medical professional, those services are considered under the supervision of a trained health care professional.  While a licensed caregiver may not be directly involved in your daily assistance, you could still qualify for a higher level of benefits since it is considered above the basic level of A&A.
In order to establish your need for aid and attendance, you must have evidence from a medical professional stating to what level daily care is needed.  The evidence ought to state that you are unable to care for yourself in a normal capacity, thus showing the requirement for ongoing aid.  As part of their evaluation, the VA often reviews your ability to perform usual activities, such as running errands or chores around the home, to see how well you get around independently and the extent to which you are in need of aid and attendance.
In some circumstances, there may not be enough supporting evidence to establish aid and attendance.  If that is the case, there is another possible route to pursue.  The VA can grant benefits based on housebound criteria.  The permanently housebound status that the VA can assign varies from aid and attendance compensation.
For housebound benefits, the VA considers you “substantially confined” as a result of your disability or disabilities.  Typically, the VA will want documentation that you will be housebound on a permanent basis as a result of your disability or disabilities.  If you are housebound due to a surgery for one of your service-connected conditions, you can file for temporary 100% which is discussed in detail in a previous blog.
So far the benefits discussed are applicable to you, as a veteran, directly.  But it is possible to receive A&A and housebound benefits for severely disabled spouses as well.  The benefits will be a part of your routine payment, as applicable.  Before these additional benefits can be awarded though, you will have to have an overall rating of at least 30% in accordance with the dependent benefit policy.
Special monthly compensation can be a slightly tricky component of your claim, especially when determining which level may be applicable.   Therefore, it is extremely beneficial to communicate with your physicians if you believe you may qualify.  If a non-licensed caregiver, such as your spouse or friend, assists you daily, try to obtain statements in addition to your medical records.  A statement from your physician confirming the level of care provided in addition to the statement from you and/or the primary caregiver, outlining your need for aid and attendance, could help your claim greatly.

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