Section H - Special Monthly Compensation (SMC) - Updated 12/16/11

Chapter 2 - Rating

Overview


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In this Section
This section contains the following topics:   ''' '''
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36.   General Information on SMC
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Introduction
This topic contains information on Special Monthly Compensation (SMC), including
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 ·      the definition of Special Monthly Compensation

 ·      the responsibility for determining loss of use

 ·      the information to request from an examiner

 ·      determining the extent of examinations

<span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      considering amputation or loss of use of extremities

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      showing entitlement to SMC in rating decisions

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      showing the denial of SMC in rating decisions, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      mandatory use of the SMC Calculator. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">December 16, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Definition:   SMC
<p class="MsoBlockText">Special Monthly Compensation (SMC) is an additional level of compensation to Veterans (above the basic levels of compensation payable based on disability ratings of 0 to 100 percent) for various types of anatomical losses or levels of impairment due solely to service-connected (SC) disabilities.
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<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on SMC, see the “ SMC Training Guide” under “Training” on the Compensation and Pension Service's Intranet website. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   Responsibility for Determining Loss of Use
<p class="MsoBlockText">The responsibility for determining whether there is loss of use of an extremity
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      rests with the rating activity, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      cannot be delegated to the examining physician. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 36. General Information on SMC, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Information to Request From an Examiner
<p class="MsoBlockText">When requesting an examination to determine loss of use of an extremity, ask the examiner to furnish a
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      detailed objective description of remaining function

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      quantitative assessment of strength for each extremity involved, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      description of any pain that affects use.

<p class="MsoBlockText">

<p class="MsoBlockText">Do not request that the examiner

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      determine loss of use, or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      express an opinion as to whether there is, or is not, loss of use of an extremity or extremities.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   If loss of use cannot be determined upon review of an examination report, request an appropriate specialized examination.

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For more information on

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      considering functional loss due to pain in claims for SMC, see Tucker v. West, 11 Vet.App 369, 374 (1998), and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      requesting a specialist examination, see M21-1MR, Part III, Subpart iv, 3.A.8. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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d.   Determining the Extent of Examinations
<p class="MsoBlockText">Exercise considerable care when requesting examinations in connection with claims involving SMC under 38 U.S.C. 1114(1) through (n).
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<p class="MsoBlockText">

<p class="MsoBlockText">Example:   A prior examination clearly established loss of use of both lower extremities at a level preventing natural knee action. Do not request a complete medical examination if the only issue in question is the extent of involvement of one or both of the upper extremities. Instead, request an examination with a notation that the examination be restricted to the degree of functional impairment of the upper extremities. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 36. General Information on SMC, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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e.   Considering Amputation or Loss of Use of an Extremity
<p class="MsoBlockText">A determination as to loss of use of a hand or foot is not restricted to organic loss; it includes functional loss of use as well.
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<p class="MsoBlockText">

<p class="MsoBlockText">The relevant inquiry concerning entitlement to SMC is not whether amputation is warranted. Instead, question whether the effective function remaining is other than that which would be equally well served by an amputation with the use of a suitable prosthetic appliance.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on determining entitlement to SMC based on loss of use that is tantamount to amputation, see Tucker v. West,  11 Vet.App. 369, 374 (1998). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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f.   Showing Entitlement to SMC in Rating Decisions
<p class="MsoBlockText">Entitlement to SMC must be reflected in the Coded Conclusion section of the rating decision by
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      noting entitlement to SMC and statutory awards immediately following citation of the combined evaluation of all SC disabilities (if more than one exists)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      listing any anatomical loss as the first entitlement in order of preference over all losses of use, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      citing separately each additional specific disability if entitlement under 38 U.S.C. 1114(k) is shown for more than one anatomical loss, or loss of use.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on the appropriate codes and phrases to use in the rating decision, see M21-1, Part I, Appendix A. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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g.   Showing the Denial of SMC in Rating Decisions
<p class="MsoBlockText">The denial of SMC, whether specifically claimed by the Veteran or inferred by the rating activity, must be addressed in the Reasons for Decision section of the rating decision. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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h.   Mandatory Use of the SMC Calculator
<p class="MsoBlockText">Rating personnel must use the SMC Calculator on the Compensation Service Rating Job Aids web page to determine the appropriate SMC codes and SMC paragraphs to input into RBA2000. RVSRs are required to file the SMC Calculator worksheet in the claims folder.
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<p class="MsoBlockText">

<p class="MsoBlockText">References:   For more information on using

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the SMC Calculator, see the SMC User Guide, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      RBA2000, see the RBA2000 User Guide. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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37.   Combining Disabilities When Entitlement to SMC Is at Issue
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Introduction
<p class="MsoBlockText">This topic contains information on combining disabilities when entitlement to SMC is at issue, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      when multiple disabilities should not be rated as a single disability

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      rating a multisystemic disorder

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an example of a rating decision involving a multisystemic disorder, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      cases involving loss of anal and bladder sphincter control. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">December 13, 2005 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   When Multiple Disabilities Should Not Be Rated as a Single Disability
<p class="MsoBlockText">Do not rate multiple disabilities as a single disability if there is a possibility of entitlement to
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC under 38 U.S.C. 1114(s), or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an intermediate or next higher rate of SMC under

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     38 CFR 3.350(f)(3), or

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     38 CFR 3.350(f)(4). {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   Rating a Multisystemic Disorder
<p class="MsoBlockText">The assignment of a single evaluation of 100 percent for a multisystemic disorder, based on loss of use of two extremities, may overlook the disorder’s involvement in other body systems. This involvement might meet requirements for
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an intermediate rate under 38 CFR 3.350(f)(3), or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the next higher rate under 38 CFR 3.350(f)(4). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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c.   Example:   Rating Multisystemic Disorders
<p class="MsoBlockText">Situation:   A Veteran has lost the use of both lower extremities due to SC multiple sclerosis.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Assign

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a 100-percent evaluation for the loss of use of both lower extremities under hyphenated diagnostic code (DC) 8018-5110, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      separate evaluations under the appropriate DCs for the involvement of any other body system so that possible entitlement to a higher level of SMC will not be overlooked. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 37. Combining Disabilities When Entitlement to SMC Is at Issue, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''

<p class="MapTitleContinued"> 37. Combining Disabilities When Entitlement to SMC Is at Issue, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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SMC coding is shown in the table below.
<p class="MsoNormal"> <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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d.   Cases Involving Loss of Anal and Bladder Sphincter Control
<p class="MsoBlockText">Under certain circumstances, loss of use of both lower extremities, together with loss of anal and bladder sphincter control, satisfies the requirements of 38 CFR 3.350(e)(2) for entitlement to SMC under 38 U.S.C. 1114(o).
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<p class="MsoBlockText">

<p class="MsoBlockText">In such cases, separate ratings for loss of anal and bladder sphincter control are not required. Use SMC code 55 as shown in M21-1, Part I, Appendix A. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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38.   Hospital Adjustments Under 38 CFR 3.552
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Introduction
<p class="MsoBlockText">This topic contains information on hospital adjustments under 38 CFR 3.552, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      specifying the basis of entitlement under 38 CFR 3.552 in the rating decision

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the consequences of an improperly assigned SMC code, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      two examples of rating decisions with properly assigned SMC hospital codes. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">December 13, 2005 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Specifying Basis of Entitlement Under 38 CFR 3.552
<p class="MsoBlockText">The rating decision must specify the basis of the Veteran’s entitlement to a hospital adjustment in order to ensure the proper application of 38 CFR 3.552.
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<p class="MsoBlockText">

<p class="MsoBlockText">The SMC allowance for aid and attendance (A&A) must be discontinued during hospitalization at government expense, unless the need for A&A is due to

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      paraplegia involving

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     paralysis of both lower extremities, together with

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     loss of anal and bladder sphincter control, or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Hansen’s disease.

<p class="MsoBlockText">

<p class="MsoBlockText">Exception:   The SMC allowance for A&A must be discontinued during hospitalization, regardless of the disability involved, if entitlement is established under

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 U.S.C. 1114(r)(1), or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 U.S.C. 1114(r)(2).

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on entitlement to a higher A&A allowance under 38 U.S.C. 1114(r), see M21-1MR, Part IV, Subpart ii, 2.H.45. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   Consequences of an Improperly Assigned SMC Code
<p class="MsoBlockText">The assignment of an improper SMC hospital code may result in erroneous adjustment of the Veteran’s award upon hospitalization. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 38. Hospital Adjustments Under 38 CFR 3.552, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Example 1:   Rating Decision With a Properly Assigned SMC Hospital Code
<p class="MsoBlockText">Situation:   The Veteran has
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<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a 100-percent disabling heart condition so severe as to require the Aid and Attendance (A&A) of another person, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral, below-knee amputations.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Entitlement under 38 U.S.C. 1114(r)(1) is warranted based upon the need for A&A; entitlement under 38 U.S.C. 1114(l) is also warranted for the bilateral amputations.

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:   The proper

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC code is 51, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC hospital code is 07 for SMC under 38 U.S.C. 1114(m). <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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d.   Example 2:   Rating Decision With a Properly Assigned SMC Hospital Code
<p class="MsoBlockText">Situation:   The Veteran has a
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<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      100-percent disabling psychiatric condition that does not require A&A, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      100-percent disabling heart condition that does require A&A.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Entitlement under 38 U.S.C. 1114(m) is warranted based upon the need for A&A plus an additional 100-percent disability.

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:   The proper

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      basic SMC code is 19, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC hospital code is 48 for SMC under 38 U.S.C. 1114(s). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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39.   Entitlement to SMC Under 38 U.S.C. 1114(k)
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Introduction
<p class="MsoBlockText">This topic contains information on entitlement to SMC under 38 U.S.C. 1114(k), including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the eligibility criteria for SMC under 38 U.S.C. 1114(k)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the history of SMC for loss, or loss (L/LOU) of use, of creative organ, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      awarding SMC for L/LOU of a creative organ

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the basis for considering entitlement to SMC for L/LOU of a creative organ

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      awarding SMC for L/LOU of a hand or foot

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      other medical indications of loss of use of the foot, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      awarding SMC for

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     loss of use of both buttocks

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     deafness

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     aphonia

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     blindness, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     loss of breast tissue. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 29, 2006 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Eligibility Criteria for SMC Under 38 U.S.C. 1114(k)
<p class="MsoBlockText">SMC under 38 U.S.C. 1114(k) is payable for the following levels of impairment:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      loss, or loss of use (L/LOU), of a creative organ

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      L/LOU of a hand

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      L/LOU of a foot

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      loss of use of both buttocks

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      deafness of both ears

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      complete organic aphonia

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      blindness in one eye, having only light perception, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      loss of tissue from one or both breasts. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

<p class="MapTitleContinued"> 39. Entitlement to SMC Under 38 U.S.C. 1114(k), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   History of SMC for L/LOU of a Creative Organ
<p class="MsoBlockText">Public Law (PL) 82-427, which went into effect August 1, 1952, provided for the payment of SMC under 38 U.S.C. 1114(k) for L/LOU of a creative organ.
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<p class="MsoBlockText">

<p class="MsoBlockText">38 CFR 3.114(a), which provides instructions for assigning effective dates pursuant to liberalizing law or VA policy, became effective December 01, 1962. Accordingly, the proper effective date for granting entitlement to a Veteran who was otherwise eligible for SMC on August 1, 1952, based on L/LOU of a creative organ, is the earlier of the following two dates, but no earlier than December 01, 1962:

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      one year before the date VA received a claim, or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      one year before the date of an administrative determination of entitlement.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on the history of SMC under 38 U.S.C. 1114(k), see M21-1MR, Part IV, Subpart ii, 2.I. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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c.   Awarding SMC for L/LOU of a Creative Organ
<p class="MsoBlockText">Award SMC based on L/LOU of a creative organ, if medical evidence of records shows
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the acquired absence of one or both testicles, ovaries or other creative organs

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a condition of the reproductive tract which results in loss of use of a creative organ, such as retrograde ejaculation or spermatozoa dumping into the bladder in a male Veteran, or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the loss of erectile power secondary to a disease process, such as diabetes or multiple sclerosis, in a male Veteran.

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For more information on loss or loss of use of a creative organ, see

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 3.350(a)(1)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 4.115b, Note, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 4.116, Note 2. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 39. Entitlement to SMC Under 38 U.S.C. 1114(k), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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d.   Basis for Considering Entitlement to SMC for L/LOU of a Creative Organ
<p class="MsoBlockText">The issue of entitlement to SMC for L/LOU of a creative organ may be
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      based on a specific claim, or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      inferred from the evidence of record, such as a Department of Veterans Affairs (VA) examination or hospitalization report.

<p class="MsoBlockText">

<p class="MsoBlockText">Undertake any development necessary, including submission of a request for a special examination, if there is a reasonable probability of entitlement.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   There is no bar to the payment of compensation or establishment of SC for anatomical loss of a creative organ, when a nonservice-connected (NSC) loss of use of a creative organ existed prior to anatomical loss resulting from service. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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e.   Awarding SMC for Loss of Use of a Hand or Foot
<p class="MsoBlockText">Award SMC for loss of use of a hand or a foot when function is no better than if the hand or foot were amputated and replaced by prosthesis.
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<p class="MsoBlockText">

<p class="MsoBlockText">When considering loss of use, determine whether the following activities could be accomplished equally well by a prosthesis:

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      grasping or manipulation (for a hand), and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      balancing, propulsion, or ambulation (for a foot).

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For more information on L/LOU of a hand or foot, see

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 3.350(a)(2), and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 4.63. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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f.   Other Medical Indications of Loss of Use of the Foot
<p class="MsoBlockText">Other medical indications of loss of use of the foot include
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      extremely unfavorable complete ankylosis of the knee

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      complete ankylosis of two major joints of a lower extremity

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      shortening of the lower extremity three and one-half inches or more, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      complete paralysis of the external popliteal (common peroneal) nerve and consequent foot drop, accompanied by characteristic organic changes. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 39. Entitlement to SMC Under 38 U.S.C. 1114(k), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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g.   Awarding SMC for Loss of Use of Both Buttocks
<p class="MsoBlockText">Award SMC for loss of use of both buttocks when there is severe damage by disease or injury to muscle group XVII, bilaterally, which renders the Veteran unable, without assistance, to
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      rise from a seated or stooped position, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      maintain postural stability.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   The assistance referred to above includes the person’s own hands or arms and, for postural stability, a special appliance.

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For more information on loss of use of the buttocks, see

<p class="MsoBlockText">38 CFR 3.350(a)(3). {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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h.   Awarding SMC for Deafness
<p class="MsoBlockText">Award SMC for deafness of both ears, having absence of air and bone conduction, if the SC, bilateral hearing loss warrants a 100-percent evaluation under the rating schedule for hearing impairment.
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<p class="MsoBlockText">

<p class="MsoBlockText">A Veteran with bilateral, SC hearing impairment, numerically designated as XI, is entitled to SMC, regardless of whether or not measurable hearing impairment was noted on entrance into service and service connection was granted based on aggravation of a pre-existing disability.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      A numeric designation of hearing impairment of

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     XI in both ears entitles the Veteran to SMC, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     less than XI in either ear precludes entitlement to SMC.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Base disability ratings only on an examination conducted in a VA-authorized audiology clinic using current testing criteria.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Hearing loss justifying an award of SMC must be permanent in nature. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 39. Entitlement to SMC Under 38 U.S.C. 1114(k), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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i.   Awarding SMC for Aphonia
<p class="MsoBlockText">Award SMC for complete organic aphonia if a disability of the organs of speech exists that constantly precludes communication by speech and
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran is unable to communicate by voice or whisper through the normal organs of speech, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the disability is constant and of organic origin.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Complete organic aphonia most frequently results from loss or paralysis of an organ of speech such as the tongue or larynx.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The use of other organs of the body or prosthetic devices to provide voice sounds does not preclude entitlement to SMC.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The assignment of total schedular ratings under DCs 6518, 6519, 6520, and 7202 generally entitles the Veteran to SMC. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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j.   Awarding SMC for Blindness
<p class="MsoBlockText">Award SMC for loss of use or blindness of one eye, having light perception only (LPO), when the Veteran is unable to
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      recognize test letters at one foot, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      recognize objects, hand movements, or count fingers at a distance of three feet.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   SMC is also payable for the anatomical loss of an eye. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 39. Entitlement to SMC Under 38 U.S.C. 1114(k), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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k.   Awarding SMC for Loss of Breast Tissue
<p class="MsoBlockText">Entitlement to SMC for loss of tissue from one or both breasts is limited to women Veterans.
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<p class="MsoBlockText">

<p class="MsoBlockText">PL 107-330, enacted December 6, 2002, provides for the payment of SMC

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      for loss of 25 percent or more of the tissue from a single breast or both breasts in combination (including loss by mastectomy or partial mastectomy), or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      when breast tissue has been subjected to radiation treatment.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Before enactment of PL 107-330, entitlement to SMC existed only upon complete surgical removal of breast tissue (or the equivalent loss of breast tissue due to injury), in which includes radical mastectomy, modified radical mastectomy and simple (or total) mastectomy.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on entitlement to SMC for loss of breast tissue, see 38 CFR 4.116. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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40.   SMC for Blindness With Other Disabilities Affecting Hearing and the Extremities
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Introduction
<p class="MsoBlockText">This topic contains information on SMC for blindness and other disabilities affecting hearing and the extremities, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the general criteria for entitlement to SMC for blindness with hearing loss or L/LOU of an extremity

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral deafness rated at 60-percent or more and bilateral visual acuity of 20/200 or less

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      total SC deafness in one ear and bilateral blindness

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      examples of rating decisions involving SMC for bilateral blindness and   total SC deafness in one ear

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC for bilateral blindness with bilateral hearing loss considered 10- or 20-percent disabling

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      examples of rating decisions involving SMC for bilateral blindness with bilateral hearing loss considered 10- or 20-percent disabling

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC for bilateral blindness with bilateral hearing loss considered 30-percent disabling

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an example of a rating decision involving SMC for bilateral blindness with bilateral hearing loss considered 30-percent disabling

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC for bilateral blindness with bilateral hearing loss considered 40-percent disabling

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      examples of rating decisions involving SMC for bilateral blindness with bilateral hearing loss considered 40-percent disabling

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC for bilateral blindness with bilateral hearing loss considered 60-percent disabling

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an example of a rating decision involving SMC for bilateral blindness with bilateral hearing loss considered 60-percent disabling

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC for bilateral blindness with L/LOU of any extremity considered at least 50 percent disabling

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an example of a rating decision involving SMC for bilateral blindness with L/LOU of any extremity considered at least 50 percent disabling.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC for bilateral blindness with L/LOU of a lower extremity considered less than 50 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an example of a rating decision involving SMC for bilateral blindness with L/LOU of a lower extremity considered less than 50 percent disabling. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 8, 2009 <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 40. SMC for Blindness With Other Disabilities Affecting Hearing and the Extremities, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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a.   General Criteria for Entitlement to SMC for Blindness With Hearing Loss or L/LOU of an Extremity
<p class="MsoBlockText">Additional SMC is payable to Veterans with bilateral blindness who are already entitled to SMC under 38 U.S.C. 1114(1) through (n) who also have varying degrees of SC hearing loss or SC L/LOU of an extremity. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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b.    Bilateral Deafness Rated at 60-Percent or More and Bilateral Visual Acuity of 20/200 or Less
<p class="MsoBlockText">A Veteran is entitled to SMC under 38 U.S.C.1114(o) if the Veteran has a combination of
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral deafness rated at 60 percent or more (and the hearing loss in either ear is SC), and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC blindness with bilateral visual acuity of 20/200 (6/60) or less.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Before the enactment of PL 110-157 on December 26, 2007, SC blindness with bilateral visual acuity of 5/200 (1.5/60) or less was required for entitlement to SMC under 38 U.S.C.1114(o). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
 * }

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c.   Total SC Deafness in One Ear and Bilateral Blindness
<p class="MsoBlockText">A Veteran with total SC deafness in one ear, such as that numerically designated as “XI,” and SC blindness with
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      LPO or less, bilaterally, is entitled to SMC under 38 U.S.C.1114(o) and 38 CFR 3.350(e)(1)(iv), or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60) or less bilaterally, is entitled to an additional half-step in the level of SMC, under the provisions of 38 CFR 3.350(f)(2)(iv). <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

<p class="MapTitleContinued"> 40. SMC for Blindness With Other Disabilities Affecting Hearing and the Extremities, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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d.   Example 1:   Rating for Total SC Deafness in One Ear and SC Blindness
<p class="MsoBlockText">Situation :   The Veteran has
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<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral SC blindness with LPO, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      total SC hearing loss in the left ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Since the Veteran has LPO bilaterally, and total SC loss of hearing in the left ear, entitlement to SMC is warranted under

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 U.S.C. 1114(o)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 3.350(e)(1)(iv), and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 U.S.C. 1114 (r)(1).

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is OB-2.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 55-37-22-00-0. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
 * }

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e.   Example 2:   Rating Total SC Deafness in One Ear and SC Blindness
<p class="MsoBlockText">Situation:   The Veteran has
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral SC blindness with

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     no light perception in the left eye, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     visual acuity of 5/200 (1.5/60) in the right eye, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      total SC hearing loss in the left ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   The Veteran is entitled to SMC under 38 U.S.C. 1114(m) for the degree of bilateral blindness alone, but an additional one-half step in the level of SMC (“m½”) is warranted, based on the degree of hearing loss, under the provisions of 38 CFR 3.350(f)(2)(iv).

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is PB-1.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 20-20-22-00-0. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
 * }

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f.   Bilateral Blindness with Bilateral Hearing Loss Considered   10- or 20-Percent Disabling
<p class="MsoBlockText">A Veteran is entitled to an additional one-half step in the level of SMC under 38 CFR 3.350(f)(2)(v) if he/she has
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC bilateral blindness with LPO or less

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing loss, considered 10-or 20-percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in at least one ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   If visual acuity in either of the eyes is better than LPO, entitlement to the additional one-half step does not exist. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

<p class="MapTitleContinued"> 40. SMC for Blindness With Other Disabilities Affecting Hearing and the Extremities, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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g.   Example 1:   Rating Bilateral Blindness with Bilateral Hearing Loss Considered 10- or 20-Percent Disabling
<p class="MsoBlockText">Situation:   The Veteran has
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      anatomical loss of the left eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      LPO in the right eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing loss, considered 20-percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in the right ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   The appropriate level of SMC for the degree of blindness alone is “m½.”   However, an additional one-half step is warranted based on the degree of hearing loss, making the Veteran entitled to SMC under 38 U.S.C. 1114(n).

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is PB-2.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 21-21-11-11-0. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
 * }

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h.   Example 2: Rating Blindness With Bilateral Hearing Loss Considered 10- or 20-Percent Disabling
<p class="MsoBlockText">Situation:   The Veteran has
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      anatomical loss of the left eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60) in the right eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing loss, considered 20-percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in the right ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Since visual acuity in the right eye is better than LPO, do not apply 38 CFR 3.350(f)(2)(v). The Veteran is entitled to SMC under 38 U.S.C. 1114(m).

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is MB-2.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 19-19-11-11-0. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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i.   Bilateral Blindness With Hearing Loss Considered 30-Percent Disabling
<p class="MsoBlockText">A Veteran is entitled to an additional full step in the level of SMC, not to exceed that provided by 38 U.S.C. 1114(o) and 38 CFR 3.350(f)(2)(vi), if he/she has
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60) or less, bilaterally

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing loss, considered 30 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in one ear. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

<p class="MapTitleContinued"> 40. SMC for Blindness With Other Disabilities Affecting Hearing and the Extremities, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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j.   Example:   Rating Bilateral Blindness With Hearing Loss Considered 30-Percent Disabling
<p class="MsoBlockText">Situation:   The Veteran has
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      anatomical loss of the left eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60) in the right eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing loss, considered 30 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in the right ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   The Veteran is entitled to SMC under the provisions of 38 U.S.C. 1114(m) for the degree of blindness alone. However, an additional full step is warranted under the provisions of 38 CFR 3.350(f)(2)(vi), thereby entitling the Veteran to SMC under 38 U.S.C. 1114(n).

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is PB-3.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 21-21-11-11-0. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
 * }

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k.   Bilateral Blindness With Hearling Loss Considered 40-Percent Disabling
<p class="MsoBlockText">A Veteran is entitled to SMC under 38 U.S.C. 1114(o) and 38 CFR 3.350(e)(1)(iv) if he/she has
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      blindness with LPO or less in both eyes

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing, considered 40 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in one ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   If bilateral blindness is present, but visual acuity in either eye is better than LPO, the Veteran is entitled to an additional full step only in the level of SMC, not to exceed that provided by 38 U.S.C. 1114(o), per 38 CFR 3.350(f)(2)(vi). <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

<p class="MapTitleContinued"> 40. SMC for Blindness With Other Disabilities Affecting Hearing and the Extremities, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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l.   Example 1:   Rating Bilateral Blindness with Bilateral Hearing Loss Considered 40-Percent Disabling
<p class="MsoBlockText">Situation:   The Veteran has
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<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      no light perception in the right eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      LPO in the left eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing loss, considered 40 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in the right ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   The appropriate level of SMC for the degree of bilateral blindness alone is “m ½.”   However, apply 38 CFR 3.350(e)(1)(iv) because of the coexisting hearing loss. The Veteran is accordingly entitled to SMC under 38 U.S.C. 1114(o) and 38 U.S.C. 1114(r)(1).

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is OB-2.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 55-37-22-00-0. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
 * }

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m.   Example 2:   Rating Bilateral Blindness with Bilateral Hearing Loss Considered 40-Percent Disabling
<p class="MsoBlockText">Situation:   The Veteran has
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<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      no light perception in the right eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60) in the left eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing loss, considered 40 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in one ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   The Veteran is entitled to SMC under 38 U.S.C. 1114(m) for the degree of bilateral blindness alone. However, because of the degree of hearing loss present, increase the level of SMC by a full step under the provisions of 38 CFR 3.350(f)(2)(vi) and award SMC under 38 U.S.C. 1114(n).

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is PB-3.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 21-21-22-00-0. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

<p class="MapTitleContinued"> 40. SMC for Blindness With Other Disabilities Affecting Hearing and the Extremities, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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n.   Bilateral Blindness With Hearing Loss Considered 60-Percent Disabling
<p class="MsoBlockText">A Veteran is entitled to SMC under 38 U.S.C. 1114(o) and 38 CFR 3.350(e)(1)(iii) if he/she has
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60), bilaterally, or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60) in one eye and LPO or less in the other eye LPO, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing loss, considered 60 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in one ear. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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o.   Example:   Rating Bilateral Blindness With Bilateral Hearing Loss Considered 60-Percent Disabling
<p class="MsoBlockText">Situation:   The Veteran has
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<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      LPO in the right eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60) in the left eye

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bilateral hearing loss, considered 60 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC hearing loss in one ear.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Due to the coexisting blindness and hearing loss, the Veteran is entitled to SMC under 38 U.S.C. 1114(o) and [http://straylight.law.cornell.edu/uscode/html/uscode38/usc_sec_38_00001114000-.html 38 U.S.C. 1114(r)(1). ]

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is OB-1.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 55-37-22-00-0. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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p.   Bilateral Blindness With L/LOU of Any Extremity Considered at Least 50 Percent Disabling
<p class="MsoBlockText">The provisions of 38 CFR 3.350(f)(2)(vii)(A) and
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<p class="MsoBlockText">38 CFR 3.350(f)(2)(vii)(B) allow for an additional full step of SMC, not to exceed entitlement under 38 U.S.C. 1114(o), if the Veteran has

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60) or less, bilaterally, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC L/LOU of an upper or lower extremity, which by itself or in combination with another compensable disability is considered at least 50 percent disabling.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Payment of this additional full step of SMC is in addition to the SMC payable under 38 CFR 3.350(a). <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

<p class="MapTitleContinued"> 40. SMC for Blindness With Other Disabilities Affecting Hearing and the Extremities, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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q.   Example:   Rating Bilateral Blindness With L/LOU of an Extremity Considered at Least 50 Percent Disabling
<p class="MsoBlockText">Situation:   The Veteran has
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<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SC bilateral blindness with visual acuity of 5/200 (1.5/60), and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      loss of use of the right hand.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   The Veteran is entitled to SMCunder 38 U.S.C. 1114(1) for the degree of blindness alone. The Veteran is also entitled to an additional full step of SMC, plus SMC under 38 CFR 3.350(a), for loss of use of the right hand. Accordingly, the appropriate level of SMC is “m+k.”

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is PB-4.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 25-25-35-00-0. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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r.   Bilateral Blindness With L/LOU of a Lower Extremity Considered Less Than 50 Percent Disabling
<p class="MsoBlockText">A Veteran is entitled to an additional one-half step of SMC under 38 CFR 3.350(f)(2)(vii)(C) if he/she has
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60) or less, bilaterally

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      L/LOU of a foot, considered less than 50 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      no other compensable SC disability.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   The level of SMC may not exceed that provided by 38 U.S.C. 1114(o). <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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s.   Example:   Rating Bilateral Blindness With L/LOU of a Lower Extremity Considered Less Than 50 Percent Disabling
<p class="MsoBlockText">Situation:   The Veteran has
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<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      visual acuity of 5/200 (1.5/60), bilaterally,

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a below-the-knee amputation of the right foot considered 40 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      no other compensable disabilities.

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   The Veteran is entitled to SMC under 38 U.S.C. 1114(l) based on the degree of blindness alone. The Veteran is also entitled to SMC under 38 U.S.C. 1114(k) for loss of the right foot. The appropriate level of SMC, therefore, is “l+k.”   Award an additional one-half step of SMC (l½ +k) under the provisions of 38 CFR 3.350(f)(2)(vii)(C).

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC paragraph code is PB-6.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The appropriate SMC coding is 18-18-21-13-0. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

41.   SMC for Additional 50- and 100-Percent Evaluations Under 38 CFR 3.350(f)(3) and 38 CFR 3.350(f)(4)
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Introduction
<p class="MsoBlockText">This topic contains information on SMC for additional 50- and 100-percent evaluations under 38 CFR 3.350(f)(3) and 38 CFR 3.350(f)(4), including information on
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the proper application of 38 CFR 3.350(f)(3) and 38 CFR 3.350(f)(4)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC under 38 CFR 3.350(f)(3)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC under 38 CFR 3.350(f)(4), and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      examples of rating decisions addressing the issue of entitlement to SMC under 38 CFR 3.350(f)(3) and 38 CFR 3.350(f)(4). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">December 16, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Proper Application of 38 CFR 3.350(f)(3) and 38 CFR 3.350(f)(4)
<p class="MsoBlockText">Apply the provisions of 38 CFR 3.350(f)(3) or 38 CFR 3.350(f)(4), whichever is appropriate, only once in a rating decision.
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<p class="MsoBlockText">

<p class="MsoBlockText">Important:   Concurrent entitlement to SMC under both 38 CFR 3.350(f)(3) and 38 CFR 3.350(f)(4) is prohibited. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   SMC Under 38 CFR 3.350(f)(3)
<p class="MsoBlockText">A Veteran entitled to SMC under 38 U.S.C. 1114(l) through (n) is entitled to the next higher intermediate rate of SMC under the provisions of 38 CFR 3.350(f)(3) if he/she has an additional single disability, or a combination of disabilities, that is independently ratable as 50 percent or more disabling. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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c.   SMC Under 38 CFR 3.350(f)(4)
<p class="MsoBlockText">A Veteran who is entitled to SMC under 38 U.S.C. 1114(l) through (n) is entitled to the next higher statutory rate if he/she has an additional single permanent disability that is independently ratable as 100 percent disabling, apart from any consideration of individual unemployability.
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<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Per Bradley v. Peake, 22 Vet.App. 280 (2008), do not define “single disability” in accordance with 38 CFR 4.16, as this regulation applies only to total evaluations based on unemployability. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

<p class="MapTitleContinued"> 41. SMC for Additional 50- and 100-Percent Evaluations Under 38 CFR 3.350(f)(3) and 38 CFR 3.350(f)(4), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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d.   Example 1:   Rating Decision Involving SMC   Under 38 CFR 3.350(f)(3)
<p class="MsoBlockText">Situation:   The Veteran has SC disabilities as shown below and qualifies for
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<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC under 38 U.S.C. 1114(m) on account of the anatomical loss of both hands, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      two disabilities (blindness of one eye, having light perception only, and loss of a creative organ) that each qualify for SMC under 38 U.S.C. 1114(k).

<p class="MsoBlockText">

<p class="MsoBlockText">Result:   As provided in 38 CFR 3.350(f)(3), in addition to and independent of the disability for which SMC is payable under 38 U.S.C. 1114(m), the following permanent disabilities exist that are independently ratable as 50 percent disabling:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      blindness of the right eye, having light perception only, considered 30 percent disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      loss of both testes, considered 30 percent disabling.

<p class="MsoBlockText">

<p class="MsoBlockText">Accordingly, the requirements of 38 CFR 3.350(f)(3) are met for the rate intermediate between 38 U.S.C. 1114(m) and 38 U.S.C. 1114(n), plus rates under 38 U.S.C. 1114(k).

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="MsoBlockText">5106   AMPUTATION, BOTH HANDS AT WRIST

<p class="MsoBlockText">100 percent from 02/01/2010.

<p class="MsoBlockText">

<p class="MsoBlockText">6064   BLINDNESS, RIGHT EYE, LIGHT PERCEPTION ONLY; LEFT 20/20

<p class="MsoBlockText">30 percent from 02/01/2010.

<p class="MsoBlockText">

<p class="MsoBlockText" style="margin-left:24.0pt;text-indent:-24.0pt;  mso-list:l9 level1 lfo4;tab-stops:list 24.0pt"> 7524   REMOVAL OF BOTH TESTES

<p class="MsoBlockText">30 percent from 02/01/2010.

<p class="MsoBlockText">

<p class="MsoBlockText">COMBINED EVALUATION FOR COMPENSATION:

<p class="MsoBlockText">100 percent from 02/01/2010.

<p class="MsoBlockText">

<p class="MsoBlockText">K-1   Entitled to SMC under 38 U.S.C. 1114(k) and 38 CFR 3.350(a) on account of blindness of one eye, having light perception only, from 02/01/2010.

<p class="MsoBlockText">

<p class="MsoBlockText">K-1   Entitled to SMC under 38 U.S.C. 1114(k) and 38 CFR 3.350(a) on account of anatomical loss of a creative organ from 02/01/2010.

<p class="MsoBlockText">

<p class="MsoBlockText">M-1   Entitled to SMC under 38 U.S.C. 1114(m) and 38 CFR 3.350(c) on account of anatomical loss of both hands from 02/01/2010. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 41. SMC for Additional 50- and 100-Percent Evaluations Under 38 CFR 3.350(f)(3) and 38 CFR 3.350(f)(4), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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e.   Example 2:   Rating Decision Involving SMC Under 38 CFR 3.350(f)(4)
<p class="MsoBlockText">Situation:   The Veteran has anatomical loss of both lower extremities that meets the requirements for SMC under 38 U.S.C. 1114(m) and a 100 percent SC evaluation for posttraumatic stress disorder that is completely independent of the anatomical loss of both lower extremities.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   As provided in 38 CFR 3.350(f)(4), the Veteran is entitled to the next higher rate of SMC, 38 U.S.C. 1114(n), because of the additional, single, permanent disability that is independently ratable as 100 percent disabling.

<p class="MsoBlockText">

<p class="MsoBlockText">Coded Conclusion:

<p class="MsoBlockText">SUBJECT TO COMPENSATION (1. SC)

<p class="MsoBlockText">

<p class="MsoBlockText">5107   ANATOMICAL LOSS OF BOTH LOWER EXTREMITIES ABOVE THE KNEES

<p class="MsoBlockText">100 percent from 12/01/2010.

<p class="MsoBlockText">

<p class="MsoBlockText">9411   POSTTRAUMATIC STRESS DISORDER

<p class="MsoBlockText">100 percent from 12/01/2010. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 41. SMC for Additional 50- and 100-Percent Evaluations Under 38 CFR 3.350(f)(3) and 38 CFR 3.350(f)(4), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''

42.   Additional SMC for L/LOU of Three Extremities Under 38 CFR 3.350(f)(5)
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Introduction
<p class="MsoBlockText">This topic contains information on additional SMC for loss or loss of use of three extremities under 38 CFR 3.350(f)(5), including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      determining the correct rate of payment under this provision, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an example of a rating decision involving additional SMC for the loss or loss of use of three extremities. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 29, 2006 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Considering L/LOU of Three Extremities
<p class="MsoBlockText">A Veteran with L/LOU of three extremities is entitled to additional SMC under 38 CFR 3.350(f)(5).
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<p class="MsoBlockText">

<p class="MsoBlockText">To determine the correct rate of SMC payable to a Veteran with the requisite degree of disability,

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      decide the rate of SMC payable without regard to 38 CFR 3.350(f)(5), and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      increase this rate to the next higher rate authorized under 38 U.S.C. 1114(1) through (n), without loss of any entitlement under 38 U.S.C. 1114(k).

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The term “next higher rate” is intended to include the intermediate rates authorized under 38 U.S.C. 1114(p).

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The total monthly amount payable (minus any additional amount for dependents) must not exceed the rate payable under 38 U.S.C. 1114(p). {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   Example:   Rating Decision Involving Additional SMC for L/LOU of Three Extremities
<p class="MsoBlockText">Situation:   The Veteran has the SC disabilities shown below and qualifies for SMC at the rate under 38 U.S.C. 1114(m) on account of the anatomical loss of both hands. Entitlement to SMC under 38 U.S.C. 1114(k) for an amputation of the left foot also exists. In addition, the Veteran is entitled to an additional one-half step in the level of SMC, under 38 CFR 3.350(f)(3), due to the separate disabilities ratable as 50 percent or more disabling.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   The rate of SMC payable without regard to 38 CFR 3.350(f)(5) is “m½ +k.”   Elevate this rate to the next higher rate authorized under 38 U.S.C. 1114(l) through (n), without loss of entitlement under 38 U.S.C. 1114(k). Accordingly, the rate of SMC payable in this case is “n+k.” <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 42. Additional SMC for L/LOU of Three Extremities Under 38 CFR 3.350(f)(5), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''

<p class="MapTitleContinued"> 42. Additional SMC for L/LOU of Three Extremities Under 38 CFR 3.350(f)(5), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<p class="MsoNormal"> <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''

43.   Entitlement to Specially Adapted Housing Under 38 U.S.C. 2101 Based on the L/LOU of Both Lower Extremities
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Introduction
<p class="MsoBlockText">This topic contains information about entitlement to specially adapted housing (SAH) under 38 U.S.C. 2101 based on the L/LOU of both lower extremities, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      entitlement to SAH based on the L/LOU of both lower extremities

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      SMC for loss of use of a lower extremity, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      circumstances under which SAH may be awarded without entitlement to SMC for loss of use of both lower extremities. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">December 16, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Entitlement to SAH Based on L/LOU of Both Lower Extremities
<p class="MsoBlockText">If the Veteran is entitled to SMC under 38 U.S.C. 1114 based on the L/LOU of both lower extremities, the Veteran also meets the requirements for SAH under 38 U.S.C. 2101.
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<p class="MsoBlockText">

<p class="MsoBlockText"> {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.    SMC for Loss of Use of a Lower Extremity
<p class="MsoBlockText">In order to establish entitlement to SMC under 38 U.S.C. 1114 based on the loss of use of both lower extremities, loss of use of each lower extremity, as defined in 38 CFR 3.350(a)(2), must be demonstrated. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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c.   Circumstances Under Which SAH May Be Awarded Without SMC
<p class="MsoBlockText">In some cases, a Veteran’s inability to walk is due solely to loss of use of
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      only one lower extremity, not improvable by prosthesis, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a paired upper extremity, which precludes locomotion without prosthetic assistance.

<p class="MsoBlockText">

<p class="MsoBlockText">In such cases,

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      do not award SMC for loss of use of an apparently normal lower extremity, but

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      grant entitlement to SAH under 38 U.S.C. 2101 and 38 CFR 3.809(b)(3). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
 * }

44.   Entitlement to SMC Based on the Need for Aid and Attendance (A&A)
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Introduction
<p class="MsoBlockText">This topic contains information on entitlement to SMC based on a demonstrated need for the aid and attendance (A&A) of another person, including information on
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the criteria for entitlement to A&A under 38 CFR 3.352(a)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      considering

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     the level of disability required for entitlement to A&A

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     entitlement to A&A when the evaluation is less than 100 percent

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     entitlement to A&A as an inferred issue

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     entitlement to A&A, with L/LOU of two extremities, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8;tab-stops:list .25in 27.35pt"> -     entitlement to A&A under 38 U.S.C. 1114(o)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      denying entitlement to A&A

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      coding the rating decision to reflect entitlement to A&A

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      entitlement to A&A under the provisions of PL 96-128, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      drafting and coding the rating decision granting entitlement to A&A under PL 96-128. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">December 16, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Criteria for Entitlement to A&A Under 38 CFR 3.352(a)
<p class="MsoBlockText">The criteria for entitlement to A&A, which appear in 38 CFR 3.352(a), require that the Veteran be so helpless that he/she requires the aid of another person to perform the personal functions required in everyday living. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   Considering the Level of Disability Required for Entitlement to A&A
<p class="MsoBlockText">A greater level of disability is required for entitlement to the additional allowance for A&A than for
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      entitlement to SMC at the Housebound rate, or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a 100-percent schedular evaluation.

<p class="MsoBlockText">

<p class="MsoBlockText">A single disability rated as 100-percent disabling under a schedular evaluation is generally a prerequisite for entitlement to A&A. Any lesser disability would be incompatible with the requirements of 38 CFR 3.352(a).

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Per Bradley v. Peake, 22 Vet.App. 280 (2008), do not define “single disability” in accordance with 38 CFR 4.16, as this regulation applies only to total evaluations based on unemployability. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 44. Entitlement to SMC Based on the Need for Aid and Attendance (A&A), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Considering Entitlement to A&A When the Evaluation is Less Than 100 Percent
<p class="MsoBlockText">The table below shows the procedures to follow when
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      entitlement to A&A is at issue, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a Veteran’s evaluation is less than 100 percent.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:   The evidence in the case must include the report from a current examination or its equivalent. <p class="MsoNormal"> <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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d.   Considering Inferred Issues
<p class="MsoBlockText">If a single disability is rated 100-percent disabling, consider entitlement to A&A.
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<p class="MsoBlockText">

<p class="MsoBlockText">If entitlement to A&A does not exist, consider entitlement to SMC at the Housebound rate.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:   If the evidence does not show entitlement or probable entitlement to SMC at the A&A or the Housebound rate, do not raise either issue merely to deny it. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 44. Entitlement to SMC Based on the Need for Aid and Attendance (A&A), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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e.   Coding the Rating Decision to Reflect Entitlement to SMC
<p class="MsoBlockText">Show entitlement to SMC, based on the need for A&A or evidence showing the Veteran is housebound, by
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      using the appropriate narrative rating code on the code sheet, immediately following statement of the combined degree of disability, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      entering the necessary SMC codes in the data table.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on proper SMC coding to ensure the Veteran’s rate is correctly adjusted during hospitalization, see M21-1MR, Part III, Subpart v, 6.B. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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f.    Entitlement to A&A, With L/LOU of Two Extremities
<p class="MsoBlockText">Do not designate 38 U.S.C. 1114 (l) as the statute under which entitlement to SMC based on the need for A&A is established if the Veteran also has L/LOU of two extremities.
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<p class="MsoBlockText">

<p class="MsoBlockText">Rationale:   The rate payable for A&A under 38 U.S.C. 1114 (l) is subject to reduction if the Veteran is hospitalized, while the rate payable under 38 U.S.C. 1114 (l) for L/LOU of two extremities is not. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 44. Entitlement to SMC Based on the Need for Aid and Attendance (A&A), Continued {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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g.   Considering Entitlement to A&A Under 38 U.S.C. 1114(o)
<p class="MsoBlockText">Make determinations of entitlement to SMC under 38 U.S.C. 1114(1) on the basis of need of regular A&A in light of the criteria contained in 38 CFR 3.352(a). Fully explain the reasoning in the Reasons for Decision section of the rating decision.
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<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The need to explain the reasoning is especially important in situations in which, under 38 CFR 3.350(c), the rate under 38 U.S.C. 1114(1) based on the need for A&A is to be used as one of the conditions that entitles the claimant to two or more of the rates (no condition being considered twice) that are provided in 38 U.S.C. 1114(1) through (n) for the purpose of establishing entitlement under 38 U.S.C. 1114(o).

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Base the determination of need for A&A on separate and distinct disabilities if the rate under 38 U.S.C. 1114(1) on account of need for A&A is used to establish entitlement under 38 U.S.C. 1114(o).

<p class="MsoBlockText">

<p class="MsoBlockText">Example:   If a Veteran has loss of use of both feet and is also being considered for the maximum rate under 38 U.S.C. 1114(o) because of his/her need for A&A, the need for A&A must be due to SC disabilities, completely independent of the loss of use of both feet. In other words, when determining whether the Veteran needs A&A, disregard the disabling effects of the loss of both feet. Show the need for A&A as due to a separate SC disability rated 100 percent disabling. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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h.   Denying Entitlement to A&A
<p class="MsoBlockText">If there is no need for A&A, dispose of the issue by explaining how this conclusion was reached in the Reasons for Decision section of the rating decision. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 44. Entitlement to SMC Based on the Need for Aid and Attendance (A&A), Continued {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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i.   Provisions of PL 96-128
<p class="MsoBlockText">PL 96-128 amended 38 U.S.C. 1114(r) concerning the awarding of A&A in cases where the SMC level is “n½ +k,” so that the SC disabilities used to establish entitlement to SMC at this level may also be used to establish entitlement to A&A if factual need is shown.
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<p class="MsoBlockText">

<p class="MsoBlockText">Under PL 96-128, entitlement to SMC under

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 U.S.C. 1114(r)(1) exists if the basic criteria contained in 38 CFR 3.352(a) is met, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 U.S.C. 1114(r)(2) exists if the basic criteria contained in 38 CFR 3.352(b) is met.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Prior to enactment of PL 96-12, a Veteran had to be entitled to SMC under 38 U.S.C. 1114(o) in order to establish entitlement to SMC under 38 U.S.C. 1114(r)(1) and 38 U.S.C. 1114(r)(2). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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j.   Drafting and Coding the Rating Decision Granting Entitlement to A&A Under PL 96-128
<p class="MsoBlockText">If entitlement to A&A is established under the provisions of PL 96-128, then
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      cite relevant evidence and information in the Reasons for Decision to fully justify awarding or denying A&A, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      use SMC code 43 or 44 in higher level care claims.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Pay the rate allowed for SMC at the “n½ +k” level, plus the additional amount allowed under 38 U.S.C. 1114(r)(1) or 38 U.S.C. 1114(r)(2), whichever is appropriate.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on entitlement to a higher A&A allowance under 38 U.S.C. 1114(r), see M21-1MR, Part IV, Subpart ii, 2.H.45. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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45.   Entitlement to a Higher A&A Allowance Under 38 U.S.C. 1114(r)(2)
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Introduction
<p class="MsoBlockText">This topic contains information the statutory provisions for a higher A&A allowance, including information on
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      considering entitlement to a higher A&A allowance under 38 U.S.C. 1114(r)(2)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      when to award a higher A&A allowance under 38 U.S.C. 1114(r)(2)

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the requirement for a statement from a treating or supervising licensed health care professional

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      handling claims for entitlement to a higher A&A allowance under 38 U.S.C. 1114(r)(2), and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      possible hospitalization adjustment under 38 CFR 3.552(b)(2). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">March 20, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Considering Entitlement to a Higher A&A Allowance Under 38 U.S.C. 1114(r)(2)
<p class="MsoBlockText">A Veteran entitled to the A&A allowance under 38 U.S.C. 1114(r) is entitled to receive, in lieu of that allowance, a higher A&A allowance if the Veteran is found to be in need of, and receiving, a higher level of care. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   When to Award a Higher A&A Allowance Under 38 U.S.C. 1114(r)(2)
<p class="MsoBlockText">Award the higher A&A allowance under 38 U.S.C. 1114(r)(2) only when the
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      need is clearly established, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      amount of skilled service required by the Veteran is substantial.

<p class="MsoBlockText">

<p class="MsoBlockText">Base eligibility to the higher allowance on medical certification that the Veteran meets the criteria set forth in 38 CFR 3.352(b).

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   This allowance is payable even if VA or another entity is furnishing such skilled service at no expense to the Veteran. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 45. Entitlement to a Higher A&A Allowance Under 38 U.S.C. 1114(r)(2), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Required Statement From a Treating or Supervising Licensed Health Care Professional
<p class="MsoBlockText">A statement from a licensed health care professional, who provides or supervises daily skilled health care on a continuing basis in the Veteran’s home, is a prerequisite to establishing entitlement to a higher A&A allowance.
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<p class="MsoBlockText">

<p class="MsoBlockText">The statement must indicate the

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      conditions justifying the need for this level of care

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      nature, extent, and frequency of the services provided, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      nature and extent of the supervision being provided, if the services are actually provided by a nonprofessional. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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d.   Processing Claims for Entitlement to a Higher Level of A&A Under 38 U.S.C. 1114(r)(2)
<p class="MsoBlockText">Follow the steps below to process claims for entitlement to a higher A&A allowance under 38 U.S.C. 1114(r)(2). <p class="MsoNormal"> <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 45. Entitlement to a Higher A&A Allowance Under 38 U.S.C. 1114(r)(2), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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e.   Possible Hospitalization Adjustment Under 38 CFR 3.552(b)(2)
<p class="MsoBlockText">The A&A allowance, including that payable under 38 U.S.C. 1114(r)(2), is subject to reduction under 38 CFR 3.552(b)(2). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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46.   Entitlement to Housebound Benefits
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Introduction
<p class="MsoBlockText">This topic contains information about entitlement to Housebound benefits, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      statutory entitlement to Housebound benefits

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      determining whether the Veteran is permanently housebound in fact, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      protected evaluations. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 8, 2009 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Statutory Entitlement to Housebound Benefits
<p class="MsoBlockText">The Housebound benefit is payable under 38 U.S.C. 1114(s) (38 CFR 3.350(i)) to a Veteran who has a single, SC disability rated as totally disabling, and
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      has an additional SC disability, or combination of disabilities, independently ratable as 60 percent or more disabling, or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      is permanently housebound due to SC disability.

<p class="MsoBlockText">

<p class="MsoBlockText">If the Veteran is entitled to Housebound benefits by statute (without demonstrating need, under 38 U.S.C. 1114(s)), the additional disability(ies), rated 60 percent or more disabling, must

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      be separate and distinct from the single disability, rated totally disabling, and

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      involve separate anatomical segments or body systems.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The principles regarding avoidance of pyramiding contained in 38 CFR 4.14 are applicable.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Within these limits, the fact that the single disability, rated totally disabling, and additional disabilility(ies), independently ratable as 60 percent or more disabling, share a common etiology, does not preclude entitlement.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Ratings of 100 percent under 38 CFR 4.28, 38 CFR 4.29, and 38 CFR 4.30 of the rating schedule may be used as a basis for entitlement.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Per Bradley v. Peake, 22 Vet.App. 280 (2008), an individual unemployability rating that is based on a single disability also satisfies the requirement for a total rating under 38 U.S.C. 1114(s). <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 46. Entitlement to Housebound Benefits, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   Determining Whether the Veteran is Permanently Housebound   in Fact
<p class="MsoBlockText">If entitlement is based on the Veteran being housebound in fact, the law requires the housebound state to be permanent.
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<p class="MsoBlockText">

<p class="MsoBlockText">Consider a Veteran permanently housebound if, as a result of a single, total disability, by itself or in combination with other SC disabilities, the Veteran is permanently and substantially confined to

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      his/her place of residence and immediate premises, or

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      ward or clinical areas, if institutionalized under 38 CFR 3.350(i)(2).

<p class="MsoBlockText">

<p class="MsoBlockText">Important:

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      There is no requirement that either the single disability, rated totally disabling, or the additional disability(ies), independently ratable as 60- percent or more disabling, be permanent in nature.

<p class="BulletText1" style="mso-list:l7 level1 lfo7"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Leaving home for medical purposes cannot, by itself, serve as the basis for finding that a Veteran is not substantially confined for purposes of SMC Housebound benefits.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on substantial confinement to home, see Howell v. Nicholson, 19 Vet.App. 535 (2006). <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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c.   Considering Protected Evaluations
<p class="MsoBlockText">Consider any evaluation protected under 38 CFR 3.951 at its protected level.
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<p class="MsoBlockText">

<p class="MsoBlockText">For the purpose of determining entitlement to Housebound benefits only, utilize ratings under the 1925 schedule, which are protected by 38 CFR 3.952 with ratings under the current rating schedule for separate and distinct disabilities. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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