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(cell phone 240-506-1556)

To: All veterans


Date: Dec 2014
Topic:
Special Monthly Compensation (SMC)

From:
Craig N. Bash, M.D.
Neuro-Radiologist
www.veteransmedadvisor.com

Independent Veteran Medical Opinion (IMO)


Veteran Medical Nexus Opinion (VMNO)
Pages: 2

NPI or UPIN-1225123318- lic #--D43471


4938 Hampden lane, Bethesda, MD 20814
Phone: (301) 767-9525 Fax: (301) 365-2589
E-Mail: drbash@doctor.com

SMC (special monthly compensation) involves the most complex constellations of medical codes (other
than the simple SMC code for loss of use of creative organ- coded as a K award) that are allowed within
the VA rating system and I have been told by a long term VA employee that only a handful of VA raters
really understand all the aspects of SMC. The largest VA retro-active claim award involved SMC codes
for post polio that had been pending for several decades and the retro award was well over 1 million
dollars due to high quality independent veterans medical opinions. In fact, this award never would have
been awarded without a series of medical opinions and often now the VA requires two corroborative
medical opinions prior to awarding complex combined awards. The medical opinions [Independent
Veteran Medical Opinion (IMO)-Veteran Medical Nexus Opinion (VMNO)} are essential because the VA
raters and judges are not physicians and will not award SMC unless the SMC medical issues are spelled
out in a Dick and Jane manner as they relate to the VA codes because as stated above most VA employees
do not understand the SMC codes. In essence, the veteran medical opinion-writing physician needs to
know more about the SMC codes than the raters in his/her Independent Veteran Medical Opinion (IMO)
Veteran Medical Nexus Opinion (VMNO).
.
The medical aspects of SMC codes often involve the neurologic system and require independent veteran
medical opinions, which accurately assign the patients illnesses to the correct VA medical codes. A
inaccurate assignment of codes can cause the patient to not be eligible for SMC. SCM is designed
to allow for special funding for the sickest veterans because they have special medical needs.
SMC is a code that allows for benefits above the 100% level and these codes allow for about a 300%
increased in the 100% rate of monetary benefits.
( ***please see this site; http://www.benefits.va.gov/compensation/resources_comp02.asp)
A good example of a typical SMC patient would be a spinal cord injury as follows:
Codes need to encompass the following

Loss of use of both upper extremities


Loss of use of both lower extremities
Loss of bladder function- complete
Loss of bowel function- complete
Loss of creative organ
Need for aid and attendance such as help with daily hygiene
Need for daily physical therapy
Need for help with medications and cooking and cleaning.
Need to use a wheelchair.
Many of these issues are shared by other neurologic illness such as the post polio patient mentioned
above or a typical multiple sclerosis patient or post stroke patient.
Once again, since the VA only grants 30-50% of the correct rating on each iteration (not considering SMC
codes) a typical example of the step wise iterative grant of ratings to the SMC is as follows:
INITIAL COMBINED CODE
10%
30%
60%
90%
100% TEMPORTAY
100% PT

ON APPEAL (this could as many as three appeals)


20-30% rating
50-60%
80-90%
100%
100% PT
SMC codes

The SMC process can take years to get thru the VA depending on how sick the patient is and what codes
are involved. Often the patients illnesses worsens over the course of the appeals process and each new
decision needs to be appealed due to a worsening medical condition with an additional independent
veteran medical opinion. This is exactly what happened in the post-polio patient, mentioned above, as
each iteration of VA award was unfortunately met with a worsening medical condition in the veteran.
Recommendations:
1. All veterans with large SMC medical diagnostic combined codes should obtain and gather the most
comprehensive medical records possible.
2. All veterans should make and keep all medical appointments, as it is very likely that their illness will
worsen over the course of the claim appeals process.
All veterans should obtain independent veteran medical opinions [Independent Veteran Medical Opinion
(IMO)-Veteran Medical Nexus Opinion (VMNO)] for each category of SMC illness that they have such
the ones mentioned above to include bladder and bowel incontinence, as these are major SMC codes.
Each appeal should also be accompanied by a veteran medical opinion which explains the SMC issues
to the rater
3. Of course all veterans should seek physicians who have 15+ years of independent veteran medical
opinions at the BVA level as the VA SMC medical diagnostic code process is complex often with multiple
layers of BVA appeals.
Additionally, all physicians who write Veteran Medical Opinions [Independent Veteran Medical Opinion
(IMO)-Veteran Medical Nexus Opinion (VMNO)] should be able to categorize the 65,000 Non VA SMC
type codes into the VAs directory of a few SMC codes. This is not a trivial process, as the VA codes all
have different a complex combinable aspects, which of course excludes pyramiding of codes.

4. Low levels of training and experience by either physicians or advocates hurts a veterans chances of
getting a correct SMC medical diagnostic code as any mistake made at the lower levels of appeals are
magnified under further appeal reviews and amount of needed extra time, medical testing, medical
opinions and associated paperwork to try and correct early errors is substantial and a correction is not
always possible.
Craig Bash M.D. Associate Professor

drbash@doctor.com cell 240-506-1556

Independent Veteran Medical Opinion (IMO)


Veteran Medical Nexus Opinion (VMNO)

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