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5.10. Special Monthly Compensation (SMC)
In addition to compensation based on the degree of disability, Congress has also authorized additional compensation for certain disabilities. This "special monthly compensation" ("SMC") is intended to compensate claimants for service-connected conditions that involve loss of use or anatomical loss (amputation) of body parts, such as hands or feet, or loss of hearing or sight. SMC can result in significantly more monthly compensation for severely injured veterans.
While a scheduler rating depends on the severity of a condition, SMC for loss of use does not depend on the degree of loss, except that the loss of use must be permanent. The more seriously disabled veteran may be eligible for SMC payments for combinations of anatomical loss or loss of use. In addition, severely disabled veterans may be awarded further compensation for regular aid and attendance needs and for permanent housebound conditions. As SMC has many possible combinations and involves a significant amount of additional compensation, VETSFIRST recommends that severely injured veterans get help in filing their SMC claims from someone experienced in such cases.
"Special Montly Compensation (SMC) is available when, 'as the result of service-connected disability,' a veteran suffers additional hardships above and beyond those contemplated by VA's schedule for rating disabilities." Breniser v. Shinseki, 25 Vet. App. 64, 68 (2011) (citing 38 U.S.C. § 1114(k)(s)). The Board's determination as to whether a veteran is entitled to SMC is a finding of fact that the Court reviews under the "clearly erroneous" standard of review. Id. (citing Prejean v. West, 13 Vet. App. 444, 447 (2000); Turco v. Brown, 9 Vet. App. 222, 224 (1996)). Section 1114( l ) provides, in pertinent part: if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, with 5/200 visual acuity or less, or is permanently bedridden or with such significant disabilities as to be in need of regular aid and attendance, the monthly compensation shall be $3,075. 38 U.S.C. § 1114(l).
VA has promulgated regulations implementing section 1114 relevant to the determination of whether a veteran "is so helpless as to be in need of regular aid and attendance are contained in § 3.352(a)." 38 C.F.R. § 3.350(b)(3); see 38 C.F.R. § 3.351(c)(3) (providing that a claimant is entitled to SMC based on the need for aid and attendance by establishing "a factual need for aid and attendance under the criteria set forth in [38 C.F.R. § 3.352(a)].").
The Court has held that the order in which disabilities are service connected is not relevant to VA's determination of a claimant's eligibility for special monthly compensation under 38 U.S.C. section 1114(s). Whenever a veteran has a total disability rating, schedular or extraschedular, based on multiple disabilities and the veteran is subsequently awarded service connection for any additional disability or disabilities, VA's duty to maximize benefits requires VA to assess all of the claimant's disabilities without regard to the order in which they were service connected to determine whether any combination of the disabilities establishes entitlement to special monthly compensation under section 1114(s). If, after such an assessment, VA determines that the claimant is entitled to special monthly compensation, the effective date of the award of special monthly compensation will be the effective date assigned for the award of benefits for the final disability that forms the relevant combination of disabilities. Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010), as amended (Apr. 21, 2011).
Levels of SMC Ratings
Each level of SMC ratings are successive and are preceded by an entitlement to certain conditions included under SMC(K). The basic elements of Special Monthly Compensation ratings include:
- anatomical (or physical) loss or the loss of use (Loss of use from neurological, muscular, vascular, contractures,etc.) of one or more of the following:
- reproductive organs;
- aphonia (loss of voice);
- loss of bowel and bladder control;
- being permanently housebound;
- and a need for regular aid and attendance with activities of daily living or a higher level of careall of which must be a result of the veteran's service-connected disabilities.
A rating of SMC(K) would include:
- The anatomical loss or loss of use (Loss of use from neurological, muscular, vascular, contractures,etc.) of:
- one hand.
- one foot.
- both buttocks (where the applicable bilateral muscle group prevents the individual from maintaining unaided upright posture, rising and stooping actions).
- one or more creative organs used for reproduction (absence of testicles, ovaries or other creative organ, ¼ loss of tissue of a single breast or both breasts in combination) due to trauma while in service, or as a residual of a service-connected disability(ies). NOTE: these do not serve as eligible prerequisite conditions for the higher levels of SMC.
- One eye (loss of use to include specific levels of blindness).
- Complete organic aphonia (constant loss of voice due to disease)
- Deafness of both ears to include absence of air and bone conduction.
A rating of SMC (L) would include:
- The 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.
- Permanently bedridden.
- Regular need for aid and attendance to assist with activities of daily living such as dressing oneself, tending to personal hygiene, care and adjustment of assistive appliances or prosthetics, feeding oneself, and the like. (specific criteria is established in 38 CFR § 3.352(a)) (NOTE: If such services are not being provided at the expense of the U.S. Government due to hospitalization).
Ratings above the SMC(L) level to include SMC(M), SMC(N), SMC(O), SMC(P), SMC(R) and SMC(S) are specialized multifaceted levels which are based on various specific combinations of anatomical loss or loss of use of designated extremities and/or senses, together with seriously disabling conditions and particular degrees of aid and attendance requirements, housebound or bedridden statuses deemed medically necessary, and explicit service-connection ratings. These levels also outline various requirements to include full and half step upgraded SMC level ratings. The conditions providing the basis of these levels are as follows.
A rating of SMC(M) would include:
- The anatomical loss or loss of use of (neurological loss):
- Both hands,
- Both legs at the region of the knee
- One arm at the region of the elbow with one leg at the region of the knee
- Blindness in both eyes having only light perception.
- Blindness in both eyes resulting in the need for regular aid and attendance.
A rating of SMC(N) would include:
- The anatomical loss or loss of use of both arms at the region of the elbow.
- The anatomical loss of both legs so near the hip that it prevents the use of a prosthetic appliance.
- The anatomical loss of one arm so near the shoulder that it prevents the use of a prosthetic appliance along with the anatomical loss of one leg so near the hip that it prevents the use of a prosthetic appliance.
- The anatomical loss of both eyes or blindness in both eyes to include loss of light perception.
A rating of SMC(O) would include:
- The anatomical loss of both arms so near the shoulder that it prevents the use of a prosthetic appliance.
- Bilateral deafness rated at least 60 percent disabling along with service-connected blindness with visual acuity of 20/200 or less of both eyes.
- Complete deafness in one ear or bilateral deafness rated at least 40 percent disabling along with service-connected blindness in both eyes to include loss of light perception.
- Paraplegia paralysis of both lower extremities along with bowel and bladder incontinence.
- Helplessness due to a combination of anatomical loss or loss of use or two extremities with deafness and blindness or a combination of multiple injuries causing severe and total disability.
A rating of SMC(P) would include:
- The anatomical loss or loss of use of a leg at or below the knee along with the anatomical loss or loss of use of the other leg at a level above the knee.
- The anatomical loss or loss of use of a leg below the knee along with the anatomical loss or loss of use of an arm above the elbow.
- The anatomical loss or loss of use of one leg above the knee and the anatomical loss or loss of use of a hand.
- Blindness in both eyes meeting the requirements outlined in SMC (L), (M) or (N) levels.
A rating of SMC(R):
Ratings under SMC(R) are assigned for seriously disabled veterans in need of advanced levels of aid and attendance.
SMC(R) ratings require a minimal combination of entitlement to both SMC(O) and SMC(L). Additionally, Veterans in receipt of SMC rates based on Aid and Attendance are strongly advised to contact their service representative and/or VA Regional Office should they become hospitalized at the expense of the U.S. Government (i.e. a VA medical facility) as failure to do so could create an overpayment of monetary benefits.
A rating of SMC(S):
Ratings under SMC(S) are also available if the veteran is permanently housebound. The VA defines "permanently housebound" as being substantially (as opposed to completely) confined to a dwelling as the result of service-connected disability and it is reasonably certain that that such disability will continue throughout the veteran's lifetime. These kinds of determinations should be made by a physician, whose written opinions or reports in this respect would serve as the best evidence to submit in support of a claim for "s" SMC benefits.
A rating of SMC(T): Traumatic Brain Injury
Ratings under SMC(T) are available to veterans who need regular aid A&A for residuals of Traumatic Brain Injury (TBI), but is not eligible for a higher level of A&A under (R)(2), and would require hospitalization, nursing home care, or other residential institutional care in absence of regular in-home aid and attendance.