VA Special Monthly Compensation (SMC): Higher Pay for Serious Limitations

CCK Law: Our Vital Role in Veterans Law

The Department of Veterans Affairs (VA) pays Special Monthly Compensation (SMC) to veterans with certain serious disabilities (e.g., amputations) or limitations (e.g., housebound or needing assistance). Most levels of SMC replace regular VA disability compensation and pay more than total disability (100 percent ratings); one level — (k) — pays in addition to regular disability compensation.

VA should automatically consider a veteran for Special Monthly Compensation if their VA claim or appeal suggests that they may qualify for it. Unfortunately, VA often overlooks or misapplies SMC. This is a complex and poorly understood benefit, even for VA adjudicators. If you need assistance, contact CCK Law for a free case evaluation. We have extensive experience with this rare but potentially lifechanging VA benefit.

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What Are the VA SMC “Levels”?

There are several types of Special Monthly Compensation with their own requirements. The different types are referred to as “levels” even though compensation and requirements do not necessarily get higher by level.

• Levels L through O list specific conditions and combinations of conditions that qualify a veteran to receive SMC. Level L contains the least severe of these conditions (and therefore, the lowest SMC rates) and Level O contains the most severe (and the highest SMC rates). Level L also provides the lowest level of “Aid & Attendance” benefits for veterans who require assistance with certain activities of daily living.
• Level K provides SMC for veterans who have, for example, experienced the loss (amputation) or loss of use of an extremity or organ.
• Level R(1) and R(2) provide for veterans who need daily aid and attendance from another person.
• Level S provides SMC for veterans who cannot leave the house.
• Level T is for veterans who require Aid & Attendance (see Level L) specifically due to traumatic brain injuries (TBI).

All Special Monthly Compensation rates are given instead of the standard VA Disability Compensation rates, except for Level K. Level K is given in addition to your standard disability pay.

Once you know which SMC level you qualify for, you can look up the exact amount you should be receiving with the VA’s Special Monthly Compensation Rates.

To be eligible for any level of SMC, the disability you are claiming must be service connected. The other eligibility requirements for each level can be complicated, especially if you qualify for multiple levels. In the rest of this post, we’ll cover the basics of each level and some of the special cases you might encounter when receiving Special Monthly Compensation.

Special Monthly Compensation Levels L Through O

Levels L through O — that is, Levels L, L ½ (i.e. “L and a half”) M, M ½, N, N ½, and O — list specific conditions and combinations of conditions that qualify a veteran for that level of compensation.

Level L, for example, lists “amputation of both feet” as a qualifying combination of disabilities. Level N ½, a higher level of Special Monthly Compensation, lists “Loss of use of one elbow and amputation of one arm so close to the shoulder that it is impossible to wear a prosthesis” as a qualifying combination of disabilities.

This chart developed by CCK Law illustrates VA SMC(l) through (o) requirements.

Special Monthly Compensation and Additional Disabilities

You can only receive one Special Monthly Compensation rating for Levels L through O. But there are a few circumstances in which you can receive more compensation if you have other, separate disabilities.

Other Disabilities Combine to 50 Percent

If you have separate, service-connected conditions that combine to 50 percent, then the level is bumped up to the next ½ level. That is, a veteran whose SMC condition was found in Level L would be moved up to compensation rates for Level L ½ (Level L ½ would move up to M, M to M ½, etc.).

For example, say a veteran has both feet amputated (100 percent rating), arthritis in the right hand (30 percent), and PTSD (30 percent). The loss of both feet qualify for SMC under Level L. The arthritis and PTSD do not qualify for SMC, but combined, they equal at least a 50 percent rating. (Note: VA calculates combined ratings using a Combined Ratings Table – ratings are not simply added together. Read our post on the VA Rating Schedule to learn how to combine ratings on your own.) So, the original Level L for the amputated feet would be moved up to Level L ½.

In the above situation, note that the additional disabilities combine to 50 percent on their own – i.e. not including the SMC-eligible condition. Also, the additional disabilities are not taken into consideration under another SMC level. That is, the above disabilities qualify for this special rule because there is no SMC level that specifies “both feet amputated and arthritis of the hand” or something similar.

Another Disability at 100 Percent

If you have a separate, service-connected disability rated at 100 percent, then the level is bumped up an entire step instead of a half step. Unlike the 50 percent situation, you just have to have one disability rated at 100 percent (not multiple disabilities that combine to 100 percent).

If the conditions that qualify you for Special Monthly Compensation are caused by a disease (for example, if your amputations were caused by service-connected diabetes), then that disease cannot count toward the 50-percent combined rating or single 100-percent rating necessary to move up to the next SMC level.

Loss or Loss of Use of Three Extremities

If you have anatomical loss or loss of use of three extremities (two legs and one arm, or one leg and two arms) that qualify for SMC, then the level for only two extremities is raised to the next ½ level. For example, if a veteran has both feet amputated, qualifying them for Level L, and one hand amputated, then they will be moved up to Level L ½.

Other Disabilities That Qualify for Special Monthly Compensation

If you have separate, service-connected conditions that qualify for SMC ratings under two (or more) different levels between L and N ½, then you will be given one SMC rating under Level O, the highest level.

For example, if a veteran has both feet amputated (below the knee), they would qualify for Level L. If they also had both hands amputated (below the elbow), they would qualify for Level M as well. Since there is no level that lists the amputation of all four extremities as a qualifying condition, VA would award SMC under Level O.

For any of the above situations, you cannot be “bumped up” past Level O, the highest level of compensation. So, if a condition already qualifies for Level O, it cannot be raised any further.

Some VA Medical Definitions

Some of the conditions listed under Levels L through O require a little more explanation. Here’s what VA means when they say…

• Blindness: For VA purposes, an eye is “blind” if it has 5/200 vision or worse, or if the field of vision is 5 degrees or worse.
• Basic needs: These include eating, using the restroom, getting dressed, etc.
• Amputation (of a joint): If VA says “amputation of the knee,” it does not necessarily mean the knee itself has been removed. If the amputation is at a place on the leg that makes use of the knee joint impossible, it is still considered “amputation of the knee.” The same applies to any other joint referred to in this way.
• Loss of use: The body part cannot function any better than if it were amputated and a prosthetic device was used. If a hand, for example, cannot grasp objects, it would be considered loss of use.
• Aid and Attendance: This means that the condition is so severe that the veteran requires supervision by another person, such as a family member, home nurse, or nursing home facility. The supervision does not necessarily need to be constant, but must be regular. Hospitalization does NOT qualify as Aid and Attendance.
• Housebound: The veteran’s condition makes it so that they cannot leave house (or hospital ward or care facility) at all, and this is expected to be the case for the rest of their life.
• Permanently bedridden: The condition is so severe that the veteran cannot get out of bed. This does not include periods of bed rest prescribed by a doctor if the veteran could still actually get out of bed. If a veteran is permanently bedridden, they qualify for Aid and Attendance. But unlike Aid and Attendance, the permanently bedridden rating continues even if the veteran is hospitalized.

Special Monthly Compensation Level K: Loss or Loss of Use

Special Monthly Compensation under Level K is based on the loss (amputation) or loss of use of a body part or function. Unlike other SMC levels, Level K compensation is paid in addition to regular VA Disability compensation, even if you do not qualify for any other type of SMC.

Level K is also paid in addition to compensation from other SMC levels, though the amount you can receive is capped in some cases:

• If you are also receiving SMC under Levels L through O, the combined compensation rate (Level K + Level L/M/N/O) cannot go beyond the amount given under Level O.
• If you are also receiving SMC under Level R, the combined compensation rate (Level K + Level R) cannot go beyond the highest amount given for Level R1 AND the condition that qualifies you for Level K cannot be the same condition that qualifies you for Level R.

Under Level K, a set amount is given for each body part or function that is lost or not functional. So if you have more than one of the qualifying conditions, you can receive multiple Level K amounts.

This chart developed by CCK Law illustrates VA SMC(k) requirements.

Level K Conditions

The following body parts can be rated under this level:

• Amputation of a hand
• Amputation of a foot
• Loss of use of a hand
• Loss of use of a foot
• Physical loss of one eye
• Total blindness in one eye to such a degree that the individual only has the ability to perceive light or less
• Physical loss of a creative organ, including ovaries, uterus, testicles, etc.
• Loss of use of a creative organ (This includes erectile dysfunction.)
• Inability to speak without the help of a prosthesis because of damage to the muscles or nerves that control the voice
• Complete deafness in BOTH ears (VA rating must be 100 percent)
• Loss of use of BOTH buttocks (For “loss of use” in this case, the veteran must be unable to rise to their feet and remain balanced without using their arms or assistance AND the condition must be rated at least 50 percent.)
• Loss of 25 percent or more of breast tissue in one or both breasts combined, or after radiation treatment to the breast tissues

Special Monthly Compensation Level S: Housebound

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Special Monthly Compensation under Level S is given if:

• The veteran is completely and permanently housebound. This means that the veteran cannot leave their home (or hospital ward, or care facility) at all, and this is expected to be the case for the rest of their life.

OR

• The veteran has at least one condition rated 100 percent AND another, unrelated condition rated at least 60 percent. The second (60 percent) disability must be service connected. The second disability must also be from a different bodily system (for example, both disabilities cannot affect the arm).

SMC under Level S is given instead of being compensated at the 100-percent rate, not in addition to that type of compensation. You can, however, receive both Level S compensation and Level K (loss or loss of use) compensation if you qualify for both.

This chart developed by CCK Law illustrates VA SMC(s) requirements.

Special Monthly Compensation Level R: Aid and Attendance

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To qualify for Special Monthly Compensation under Level R, a veteran must:

• Qualify for SMC under Level O OR under Levels N ½ and K together

AND

• Require the help of another person every day (aid and attendance) to perform the majority of the following tasks:
  • Dressing and undressing
  • Cleaning and grooming
  • Eating
  • Using the restroom
  • Adjusting prosthetic or orthopedic appliances frequently (that is, appliances that most people could adjust on their own)

A veteran can also qualify if:

• Their disability (mental or physical) requires that another person regularly help to keep them from harming themselves or others.

OR

• They are bedridden. That is, their condition is severe enough that it requires them to always be in bed. This rule does not apply if the veteran chooses to remain in bed or if a doctor prescribes a period of bed rest.

Level R compensation is not given if the individual is hospitalized or in a care institution — only if they are being cared for at home.

This chart developed by CCK Law illustrates VA SMC R(1) and R(2) requirements.

Special Monthly Compensation Level R1 vs. Level R2

There are two different levels of Level R (R1 and R2), depending on the level of care needed.

Level R1 is given if the aid and attendance needed can be performed by a non-professional, like a family member or friend.

Level R2 is given if the aid and attendance must be provided by a licensed medical professional or someone working on behalf of a licensed medical professional. To qualify for R2, VA must judge that the veteran would have to be hospitalized or put in a nursing home (or other institution) if they did not have professional care at home.

SMC under Level R, whether R1 or R2, is paid instead of any other compensation for any other condition (except for a separate condition under Level K). If you qualify for Level R, you will not receive any other disability pay from VA, including for regular VA disability ratings.

Special Monthly Compensation Level T

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SMC (T) compensates veterans who suffer from Traumatic Brain Injury (TBI), specifically. If a veteran has a TBI and needs regular aid and attendance for the residuals of that TBI, they can be eligible for (T). This includes veterans who need to be in a residential care program or hospitalized due to the residuals of their TBI.

The rate for (T) is the same as the rate for (R-2).

Call Chisholm Chisholm & Kilpatrick for a Free Case Evaluation

If your claim for SMC has been denied or you believe you are entitled to a higher rating, our team of experienced attorneys may be able to help you. Contact us today at (800) 544-9144.