The majority of service-connected disabilities are defined by a percentage ranging from 0 to 100 percent to reflect the severity of the condition(s) and the disabling effects they have on the veteran. These percentages are explicitly defined by Federal Regulations under the Schedule for Rating Disabilities and are assigned a monetary compensation award based on the vocational limitations that these injuries or disorders cause and subsequently the effect they may have on monetary earnings.
Some injuries and disorders are more severe in nature and result in several additional debilitating residual conditions that can have additional adverse affects on an individual’s socioeconomic state. To better assist with meeting the specialized needs of these individuals, additional benefits are available under Special Monthly Compensation (SMC) ratings provided under Title 38 of U.S.C. 1114. These ratings are in addition to the numerical ratings established under the standard rating schedule and are identified by letters such as SMC (k), SMC (l), SMC (m), SMC (n), SMC (o), SMC(p), SMC (r), SMC (s) and the recently added SMC (t). These rates are simply named after the subsections of the Code of Federal Regulations that outline the required eligibility requirements for each level of SMC. SMC provides additional monetary compensation awards and where applicable can establish entitlement to additional ancillary benefits such as the VA’s Specially Adapted Housing Grant and the Automobile and Adaptive Equipment Grants.
The basic elements of Special Monthly Compensation Ratings include anatomical (or physical) loss or the loss of use of limbs, hands, feet and/or reproductive organs; aphonia; deafness; blindness; loss of bowel and bladder control; being permanently housebound; and a need for regular aid and attendance with activities of daily living or a higher level of care–all of which must be a result of the veteran’s service-connected disabilities. Each level of SMC ratings are successive and are preceded by an entitlement to certain conditions included under SMC level (k).
A rating of SMC(k) would include:
• the anatomical loss or loss of use of:
o one hand.
o one foot.
o both buttocks (where the applicable bilateral muscle group prevents the individual from maintaining unaided upright posture, rising and stooping actions).
o one or more creative organs used for reproduction (absence of testicles, ovaries or other creative organ, ¼ loss of tissue of a single breast or both breasts in combination) due to trauma while in service, or as a residual of a service-connected disability(ies). *(these do not serve as eligible prerequisite conditions for the higher levels of SMC)*
o One eye (loss of use to include specific levels of blindness).
• complete organic aphonia (constant loss of voice due to disease)
• Deafness of both ears to include absence of air and bone conduction.
A rating of SMC(l) would include:
• The anatomical loss or loss of use of:
o Both feet,
o One hand and one foot
• Blindness in both eyes with visual acuity of 5/200 or less.
• Permanently bedridden.
• Regular need for aid and attendance to assist with activities of daily living such as dressing oneself, tending to personal hygiene, care and adjustment of assistive appliances or prosthetics, feeding oneself, and the like. (specific criteria is established in 38 CFR § 3.352(a) ) (*if such services are not being provided at the expense of the U.S. Government due to hospitalization).
Ratings above the SMC(l) level to include SMC (m), SMC (n), SMC (o), SMC (p), SMC(r) and SMC (s) are specialized multifaceted levels which are based on various specific combinations of anatomical loss or loss of use of designated extremities and/or senses, together with seriously disabling conditions and particular degrees of aid and attendance requirements, housebound or bedridden statuses deemed medically necessary, and explicit service-connection ratings. These levels also outline various requirements to include full and half step upgraded SMC level ratings. The conditions providing the basis of these levels are as follows.
A rating of SMC(m) would include:
• The anatomical loss or loss of use of:
o Both hands,
o Both legs at the region of the knee
o One arm at the region of the elbow with one leg at the region of the knee
• Blindness in both eyes having only light perception.
• Blindness in both eyes resulting in the need for regular aid and attendance.
A rating of SMC(n) would include:
• The anatomical loss or loss of use of both arms at the region of the elbow.
• The anatomical loss of both legs so near the hip that it prevents the use of a prosthetic appliance.
• The anatomical loss of one arm so near the shoulder that it prevents the use of a prosthetic appliance along with the anatomical loss of one leg so near the hip that it prevents the use of a prosthetic appliance.
• The anatomical loss of both eyes or blindness in both eyes to include loss of light perception.
A rating of SMC(o) would include:
• The anatomical loss of both arms so near the shoulder that it prevents the use of a prosthetic appliance.
• Bilateral deafness rated at least 60 percent disabling along with service-connected blindness with visual acuity of 20/200 or less of both eyes.
• Complete deafness in one ear or bilateral deafness rated at least 40 percent disabling along with service-connected blindness in both eyes to include loss of light perception.
• Paraplegia – paralysis of both lower extremities along with bowel and bladder incontinence.
• Helplessness due to a combination of anatomical loss or loss of use or two extremities with deafness and blindness or a combination of multiple injuries causing severe and total disability.
A rating of SMC(p) would include:
• The anatomical loss or loss of use of a leg at or below the knee along with the anatomical loss or loss of use of the other leg at a level above the knee.
• The anatomical loss or loss of use of a leg below the knee along with the anatomical loss or loss of use of an arm above the elbow.
• The anatomical loss or loss of use of one leg above the knee and the anatomical loss or loss of use of a hand.
• Blindness in both eyes meeting the requirements outlined in SMC (l), (m) or (n) levels.
Ratings under SMC(r) are assigned for seriously disabled veterans in need of advanced levels of aid and attendance. SMC(r) ratings require a minimal combination of entitlement to both SMC(o) and SMC(l). Additionally, Veterans in receipt of SMC rates based on Aid and Attendance are strongly advised to contact their service representative and/or VA Regional Office should they become hospitalized at the expense of the U.S. Government (i.e. a VA medical facility) as failure to do so could create an overpayment of monetary benefits.
Ratings under SMC(s) are also available if the veteran is permanently housebound. The VA defines “permanently housebound” as being substantially (as opposed to completely) confined to a dwelling as the result of service-connected disability and it is reasonably certain that that such disability will continue throughout the veteran’s lifetime. These kinds of determinations should be made by a physician, whose written opinions or reports in this respect would serve as the best evidence to submit in support of a claim for “s” SMC benefits.
Ratings under SMC(t) are available to veterans who need regular aid A&A for residuals of Traumatic Brain Injury (TBI), but is not eligible for a higher level of A&A under (R)(2), and would require hospitalization, nursing home care, or other residential institutional care in absence of regular in-home aid and attendance.
As Special Monthly Compensation ratings are very complex, this outline is simply to serve as an informational reference. It is important that you consult your service representative for assistance with determining eligibility and filing or maintaining claims for such ratings. please be sure to contact your VetsFirst Service Representative or submit your inquiry to our Ask VetsFirst online service at http://helpdesk.vetsfirst.org.
Veterans Service Representative