NCACVSO-Spring-Training

Report
NCACVSO SPRING
TRAINING
IU, SMC Ratings, Secondary S/C, &
DBQs
April 2012
VA Regional Office Winston-Salem
Presenter: Jack Hudson
Winston-Salem Regional Office
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Individual Unemployability (IU)
The provisions of 38 C.F.R. § 4.16(a) provide the
minimal schedular standards for TDIU consideration:
• if there is one disability, this disability shall be ratable
at 60 percent or more;
• and, if there are two or more disabilities, there must be
at least one disability ratable at 40 percent or more
and additional disability to bring the combined rating to
70 percent or more.
Winston-Salem Regional Office
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Individual Unemployability (IU)
Alternatively, if these schedular requirements are not met,
but the evidence shows the Veteran is unemployable due
to service-connected disabilities, 38 C.F.R. § 4.16(b)
authorizes VA to grant a TDIU evaluation on an extraschedular basis upon approval by the Director,
Compensation Service.
Winston-Salem Regional Office
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Individual Unemployability (IU)
If a VA Form 21-8940, Veteran’s Application for Increased
Compensation based on Unemployability, or other
submission expressly requests TDIU, this will be
considered a claim for increased evaluation in all S/C
disabilities unless TDIU is expressly claimed as being due
to one or more specific disabilities. The initial notice letter
will provide VCAA compliant information for all S/C
disabilities that are not currently evaluated at the
schedular maximum evaluation for that condition.
Winston-Salem Regional Office
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Individual Unemployability (IU)
The VA Form 21-8940 remains an important vehicle for
developing the claim and determining entitlement to a
TDIU evaluation. However, the determination of an
effective date for the establishment of a TDIU evaluation
is no longer primarily based upon the date of receipt of
the VAF 21-8940, but upon consideration of other factors
such as the date of the original claim or claim for increase
and the date that the evidence establishes inability to
maintain substantially gainful employment due to S/C
disability(ies).
Winston-Salem Regional Office
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Individual Unemployability (IU)
As inability to maintain substantially gainful employment constitutes
the basic criteria that must be satisfied for a TDIU evaluation, after
the initial TDIU grant is awarded, VA must continue to ensure that the
Veteran is unemployable.
Therefore, the Veteran must complete and return a VA Form 21-4140,
Employment Questionnaire, annually for as long as the TDIU
evaluation is in effect. Yearly submission of the form is required
unless the Veteran is 70 years of age or older, or has been in receipt
of a TDIU evaluation for a period of 20 or more consecutive years
(See 38 C.F.R. § 3.951(b)), or has been granted a 100-percent
schedular evaluation.
Winston-Salem Regional Office
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Individual Unemployability (IU)
The VA Form 21-4140 must be returned within 60 days or
the Veteran’s benefits may be reduced. If the form is
returned in a timely manner and shows no employment,
then the TDIU evaluation will continue uninterrupted.
The VA Form 21-4140 must be returned with the
Veteran’s signature certifying employment status. A
telephone call to the Veteran is not acceptable to certify
employment status for TDIU claims.
Winston-Salem Regional Office
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Special Monthly Compensation (SMC)
Special Monthly Compensation” came about to recognize
the severity of certain disabilities or combinations of
disabilities by adding an additional compensation to the
basic rate.
Winston-Salem Regional Office
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Special Monthly Compensation (SMC)
1. Loss or loss of use (LOU) of specific organs, sensory functions,
or extremities;
2. Disabilities that confine the veteran to his/her residence;
3. Disabilities that render the veteran permanently bedridden or in
need of aid and attendance (A&A);
4. Combinations of severe disabilities that significantly affect
locomotion;
5. Existence of multiple, independent disabilities each rated at 50%
or 100%;
6. Existence of multiple disabilities which, in total, render the
veteran in need of such a degree of special skilled assistance that,
without same, would be permanently confined to a skilled-care
nursing home.
Winston-Salem Regional Office
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Special Monthly Compensation (SMC)
SMC’s are paid in addition to schedular disability
compensation. SMC’s are evaluations, not disabilities.
Thus, they accrue protection under 38 CFR 3.951.
They are referred to in VA vernacular or acronym by the
letter of the subparagraph of 38 USC 1114 that
establishes the rate of payment. For example, SMC “K”
refers to 38 USC 1114(k) that establishes the rate. Thus,
that SMC is referred to as a “K”.
Winston-Salem Regional Office
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Special Monthly Compensation (SMC)
Entitlement to SMC “K” requires:
• Anatomical loss or LOU of one hand;
• Anatomical loss or LOU of one foot;
• Loss or LOU of both buttocks;
• Loss or LOU of one or more creative organ(s);
• Blindness of one eye;
• Deafness of both ears;
• Complete organic aphonia; or,
• in the case of a women veteran, loss of breast tissue
or following receipt of radiation treatment of breast
tissue.
Winston-Salem Regional Office
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Special Monthly Compensation (SMC)
Entitlement to SMC “L” requires:
• Anatomical loss or LOU of both feet;
• Anatomical loss or LOU of one hand and one foot;
• Blindness in both eyes with bilateral visual acuity of 5/200 or less;
• Being permanently bedridden; or
• In need of A&A.
For entitlement to SMC “L” on account of being permanently
bedridden, it must only be shown that the veteran is permanently
bedridden on account of S/C disability.
The criteria for determining entitlement to A&A requires that the
veteran be so helpless as to require the aid and attendance of
another person to perform the personal functions necessary for daily
living.
Winston-Salem Regional Office
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Special Monthly Compensation (SMC)
Entitlement to SMC “S” requires a single 100% S/C disability, and:
• additional S/C disability or disabilities independently ratable at 60
percent, or
• be factually housebound due to S/C disability.
Unlike other SMC’s, “S” can be temporary rather than permanent. A
situation known as “statutory housebound” is often encountered when
a veteran with a 60% S/C disability is awarded a temporary 100%
evaluation for another S/C disability.
In order to be considered factually housebound, the veteran must be
substantially confined to his/her dwelling and the immediate premises
solely because of S/C disability, and it must be reasonably certain
that the disability (ies) and resultant confinement will continue
throughout his/her lifetime.
Winston-Salem Regional Office
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Secondary Service Connection
Grant service connection for the following under the
provisions of 38 CFR 03.310(a) and (b):
 disabilities that are proximately due to, or the result of,
a SC condition, or
 the increase in severity of a nonservice-connected
(NSC) disability that is attributable to aggravation by
an SC disability, and not to the natural progress of the
NSC disability.
Winston-Salem Regional Office
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Secondary Service Connection
When developing a claim for secondary service
connection based on aggravation of an NSC disability,
ask the Veteran to furnish medical evidence showing the
 current level of severity of the NSC disability, and
 its level of severity before aggravation by the SC
disability, or as soon as possible after aggravation.
Upon receipt of this evidence, VA will request a medical
examination and opinion, to include a review of the Cfolder by the examiner, to establish whether increased
manifestations of the NSC disability are proximately due
to an SC disability
Winston-Salem Regional Office
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Disability Benefits Questionnaires (DBQs)
The Veterans Benefits Administration (VBA), in coordination
and cooperation with the Veterans Health Administration
(VHA), the Board of Veterans’ Appeals (BVA), and the VA
Office of General Counsel (OGC), developed 81 DBQs.
DBQs standardize VHA exam reports and enable private
physicians to provide sufficient disability assessment
information. DBQs from private physicians will preclude the
need for VA exams in many cases.
Winston-Salem Regional Office
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Disability Benefits Questionnaires (DBQs)
Who is qualified to complete Disability Benefits
Questionnaires?
In the private sector, a private physician with an active
medical license is qualified to sign and attest to completed
DBQs. The physician must have sufficient medical expertise
to conduct a medical assessment regarding the type of DBQ
completed. Within VHA, a wider category of physicians and
clinicians are qualified to complete and release DBQs,
including nurse practitioners and physician’s assistants.
Winston-Salem Regional Office
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Disability Benefits Questionnaires (DBQs)
How are completed Disability Benefits Questionnaires
submitted to VA?
Physicians may mail or securely fax completed DBQs to the
VA Regional Office (RO) handling the Veteran’s or
Servicemember’s claim. The Veteran, Servicemember or
their accredited representative may also submit completed
DBQs directly to the VA RO in support of their claim.
Winston-Salem Regional Office
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Disability Benefits Questionnaires (DBQs)
Vietnam Veterans with verified in-country service can also
submit their claims for one of the three new Agent Orange
presumptive conditions electronically through the Fast Track
system at https://www.fasttrack.va.gov/AOFastTrack/.
The Fast Track system contains the Ischemic Heart Disease,
Hairy and other B-cell Leukemia, and the Parkinson’s
Disease DBQs in interactive electronic format, so physicians
can quickly and easily access, complete, and submit those
specific DBQs.
Winston-Salem Regional Office
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Disability Benefits Questionnaires (DBQs)
All OMB-approved DBQs are available for download at:
http://www.va.gov/vaforms/
as well as the DBQ Internet site at
http://benefits.va.gov/disabilityexams.
Winston-Salem Regional Office
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