### Section I. History of SMC

#### Overview

+------------+---------------------------------------------------------+
| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ------------ ---------------------------------------------- ------------
  Topic        Topic Name                                     See Page

  47           General Information on the History of SMC      2-I-2

  48           SMC Under 38 U.S.C. 1114(k)                    2-I-4

  49           SMC Under 38 U.S.C. 1114(l)                    2-I-7

  50           SMC Under 38 U.S.C. 1114(m)                    2-I-9

  51           SMC Under 38 U.S.C. 1114(n)                    2-I-11

  52           SMC Under 38 U.S.C. 1114(o)                    2-I-13

  53           SMC Under 38 U.S.C. 1114(p)                    2-I-15

  54           SMC Under 38 U.S.C. 1114(q)                    2-I-21

  55           SMC Under 38 U.S.C. 1114(r)                    2-I-22

  56           SMC Under 38 U.S.C. 1114(s)                    2-I-24

  57           SMC Under 38 U.S.C. 1114(t)                    2-I-25

  58           Maximum Allowable Rates Under 38 U.S.C.        2-I-26
               1114(p)                                        
  ------------ ---------------------------------------------- ------------

#### 47. General Information on the History of SMC

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains general information on the        |
| troduction | > history of Special Monthly Compensation (SMC),        |
|            | > including                                             |
|            |                                                         |
|            | -   the purpose of this section                         |
|            |                                                         |
|            | -   the content of this section                         |
|            |                                                         |
|            | -   CO assistance in resolving difficult SMC cases, and |
|            |                                                         |
|            | -   an overview of the history of SMC changes from July |
|            |     1, 1933, *Public Law (PL) 73-2*, to the present.    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > This section has been designed for use by Rating      |
| ### a. Pur | > Veterans Service Representatives (RVSRs) when         |
| pose of Th | > reviewing prior rating decisions for accuracy in the  |
| is Section | > awarding of Special Monthly Compensation (SMC).       |
|            | >                                                       |
|            | > Prior rating decisions addressing the issue of        |
|            | > entitlement to SMC may appear to be erroneous based   |
|            | > upon current criteria, when, in fact, they were       |
|            | > totally correct based upon the criteria in effect at  |
|            | > the time the prior rating decision was made.          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > This section                                          |
| ### b. Con |                                                         |
| tent of Th | -   contains only an overview of the history of SMC,    |
| is Section |     not all of the historical aspects involving the     |
|            |     payment of SMC                                      |
|            |                                                         |
|            | -   provides a breakdown for each of the levels of SMC, |
|            |     and                                                 |
|            |                                                         |
|            | -   does not address the limited number of cases in     |
|            |     which the criteria for SMC that was in effect       |
|            |     before July 1, 1933, would be at issue.             |
|            |                                                         |
|            | > ***Note***: Where appropriate, cross-references have  |
|            | > been made to other levels of SMC where there are, or  |
|            | > were, restrictions in the simultaneous payment of SMC |
|            | > at one or more levels.                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > If there is any question as to which level of SMC is  |
|  c. CO Ass | > appropriate in a given case, submit the claims folder |
| istance in | > to Central Office (CO) (211B) for an advisory         |
|  Resolving | > opinion.                                              |
|  Difficult |                                                         |
|  SMC Cases |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

47\. General Information on the History of SMC, Continued

+------------+---------------------------------------------------------+
| ##### d. O | > The table below describes the history of changes      |
| verview of | > affecting the payment of SMC since the enactment of   |
|  the Histo | > *Public Law (PL) 73-2*, on July 1, 1933, to the       |
| ry of SMC  | > present.                                              |
| Changes Fr | >                                                       |
| om July 1, | > ***Important***: Prior to July 1, 1933, SMC at        |
|  1933, PL  | > various levels was payable under the provisions of    |
| 73-2, to t | > the *World War Veterans' Act of 1924*.                |
| he Present | >                                                       |
|            | > ***Legend***:                                         |
|            |                                                         |
|            | -   The letters K through T indicate subsections of 38  |
|            |     U.S.C. 1114.                                        |
|            |                                                         |
|            | -   IA indicates the initial authority for the          |
|            |     subsection                                          |
|            |                                                         |
|            | -   A indicates that the subsection was amended         |
|            |                                                         |
|            | -   D indicates that the subsection was deleted, and    |
|            |                                                         |
|            | -   C-R indicates that the subsection was changed and   |
|            |     the change involves restriction of payment.         |
+------------+---------------------------------------------------------+

  ---------- ------------ ----- ---- ---- ---- ----- ----- ---- ---- ----- ----
  Public Law Effective    K     L    M    N    O     P     Q    R    S     T
             Date                                                          

  *PL 73-2*  07/01/1933   IA    IA   IA   IA   IA                          

  *PL        10/01/1945   A     A    A    A    A     IA                    
  79-182*                                                                  

  *PL        08/01/1952   A                                IA              
  82-427*                                                                  

  *PL        10/01/1956   A                                                
  84-969*                                                                  

  *PL        09/01/1958              A                                     
  85-652*                                                                  

  *PL        10/01/1958                        C-R   C-R        IA         
  85-782*                                                                  

  *PL        09/01/1960   C-R                                        IA    
  86-663*                                                                  

  *PL 88-20* 07/011963    A                                                

  *PL 88-22* 07/01/1963   A                                                

  *PL        12/01/1965                        A     A                     
  89-311*                                                                  

  *PL 90-77* 10/01/1967   C-R                        C-R             C-R   

  *PL        08/19/1968                                    D               
  90-493*                                                                  

  *PL        10/01/1978                              A          A          IA
  95-479*                                                                  

  *PL        10/01/1979                                         A          
  96-128*                                                                  

  *PL 97-66* 10/01/1981         A    A    A    A     A                     

  *PL        10/01/1982                   A          A                     
  97-306*                                                                  

  *PL        10/01/1983                        A     A                     
  98-223*                                                                  

  *PL        10/28/1986                                                    D
  99-576*                                                                  

  *PL        11/01/2000   A                                                
  106-419*                                                                 

  *PL        12/06/2002   A                                                
  107-330*                                                                 
  ---------- ------------ ----- ---- ---- ---- ----- ----- ---- ---- ----- ----

#### 48. SMC Under 38 U.S.C. 1114(k)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(k). It includes information on SMC under: |
|            |                                                         |
|            | -   *PL 73-2*                                           |
|            |                                                         |
|            | -   *PL 79-182*                                         |
|            |                                                         |
|            | -   *PL 82-427*                                         |
|            |                                                         |
|            | -   *PL 84-969*                                         |
|            |                                                         |
|            | -   *PL 86-663*                                         |
|            |                                                         |
|            | -   *PL 88-20*                                          |
|            |                                                         |
|            | -   *PL 88-22*                                          |
|            |                                                         |
|            | -   *PL 90-77*                                          |
|            |                                                         |
|            | -   *PL 106-419*, and                                   |
|            |                                                         |
|            | -   *PL 107-330*.                                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > *PL 73-2*, effective July 1, 1933, provided for       |
| a. SMC Und | > payment of SMC for the anatomical loss or loss of use |
| er PL 73-2 | > (L/LOU) of only                                       |
|            |                                                         |
|            | -   one foot                                            |
|            |                                                         |
|            | -   one hand, or                                        |
|            |                                                         |
|            | -   one eye.                                            |
|            |                                                         |
|            | > ***Note***: SMC under 38 U.S.C. 1114(k) was           |
|            |                                                         |
|            | -   payable in addition to the basic rate of            |
|            |     compensation payable for disability ratings of 10   |
|            |     percent through 100 percent                         |
|            |                                                         |
|            | -   payable for only one disability meeting the         |
|            |     criteria under 38 U.S.C. 1114(k), even though       |
|            |     multiple disabilities meeting the criteria may have |
|            |     existed, and                                        |
|            |                                                         |
|            | -   *not* payable in addition to SMC under 38 U.S.C.    |
|            |     1114(l) through 38 U.S.C. 1114(n).                  |
|            |                                                         |
|            | > ***Example***: A veteran with loss of one foot, plus  |
|            | > the loss of one eye, would have been entitled to      |
|            | > compensation based on the disability evaluation       |
|            | > assigned, plus SMC under 38 U.S.C. 1114(k) for        |
|            | > *either* loss of the foot *or* loss of the eye, but   |
|            | > not both.                                             |
+------------+---------------------------------------------------------+

Continued on next page

48\. SMC Under 38 U.S.C. 1114(k), Continued

+------------+---------------------------------------------------------+
| ##### b.   | > *PL 79-182*, effective October 1, 1945,               |
|  SMC Under |                                                         |
|  PL 79-182 | -   clarified the standard for blindness of one eye as  |
|            |     having light perception only (LPO), and             |
|            |                                                         |
|            | -   provided for the payment of SMC under 38 U.S.C.     |
|            |     1114(k), in addition to SMC under 38 U.S.C. 1114(l) |
|            |     through (n), for each loss, or loss of use, under   |
|            |     38 U.S.C. 1114(k).                                  |
|            |                                                         |
|            | > ***Note***: The prohibition against the payment of    |
|            | > SMC for more than one disability meeting the criteria |
|            | > under 38 U.S.C. 1114(k) was continued.                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > *PL 82-427*, effective August 1, 1952, provided for   |
|  SMC Under | > the payment of SMC under 38 U.S.C. 1114(k) for        |
|  PL 82-427 | > anatomical L/LOU of a creative organ.                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > *PL 84-969*, effective October 1, 1956, provided for  |
|  SMC Under | > the payment of SMC under 38 U.S.C. 1114(k) for        |
|  PL 84-969 | > anatomical L/LOU of both buttocks.                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e.   | > *PL 86-663*, effective September 1, 1960, created a   |
|  SMC Under | > new level of SMC under 38 U.S.C. 1114(s). SMC under   |
|  PL 86-663 | > 38 U.S.C. 1114(k) was not payable in addition to SMC  |
|            | > under 38 U.S.C. 1114(s).                              |
|            | >                                                       |
|            | > ***Note***: If the additional 60 percent disability   |
|            | > establishing entitlement at the "s" level included    |
|            | > entitlement under 38 U.S.C. 1114(k), payment was to   |
|            | > be made at the 100 percent + "k" level, as this was a |
|            | > greater benefit than the 100 percent + "s" level.     |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### f    | > *PL 88-20*, effective July 1, 1963, provided for the  |
| . SMC Unde | > payment of SMC under 38 U.S.C. 1114(k) for deafness   |
| r PL 88-20 | > in both ears, with absence of air and bone            |
|            | > conduction.                                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### g.   | > *PL 88-22*, effective July 1, 1963, provided for the  |
|  SMC Under | > payment of SMC under 38 U.S.C. 1114(k) for organic    |
|  PL 88-22  | > aphonia with constant inability to communicate by     |
|            | > speech.                                               |
+------------+---------------------------------------------------------+

Continued on next page

48\. SMC Under 38 U.S.C. 1114(k), Continued

+------------+---------------------------------------------------------+
| ##### h.   | > *PL 90-77*, effective October 1, 1967                 |
|  SMC Under |                                                         |
|  PL 90-77  | -   provided for the payment of SMC                     |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   for each disability that met the criteria under 38  |
|            |     U.S.C. 1114(k), and                                 |
|            |                                                         |
|            | -   under both 38 U.S.C. 1114(s) and 38 U.S.C. 1114(k), |
|            |     and                                                 |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   removed the prohibition against using an additional |
|            |     disability, ratable as 50 percent disabling, to     |
|            |     justify granting an intermediate rate under 38      |
|            |     U.S.C. 1114(p), when the same disability had been   |
|            |     used as the basis for establishing entitlement to   |
|            |     SMC under 38 U.S.C. 1114(k).                        |
|            |                                                         |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   granting entitlement to SMC based on anatomical     |
|            |     loss, see *PL 79-182*                               |
|            |                                                         |
|            | -   granting entitlement to SMC for additional          |
|            |     disabilities, see *PL 86-663*, and/or               |
|            |                                                         |
|            | -   related changes to 38 CFR, Part 3, Adjudication,    |
|            |     see *Transmittal Sheet 407* and *Transmittal Sheet  |
|            |     415*.                                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### i.   | > *PL 106-419,* effective November 1, 2000, amended the |
| SMC Under  | > criteria for payment to include a woman veteran's     |
| PL 106-419 | > anatomical loss of one or both breasts, including     |
|            | > loss by mastectomy.                                   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### j.   | > *PL 107-330*, effective December 6, 2002, clarified   |
| SMC Under  | > that loss of one or both breasts includes             |
| PL 107-330 |                                                         |
|            | -   loss of 25 percent or more of breast tissue from a  |
|            |     single breast or both breasts in combination, and   |
|            |                                                         |
|            | -   subjection of breast tissue to radiation treatment. |
+------------+---------------------------------------------------------+

#### 49. SMC Under 38 U.S.C. 1114(l)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(l). It includes information on SMC under  |
|            |                                                         |
|            | -   *PL 73-2*                                           |
|            |                                                         |
|            | -   *PL 79-182*, and                                    |
|            |                                                         |
|            | -   *PL 97-66*.                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > *PL 73-2*, effective July 1, 1933, provided for the   |
| a. SMC Und | > payment of SMC under 38 U.S.C. 1114(l) for            |
| er PL 73-2 |                                                         |
|            | -   the anatomical L/LOU of                             |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   both hands or both feet                             |
|            |                                                         |
|            | -   one hand and one foot, or                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   being so helpless as to be in need of regular Aid   |
|            |     and Attendance (A&A).                               |
|            |                                                         |
|            | > ***Note***: Since *PL 73-2* did not provide for the   |
|            | > payment of intermediate levels of SMC, the level of   |
|            | > loss or loss of use had no effect on the level of SMC |
|            | > payable.                                              |
|            | >                                                       |
|            | > ***Example***: Amputation of one arm above the elbow  |
|            | > and amputation below the elbow of the other arm would |
|            | > establish entitlement to SMC under 38 U.S.C. 1114(l). |
+------------+---------------------------------------------------------+

Continued on next page

49\. SMC Under 38 U.S.C. 1114(l), Continued

+------------+---------------------------------------------------------+
| ##### b.   | > *PL 79-183*, effective October 1, 1945, provided for  |
|  SMC Under | > the payment of SMC under 38 U.S.C. 1114(l) if the     |
|  PL 79-182 | > veteran was                                           |
|            |                                                         |
|            | -   blind in both eyes, with visual acuity of 5/200     |
|            |     (1.5/60) or less, or                                |
|            |                                                         |
|            | -   permanently bedridden.                              |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   Concentric contraction of the field of vision       |
|            |     beyond 10 degrees was considered equivalent to      |
|            |     visual acuity of 5/200 (1.5/60) until July 6, 1950, |
|            |     the effective date of a change to the 1945 rating   |
|            |     schedule. Under the revised rating schedule,        |
|            |     concentric contraction of the field of vision       |
|            |     beyond 5 degrees was considered equivalent to       |
|            |     visual acuity of 5/200 (1.5/60)                     |
|            |                                                         |
|            | -   *PL 79-182* provided for payment of SMC at          |
|            |     intermediate levels.                                |
|            |                                                         |
|            | > ***Reference***: For more information on payment of   |
|            | > SMC at intermediate levels, see                       |
|            |                                                         |
|            | -   38 U.S.C. 1114(p), and                              |
|            |                                                         |
|            | -   M21-1MR, Part IV, Subpart ii, 2.I.53.               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c    | > *PL 97-66*, effective October 1, 1981, removed loss,  |
| . SMC Unde | > or loss of use, of both hands as a condition          |
| r PL 97-66 | > warranting entitlement to SMC under 38 U.S.C.         |
|            | > 1114(l).                                              |
|            | >                                                       |
|            | > ***Rationale***: Effective October 1, 1981, the loss, |
|            | > or loss of use, of both hands became one of the       |
|            | > criteria for entitlement to SMC under 38 U.S.C.       |
|            | > 1114(m).                                              |
|            | >                                                       |
|            | > ***Reference***: For more information on              |
|            |                                                         |
|            | -   related changes to 38 CFR, Part 3, Adjudication,    |
|            |     see *Transmittal Sheet 703*, and                    |
|            |                                                         |
|            | -   38 U.S.C. 1114(m), see M21-1MR, Part IV, Subpart    |
|            |     ii, 2.I.50.                                         |
+------------+---------------------------------------------------------+

#### 50. SMC Under 38 U.S.C. 1114(m)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(m). It includes information on SMC under  |
|            |                                                         |
|            | -   *PL 73-2*                                           |
|            |                                                         |
|            | -   *PL 79-182*                                         |
|            |                                                         |
|            | -   *PL 85-652*, and                                    |
|            |                                                         |
|            | -   *PL 97-66*.                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > *PL 73-2*, effective July 1, 1933, established the    |
| a. SMC Und | > criteria for payment of 38 U.S.C. 1114(m) as          |
| er PL 73-2 |                                                         |
|            | -   the L/LOU of three extremities, or                  |
|            |                                                         |
|            | -   blindness in both eyes, having LPO.                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > *PL 79-182*, effective October 1, 1945, provided for  |
|  b. SMC Un | > payment of SMC under 38 U.S.C. 1114(m) if the         |
| der 79-182 | > evidence showed                                       |
|            |                                                         |
|            | -   L/LOU of two extremities at a level, or with        |
|            |     complications, preventing natural elbow or knee     |
|            |     action with prosthesis in place, or                 |
|            |                                                         |
|            | -   blindness in both eyes, leaving the veteran so      |
|            |     helpless as to require A&A.                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > *PL 85-652*, effective September 1, 1958, reinstated  |
|  SMC Under | > blindness in both eyes, having LPO, as a condition    |
|  PL 85-652 | > warranting entitlement to SMC under 38 U.S.C.         |
|            | > 1114(m).                                              |
+------------+---------------------------------------------------------+

Continued on next page

50\. SMC Under 38 U.S.C. 1114(m), Continued

+------------+---------------------------------------------------------+
| ##### d    | > *PL 97-66*, effective October 1, 1981, elevated the   |
| . SMC Unde | > level of SMC for                                      |
| r PL 97-66 |                                                         |
|            | -   L/LOU of both hands from 38 U.S.C. 1114(l) to 38    |
|            |     U.S.C. 1114(m), and                                 |
|            |                                                         |
|            | -   L/LOU of both arms at levels, or with               |
|            |     complications, preventing natural elbow action with |
|            |     prosthesis in place from 38 U.S.C. 1114(m) to 38    |
|            |     U.S.C. 1114(n).                                     |
|            |                                                         |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 703*.                              |
+------------+---------------------------------------------------------+

#### 51. SMC Under 38 U.S.C. 1114(n)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(n). It includes information on SMC under  |
|            |                                                         |
|            | -   *PL 73-2*                                           |
|            |                                                         |
|            | -   *PL 79-182*                                         |
|            |                                                         |
|            | -   *PL 97-66*, and                                     |
|            |                                                         |
|            | -   *PL 97-306*.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > *PL 73-2*, effective July 1, 1933, provided for       |
| a. SMC Und | > payment of SMC under 38 U.S.C. 1114(n) as blindness   |
| er PL 73-2 | > in both eyes, having LPO, ***plus*** the L/LOU of one |
|            | > extremity.                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > *PL 79-182*, effective October 1, 1945, provided for  |
|  SMC Under | > payment of SMC under 38 U.S.C. 1114(n) if the         |
|  PL 79-182 | > evidence showed anatomical loss of                    |
|            |                                                         |
|            | -   two extremities so near the shoulder or hip as to   |
|            |     prevent the use of a prosthetic appliance, or       |
|            |                                                         |
|            | -   both eyes, or total blindness of both eyes, having  |
|            |     no light perception, accompanied by                 |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   phthisis bulbi                                      |
|            |                                                         |
|            | -   evisceration, or                                    |
|            |                                                         |
|            | -   other obvious deformity or disfigurement.           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c    | > *PL 97-66*, effective October 1, 1981, elevated the   |
| . SMC Unde | > level of SMC for                                      |
| r PL 97-66 |                                                         |
|            | -   L/LOU of both arms at levels, or with               |
|            |     complications, preventing natural elbow action with |
|            |     a prosthesis in place from 38 U.S.C. 1114(m) to 38  |
|            |     U.S.C. 1114(n), and                                 |
|            |                                                         |
|            | -   anatomical loss of both arms so near the shoulder   |
|            |     as to prevent the use of a prosthetic appliance     |
|            |     from 38 U.S.C. 1114(n) to 38 U.S.C. 1114(o).        |
|            |                                                         |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 703*.                              |
+------------+---------------------------------------------------------+

Continued on next page

51\. SMC Under 38 U.S.C. 1114(n), Continued

+------------+---------------------------------------------------------+
| ##### d.   | > *PL 97-306*, effective October 1, 1982,               |
|  SMC Under |                                                         |
|  PL 97-306 | -   added blindness without light perception in both    |
|            |     eyes as a condition warranting entitlement to SMC,  |
|            |     and                                                 |
|            |                                                         |
|            | -   removed the requirement that blindness must be      |
|            |     accompanied by                                      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   phthisis bulbi                                      |
|            |                                                         |
|            | -   evisceration, or                                    |
|            |                                                         |
|            | -   other obvious deformity or disfigurement.           |
|            |                                                         |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   SMC for anatomical loss or blindness, see *PL       |
|            |     79-182*, and                                        |
|            |                                                         |
|            | -   related changes to 38 CFR, Part 3, Adjudication,    |
|            |     see *Transmittal Sheet 721*.                        |
+------------+---------------------------------------------------------+

#### 52. SMC Under 38 U.S.C. 1114(o)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(o). It includes information on SMC under  |
|            |                                                         |
|            | -   *PL 73-2*                                           |
|            |                                                         |
|            | -   *PL 79-182*                                         |
|            |                                                         |
|            | -   *PL 85-782*                                         |
|            |                                                         |
|            | -   *PL 89-311*                                         |
|            |                                                         |
|            | -   *PL 97-66*, and                                     |
|            |                                                         |
|            | -   *PL 98-223*.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > *PL 73-2*, effective July 1, 1933, established the    |
| a. SMC Und | > criterion for payment of SMC under 38 U.S.C. 1114(o)  |
| er PL 73-2 | > for two or more conditions warranting entitlement to  |
|            | > SMC under 38 U.S.C. 1114(l) through (n).              |
|            | >                                                       |
|            | > ***Important***: No condition could be considered     |
|            | > twice.                                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > *PL 79-182*, effective October 1, 1945, provided for  |
|  SMC Under | > payment of SMC under 38 U.S.C. 1114(o) for            |
|  PL 79-182 |                                                         |
|            | -   bilateral blindness, with visual acuity of 5/200    |
|            |     (1.5/60) or less, in combination with bilateral     |
|            |     total deafness, and/or                              |
|            |                                                         |
|            | -   transverse myelitis, with loss of use of both legs  |
|            |     and loss of anal and bladder control.               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > *PL 85-782*, effective October 1, 1958, created a new |
|  SMC Under | > level of SMC under 38 U.S.C. 1114(r).                 |
|  PL 85-782 | >                                                       |
|            | > ***Reference***: For more information on              |
|            |                                                         |
|            | -   SMC under 38 U.S.C. 1114(r), see M21-1MR, Part IV,  |
|            |     Subpart ii, 2.I.55, and                             |
|            |                                                         |
|            | -   determining the maximum rate payable under 38       |
|            |     U.S.C. 1114(p), see M21-1MR, Part IV, Subpart ii,   |
|            |     2.I.58.                                             |
+------------+---------------------------------------------------------+

Continued on next page

52\. SMC Under 38 U.S.C. 1114(o), Continued

+------------+---------------------------------------------------------+
| ##### d.   | > *PL 89-311*, effective December 1, 1965, amended the  |
|  SMC Under | > criteria under 38 U.S.C. 1114(o) (*PL 85-782*) to     |
|  PL 89-311 | > read: bilateral deafness, with the hearing impairment |
|            | > in one or both ears service-connected (SC), rated at  |
|            | > 60 percent, or more, plus SC total blindness with     |
|            | > 5/200 (1.5/60) visual acuity, or less.                |
|            | >                                                       |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 364.*                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e    | > *PL 97-66*, effective October 1, 1981, elevated the   |
| . SMC Unde | > level of SMC for anatomical loss of both arms so near |
| r PL 97-66 | > the shoulder as to prevent the use of prosthetic      |
|            | > appliances from 38 U.S.C. 1114(o) to 38 U.S.C.        |
|            | > 1114(n).                                              |
|            | >                                                       |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 703*.                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### f.   | > *PL 98-223*, effective October 1, 1983, provided for  |
|  SMC Under | > payment of SMC under 38 U.S.C. 1114(o) to include     |
|  PL 98-223 | > bilateral blindness, having LPO or less, with         |
|            |                                                         |
|            | -   SC total deafness in one ear, or                    |
|            |                                                         |
|            | -   bilateral hearing loss, rated 40 percent or more    |
|            |     disabling, with SC hearing impairment in at least   |
|            |     one ear.                                            |
+------------+---------------------------------------------------------+

#### 53. SMC Under 38 U.S.C. 1114(p)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(p). It includes information on SMC under  |
|            |                                                         |
|            | -   *PL 79-182*                                         |
|            |                                                         |
|            | -   *PL 85-782*                                         |
|            |                                                         |
|            | -   *PL 89-311*                                         |
|            |                                                         |
|            | -   *PL 90-77*                                          |
|            |                                                         |
|            | -   *PL 95-479*                                         |
|            |                                                         |
|            | -   *PL 97-66*                                          |
|            |                                                         |
|            | -   *PL 97-306*, and                                    |
|            |                                                         |
|            | -   *PL 98-223*.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > *PL 79-182*, effective October 1, 1945, established   |
|  SMC Under | > intermediate steps of SMC for disablement that        |
|  PL 79-182 | > exceeded the requirements for entitlement to any of   |
|            | > the levels of SMC under 38 U.S.C. 1114(l) through     |
|            | > (n).                                                  |
|            | >                                                       |
|            | > The table below lists the criteria set forth in *PL   |
|            | > 79-182* for establishing entitlement to each          |
|            | > intermediate step of SMC.                             |
+------------+---------------------------------------------------------+

+-------------+--------------------------------------------------------+
| I           | Criteria                                               |
| ntermediate |                                                        |
| Step        |                                                        |
+-------------+--------------------------------------------------------+
| l½          | -   L/LOU of                                           |
|             |                                                        |
|             | ```{=html}                                             |
|             | <!-- -->                                               |
|             | ```                                                    |
|             | -   one hand or one foot, and                          |
|             |                                                        |
|             | -   another extremity at a level or with complications |
|             |     preventing natural elbow or knee action with       |
|             |     prosthesis in place, or                            |
|             |                                                        |
|             | ```{=html}                                             |
|             | <!-- -->                                               |
|             | ```                                                    |
|             | -   blindness of one eye with 5/200 (1.5/60) visual    |
|             |     acuity or less, and blindness of the other eye     |
|             |     having LPO.                                        |
+-------------+--------------------------------------------------------+

Continued on next page

53\. SMC Under 38 U.S.C. 1114(p), Continued

  -----------------------------------------------------------------------
  a\. SMC Under PL 79-182 (continued)

  -----------------------------------------------------------------------

+-------------+--------------------------------------------------------+
| I           | Criteria                                               |
| ntermediate |                                                        |
| Step        |                                                        |
+-------------+--------------------------------------------------------+
| m           | -   the anatomical loss                                |
|             |                                                        |
|             | ```{=html}                                             |
|             | <!-- -->                                               |
|             | ```                                                    |
|             | -   or loss of use, of one hand or one foot, and       |
|             |                                                        |
|             | -   of another extremity so near the shoulder or hip   |
|             |     as to prevent the use of a prosthetic appliance,   |
|             |     or                                                 |
|             |                                                        |
|             | ```{=html}                                             |
|             | <!-- -->                                               |
|             | ```                                                    |
|             | -   blindness of one eye, having 5/200 (1.5/60) visual |
|             |     acuity or less, and anatomical loss, or blindness, |
|             |     having no light perception, accompanied by         |
|             |     phthisis bulbi, evisceration, or other obvious     |
|             |     deformity or disfigurement of the other eye.       |
+-------------+--------------------------------------------------------+
| m½          | -   the anatomical loss                                |
|             |                                                        |
|             | ```{=html}                                             |
|             | <!-- -->                                               |
|             | ```                                                    |
|             | -   or loss of use, of one extremity at a level or     |
|             |     with complications preventing natural elbow or     |
|             |     knee action with prosthesis in place, and          |
|             |                                                        |
|             | -   of another extremity so near the shoulder or hip   |
|             |     as to prevent the use of a prosthetic appliance,   |
|             |     or                                                 |
|             |                                                        |
|             | ```{=html}                                             |
|             | <!-- -->                                               |
|             | ```                                                    |
|             | -   blindness of one eye, having light perception, and |
|             |     anatomical loss, or blindness, having no light     |
|             |     perception accompanied by phthisis bulbi,          |
|             |     evisceration, or other obvious deformity or        |
|             |     disfigurement of the other eye.                    |
+-------------+--------------------------------------------------------+
| additional  | an additional SC disability independently rated 50     |
| ½ step      | percent or more disabling.                             |
+-------------+--------------------------------------------------------+
| additional  | an additional SC disability independently rated 100    |
| full step   | percent disabling.                                     |
+-------------+--------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > *PL 85-782*, effective October 10, 1958, established  |
|  SMC Under | > a level of SMC under 38 U.S.C. 1114(r).               |
|  PL 85-782 | >                                                       |
|            | > ***Note***: One way to establish basic entitlement to |
|            | > SMC under 38 U.S.C. 1114(r) was for the veteran to be |
|            | > entitled to the maximum rate under 38 U.S.C. 1114(p). |
|            | >                                                       |
|            | > ***Reference***: For a history of decisions regarding |
|            | > determination of the maximum rate under 38 U.S.C.     |
|            | > 1114(p), see M21-1MR, Part IV, Subpart ii, 2.I.58.    |
+------------+---------------------------------------------------------+

Continued on next page

53\. SMC Under 38 U.S.C. 1114(p), Continued

+------------+---------------------------------------------------------+
| ##### c.   | > *PL 89-311*, effective December 1, 1965, provided for |
|  SMC Under | > the payment of SMC under 38 U.S.C. 1114(p) to include |
|  PL 89-311 |                                                         |
|            | -   blindness plus bilateral deafness, which            |
|            |     established entitlement to an additional full step  |
|            |     of SMC if the evidence showed                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   SC blindness with 5/200 (1.5/60) visual acuity, or  |
|            |     less, and                                           |
|            |                                                         |
|            | -   bilateral deafness, rated at least 40 percent       |
|            |     disabling, with SC hearing impairment in at least   |
|            |     one ear, and                                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   blindness plus total deafness in one ear, which     |
|            |     established entitlement to an additional half step  |
|            |     of SMC if the veteran had                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   SC blindness with 5/200 (1.5/60) visual acuity, or  |
|            |     less, and                                           |
|            |                                                         |
|            | -   SC total deafness in one ear.                       |
|            |                                                         |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 364*.                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d    | > *PL 90-77*, effective October 1, 1967                 |
| . SMC Unde |                                                         |
| r PL 90-77 | -   amended the criterion restricting concurrent        |
|            |     payment under 38 U.S.C. 1114(k) and 38 U.S.C.       |
|            |     1114(s), and                                        |
|            |                                                         |
|            | -   deleted the prohibition against using an additional |
|            |     disability, rated at least 50 percent disabling, to |
|            |     grant entitlement to an additional half step of SMC |
|            |     under 38 U.S.C. 1114(p), when the same disability   |
|            |     had been used to establish entitlement to SMC under |
|            |     38 U.S.C. 1114(k).                                  |
|            |                                                         |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   38 U.S.C. 1114(s), see M21-1MR, Part IV, Subpart    |
|            |     ii, 2.I.56, and                                     |
|            |                                                         |
|            | -   related changes to 38 CFR, Part 3, Adjudication,    |
|            |     see *Transmittal Sheet 415*.                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e.   | > *PL 95-479*, effective October 1, 1978, authorized an |
|  SMC Under | > additional half step of SMC for L/LOU of use of three |
|  PL 95-479 | > extremities.                                          |
|            | >                                                       |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 649*.                              |
+------------+---------------------------------------------------------+

Continued on next page

53\. SMC Under 38 U.S.C. 1114(p), Continued

+-----------+----------------------------------------------------------+
| ##### f.  | > *PL 97-66*, effective October 1, 1981                  |
| SMC Under |                                                          |
|  PL 97-66 | -   increased by one full step the levels of SMC payable |
|           |     for bilateral L/LOU of both upper extremities, and   |
|           |                                                          |
|           | -   established levels of SMC under 38 U.S.C. 1114(p)    |
|           |     for the varying levels of L/LOU of the upper         |
|           |     extremities.                                         |
|           |                                                          |
|           | > The table below lists the criteria set forth in *PL    |
|           | > 97-66* for establishing entitlement to SMC at the      |
|           | > three levels shown.                                    |
+-----------+----------------------------------------------------------+

+----------------+-----------------------------------------------------+
| SMC level      | Criteria                                            |
+----------------+-----------------------------------------------------+
| m½             | -   L/LOU of one hand, and                          |
|                |                                                     |
|                | -   L/LOU of one arm at a level, or with            |
|                |     complications, preventing natural elbow action  |
|                |     with prosthesis in place.                       |
|                |                                                     |
|                | ***Note***: Level "m½" was previously designated    |
|                | "l½."                                               |
+----------------+-----------------------------------------------------+
| n              | -   L/LOU of one hand, and                          |
|                |                                                     |
|                | -   loss of one arm so near the shoulder as to      |
|                |     prevent the use of a prosthetic appliance.      |
|                |                                                     |
|                | ***Note***: Level "n" was previously designated     |
|                | "m."                                                |
+----------------+-----------------------------------------------------+
| n½             | -   L/LOU of one arm at a level or with             |
|                |     complications preventing natural elbow action   |
|                |     with prosthesis in place, and                   |
|                |                                                     |
|                | -   loss of one arm so near the shoulder as to      |
|                |     prevent the use of a prosthetic appliance.      |
|                |                                                     |
|                | ***Note***: Level "n½" was previously designated    |
|                | "m½."                                               |
+----------------+-----------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Reference***: For more information on related changes to 38 CFR, |
| > Part 3, Adjudication, see *Transmittal Sheet 703*.                  |
+-----------------------------------------------------------------------+

Continued on next page

53\. SMC Under 38 U.S.C. 1114(p), Continued

+------------+---------------------------------------------------------+
| ##### g.   | > *PL 97-306*, effective October 1, 1982, provided for  |
|  SMC Under | > the payment of an additional half step or a full step |
|  PL 97-306 | > of SMC for blindness with loss, or loss of use, of    |
|            | > one hand or one foot.                                 |
|            | >                                                       |
|            | > The table below lists the criteria set forth in *PL   |
|            | > 97-306* for establishing entitlement to an additional |
|            | > half or full step of SMC.                             |
+------------+---------------------------------------------------------+

+---------------+------------------------------------------------------+
| The veteran   | If the medical evidence shows ...                    |
| is entitled   |                                                      |
| to ...        |                                                      |
+---------------+------------------------------------------------------+
| a full step   | -   bilateral blindness, with visual acuity of 5/200 |
| of SMC        |     (1.5/60) or less, and                            |
|               |                                                      |
|               | -   L/LOU of one hand.                               |
+---------------+------------------------------------------------------+
| a full step   | -   bilateral blindness, with visual acuity of 5/200 |
| of SMC        |     (1.5/60), or less, and                           |
|               |                                                      |
|               | -   L/LOU of one foot which, by itself, or in        |
|               |     combination with another compensable disability, |
|               |     is 50 percent or more disabling.                 |
+---------------+------------------------------------------------------+
| a half step   | -   bilateral blindness, with visual acuity of 5/200 |
| of SMC        |     (1.5/60) or less, and                            |
|               |                                                      |
|               | -   L/LOU of one foot, which is                      |
|               |                                                      |
|               | ```{=html}                                           |
|               | <!-- -->                                             |
|               | ```                                                  |
|               | -   less than 50 percent disabling, and              |
|               |                                                      |
|               | -   the only compensable disability, other than      |
|               |     bilateral blindness.                             |
+---------------+------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Note***: *PL 97-306* also removed the previous requirement that  |
| > blindness with no light perception be accompanied by phthisis       |
| > bulbi, evisceration, or other obvious deformity or disfigurement.   |
| >                                                                     |
| > ***References***: For more information on                           |
|                                                                       |
| -   additional disabilities rated 50-percent and 100-percent          |
|     disabling, see M21-1MR, Part IV, Subpart ii, 2.H.41, and          |
|                                                                       |
| -   related changes to 38 CFR, Part 3, Adjudication, see *Transmittal |
|     Sheet 721*.                                                       |
+-----------------------------------------------------------------------+

Continued on next page

53\. SMC Under 38 U.S.C. 1114(p), Continued

+------------+---------------------------------------------------------+
| ##         | > The veteran is entitled to increased levels of SMC    |
| ### h. SMC | > for bilateral blindness with no light perception in   |
|  Under PL  | > one eye.                                              |
| 97-306 for | >                                                       |
|  Bilateral | > ***Note***: *PL 97-306* changed the level of SMC that |
|  Blindness | > may be awarded for blindness by equating blindness    |
|            | > with no light perception to enucleation of the eye.   |
|            | >                                                       |
|            | > ***Example***: The appropriate level of SMC for       |
|            | > bilateral blindness with no light perception in one   |
|            | > eye may be calculated as follows:                     |
|            |                                                         |
|            | -   5/200 (1.5/60) & NLP = "m," and                     |
|            |                                                         |
|            | -   LPO & NLP = "m½."                                   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### i.   | > *PL 98-223*, effective October 1, 1983, authorized an |
|  SMC Under | > additional                                            |
|  PL 98-223 |                                                         |
|            | -   full step of SMC for                                |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   SC blindness, with visual acuity of 5/200 (1.5/60)  |
|            |     or less, in combination with                        |
|            |                                                         |
|            | -   bilateral deafness, rated at least 30 percent       |
|            |     disabling (with SC hearing impairment in one or     |
|            |     both ears), and                                     |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   half step of SMC for                                |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   SC blindness, having LPO or less, with              |
|            |                                                         |
|            | -   bilateral deafness, rated 10 or 20 percent          |
|            |     disabling (with SC hearing impairment in one or     |
|            |     both ears).                                         |
|            |                                                         |
|            | ***Notes***:                                            |
|            |                                                         |
|            | -   Prior to enactment of *PL 98-223*, hearing          |
|            |     impairment rated 40 percent disabling was required  |
|            |     for entitlement to a full step of SMC.              |
|            |                                                         |
|            | -   Veterans with bilateral blindness, having better    |
|            |     than LPO in either eye, plus SC total deafness in   |
|            |     one ear, remain entitled to an additional half step |
|            |     of SMC.                                             |
|            |                                                         |
|            | -   Veterans with bilateral blindness, having LPO or    |
|            |     less, plus SC total deafness in one ear, are        |
|            |     entitled to SMC under 38 U.S.C. 1114(o).            |
|            |                                                         |
|            | > ***Reference***: For more information on 38 U.S.C.    |
|            | > 1114(o), see M21-1MR, Part IV, Subpart ii, 2.I.52.    |
+------------+---------------------------------------------------------+

#### 54. SMC Under 38 U.S.C. 1114(q)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(q). It includes information on SMC under  |
|            |                                                         |
|            | -   *PL 82-427*, and                                    |
|            |                                                         |
|            | -   *PL 90-493*.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > *PL 82-427*, effective August 1, 1968, established a  |
|  SMC Under | > minimum level of SMC for veterans whose tuberculosis  |
|  PL 82-427 | > was completely arrested.                              |
|            | >                                                       |
|            | > ***Note***: The minimum rate of SMC payable under     |
|            | > this law was \$67.00.                                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > *PL 90-493*, effective August 19, 1968, repealed 38   |
|  SMC Under | > U.S.C. 1114(q) except for those veterans who on       |
|  PL 90-493 | > August 19, 1968, were receiving or entitled to        |
|            | > receive disability compensation for tuberculosis.     |
|            | >                                                       |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 429*.                              |
+------------+---------------------------------------------------------+

#### 55. SMC Under 38 U.S.C. 1114(r)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(r). It includes information on SMC under  |
|            |                                                         |
|            | -   *PL 85-782*                                         |
|            |                                                         |
|            | -   *PL 95-479*, and                                    |
|            |                                                         |
|            | -   *PL 96-128*.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > *PL 85-782*, effective October 1, 1958, established a |
|  SMC Under | > new level of SMC under 38 U.S.C. 1114(r). Entitlement |
|  PL 85-782 | > was granted if the veteran met the following          |
|            | > criteria:                                             |
|            |                                                         |
|            | -   the veteran was entitled to the maximum rate under  |
|            |     either                                              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   38 U.S.C. 1114(o), or                               |
|            |                                                         |
|            | -   38 U.S.C. 1114(p), and                              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   was in need of regular A&A.                         |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   Payment of SMC under 38 U.S.C. 1114(r) while        |
|            |     hospitalized at government expense was prohibited.  |
|            |                                                         |
|            | -   If the need for A&A was one of the bases for        |
|            |     establishing entitlement under either 38 U.S.C.     |
|            |     1114(o) or 38 U.S.C. 1114(p), VA still paid the     |
|            |     additional benefit under 38 U.S.C. 1114(r).         |
+------------+---------------------------------------------------------+

Continued on next page

55\. SMC Under 38 U.S.C. 1114(r), Continued

+------------+---------------------------------------------------------+
| ##### b.   | > *PL 95-479*, effective October 1, 1978                |
|  SMC Under |                                                         |
|  PL 95-479 | -   added a new subsection, 38 U.S.C. 1114(r)(2)        |
|            |                                                         |
|            | -   redesignated the existing 38 U.S.C. 1114(r) as 38   |
|            |     U.S.C. 1114(r)(1), and                              |
|            |                                                         |
|            | -   provided for the payment of SMC under 38 U.S.C.     |
|            |     1114(r)(2) if a veteran in receipt of SMC under 38  |
|            |     U.S.C. 1114(r)(1) was entitled to a higher level of |
|            |     care.                                               |
|            |                                                         |
|            | > ***Note***: Entitlement under 38 U.S.C. 1114(r)(2)    |
|            | > while hospitalized at government expense was          |
|            | > prohibited.                                           |
|            | >                                                       |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 649*.                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > *PL 96-128*, effective October 1, 1979, expanded the  |
|  SMC Under | > field of eligible veterans under both 38 U.S.C.       |
|  PL 96-128 | > 1114(r)(1) and 38 U.S.C. 1114(r)(2) to include        |
|            | > veterans rated 100 percent disabled, who are also     |
|            | > entitled to SMC at a level of "n½+k," and are in need |
|            | > of                                                    |
|            |                                                         |
|            | -   regular A&A under 38 U.S.C. 1114(r)(1), and         |
|            |                                                         |
|            | -   a higher level of care under 38 U.S.C. 1114(r)(2).  |
|            |                                                         |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 669*.                              |
+------------+---------------------------------------------------------+

#### 56. SMC Under 38 U.S.C. 1114(s)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(s). It includes information on SMC under  |
|            |                                                         |
|            | -   *PL 86-663*, and                                    |
|            |                                                         |
|            | -   *PL 90-77*.                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > *PL 86-663*, effective September 1, 1960, established |
|  SMC Under | > a new level of SMC under 38 U.S.C. 1114(s).           |
|  PL 86-663 | > Entitlement existed if the veteran had an SC          |
|            | > disability rated 100 percent disabling and            |
|            |                                                         |
|            | -   an additional SC disability or disabilities,        |
|            |     independently ratable as 60 percent or more         |
|            |     disabling, or                                       |
|            |                                                         |
|            | -   was permanently housebound by reason of the SC      |
|            |     disability or disabilities.                         |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   If the veteran was entitled to SMC under 38 U.S.C.  |
|            |     1114(k) by virtue of the disability ratable as 60   |
|            |     percent disabling, the veteran was to be paid basic |
|            |     disability compensation for the disability          |
|            |     considered 100 percent disabling, plus SMC under 38 |
|            |     U.S.C. 1114(k), since the combined rate was a       |
|            |     greater benefit than paying basic disability        |
|            |     compensation for the disability rated 100 percent   |
|            |     disabling, plus SMC under 38 U.S.C. 1114(s).        |
|            |                                                         |
|            | -   SMC under 38 U.S.C. 1114(k) was not payable in      |
|            |     addition to SMC under 38 U.S.C. 1114(s).            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b    | > *PL 90-77*, effective October 1, 1967, allowed for    |
| . SMC Unde | > the payment of SMC under 38 U.S.C. 1114(k), in        |
| r PL 90-77 | > addition to SMC under 38 U.S.C. 1114(s).              |
|            | >                                                       |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 407*.                              |
+------------+---------------------------------------------------------+

#### 57. SMC Under 38 U.S.C. 1114(t)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on SMC under 38       |
| troduction | > U.S.C. 1114(t). It includes information on SMC under  |
|            |                                                         |
|            | -   *PL 95-479*, and                                    |
|            |                                                         |
|            | -   *PL 99-576*.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > *PL 95-479*, effective October 1, 1978, established a |
|  SMC Under | > new level of SMC under 38 U.S.C. 1114(t). Entitlement |
|  PL 95-479 | > was granted if the veteran                            |
|            |                                                         |
|            | -   was rated less than 100 percent disabled and was    |
|            |     entitled to SMC under 38 U.S.C. 1114(k) for the     |
|            |     L/LOU of an extremity rated 40 percent or more      |
|            |     disabling, and                                      |
|            |                                                         |
|            | -   had L/LOU of a paired extremity as a result of a    |
|            |     nonservice-connected (NSC) disability, not the      |
|            |     result of the veteran\'s own willful misconduct,    |
|            |     that would be rated, if SC, at least 40 percent     |
|            |     disabling.                                          |
|            |                                                         |
|            | > ***Note***: 38 CFR 3.383 and 38 U.S.C. 1160 allow for |
|            | > the rating of a NSC paired organ or extremity as if   |
|            | > SC.                                                   |
|            | >                                                       |
|            | > ***Reference***: For more information on related      |
|            | > changes to 38 CFR, Part 3, Adjudication, see          |
|            | > *Transmittal Sheet 649*.                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > *PL 99-576*, effective October 28, 1986, repealed 38  |
|  SMC Under | > U.S.C. 1114(t).                                       |
|  PL 99-576 |                                                         |
+------------+---------------------------------------------------------+

#### 58. Maximum Allowable Rates Under 38 U.S.C. 1114(p)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on maximum allowable  |
| troduction | > rates, including information on                       |
|            |                                                         |
|            | -   determining the maximum rate under 38 U.S.C.        |
|            |     1114(p) for the purpose of determining entitlement  |
|            |     to SMC under 38 U.S.C. 1114(r)                      |
|            |                                                         |
|            | -   the history of decisions affecting determinations   |
|            |     of the maximum allowable rate under 38 U.S.C.       |
|            |     1114(p)                                             |
|            |                                                         |
|            | -   the consequences of the reinterpretation of General |
|            |     Counsel (GC) Opinion 9-63 in 1977                   |
|            |                                                         |
|            | -   determining entitlement to SMC under 38 U.S.C.      |
|            |     1114(r) after 1977                                  |
|            |                                                         |
|            | -   disabilities warranting consideration under 38      |
|            |     U.S.C. 1114(o) or (p), as well as 38 U.S.C.         |
|            |     1114(r).                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > *PL 85-782*, effective October 1, 1958, created a     |
| #### a. De | > level of SMC under 38 U.S.C. 1114(r). One of the ways |
| termining  | > to establish basic entitlement under 38 U.S.C.        |
| the Maximu | > 1114(r) was for the veteran to be entitled to the     |
| m Rate Und | > maximum rate under 38 U.S.C. 1114(p), that is, 38     |
| er 38 U.S. | > U.S.C. 1114(o).                                       |
| C. 1114(p) | >                                                       |
|            | > The question arose as to what constituted the maximum |
|            | > rate under 38 U.S.C. 1114(p). For example, if a       |
|            | > veteran was entitled to "n½" under 38 U.S.C. 1114(p), |
|            | > this rate was less than the maximum under 38 U.S.C.   |
|            | > 1114(o). However, if the veteran also had independent |
|            | > entitlement to SMC under 38 U.S.C. 1114(k), that is,  |
|            | > "n½ +k," the rate payable exceeded the maximum under  |
|            | > 38 U.S.C. 1114(p), that is, 38 U.S.C. 1114(o).        |
|            | >                                                       |
|            | > ***Question***: The question to be resolved then was  |
|            | > whether the SMC payable under 38 U.S.C. 1114(k) could |
|            | > be added to the rate payable under 38 U.S.C. 1114(p), |
|            | > in this example, "n½," to establish basic entitlement |
|            | > to 38 U.S.C. 1114(r).                                 |
|            | >                                                       |
|            | > ***Response***: For a history of the relevant         |
|            | > decisions that have addressed the question of what    |
|            | > constitutes the maximum rate of SMC under 38 U.S.C.   |
|            | > 1114(p), see M21-1MR, Part IV, Subpart ii, 2.I.58.b   |
|            | > though d.                                             |
+------------+---------------------------------------------------------+

Continued on next page

58\. Maximum Allowable Rates Under 38 U.S.C. 1114(p), Continued

+------------+---------------------------------------------------------+
| ##### b.   | > The table below describes the history of relevant     |
|  History o | > decisions affecting determinations of the maximum     |
| f Decision | > rate of SMC under 38 U.S.C. 1114(p).                  |
| s Affectin |                                                         |
| g Determin |                                                         |
| ations of  |                                                         |
| the Maximu |                                                         |
| m Allowabl |                                                         |
| e Rate Und |                                                         |
| er 38 U.S. |                                                         |
| C. 1114(p) |                                                         |
+------------+---------------------------------------------------------+

+--------------------+-------------------------------------------------+
| Decision and Date  | Opinion                                         |
+--------------------+-------------------------------------------------+
| General Counsel    | Held that since 38 U.S.C. 1114(k) is not part   |
| (GC) Opinion       | of 38 U.S.C. 1114(p), the maximum rate under 38 |
| 18-59, dated June  | U.S.C. 1114(p) was not being paid, and          |
| 18, 1959           | therefore the veteran                           |
|                    |                                                 |
|                    | -   did *not* have basic eligibility to SMC     |
|                    |     under 38 U.S.C. 1114(r), and                |
|                    |                                                 |
|                    | -   should be paid SMC under 38 U.S.C. 1114(o). |
+--------------------+-------------------------------------------------+
| GC Opinion 9-63,   | Reversed GC opinion 18-59 and held that any     |
| dated June 13,     | veteran entitled to the maximum SMC rate, which |
| 1963               | is SMC under 38 U.S.C. 1114(o), under any       |
|                    | provision in 38 U.S.C. 1114 met the basic       |
|                    | eligibility criteria for SMC under 38 U.S.C.    |
|                    | 1114(r).                                        |
|                    |                                                 |
|                    | This meant that veterans who were entitled to   |
|                    | SMC at the level of "n+2k," "n+3k," or "n½ +k," |
|                    | all of which exceeded the rate of SMC under 38  |
|                    | U.S.C. 1114(o), were to be paid SMC under 38    |
|                    | U.S.C. 1114(r).                                 |
+--------------------+-------------------------------------------------+
| Reinterpretation   | -   Determined that GC Opinion 9-63 did *not*   |
| of GC Opinion 9-63 |     say that all veterans entitled to the       |
| in 1977            |     maximum rate under 38 U.S.C. 1114(o) were   |
|                    |     also entitled automatically to SMC under 38 |
|                    |     U.S.C. 1114(r), and                         |
|                    |                                                 |
|                    | -   held that basic eligibility to the SMC      |
|                    |     under 38 U.S.C. 1114(r) was established,    |
|                    |     and if the need for A&A was demonstrated,   |
|                    |     SMC under 38 U.S.C. 1114(r) could then be   |
|                    |     paid.                                       |
+--------------------+-------------------------------------------------+

Continued on next page

58\. Maximum Allowable Rates Under 38 U.S.C. 1114(p), Continued

+------------+---------------------------------------------------------+
| #####      | > As a consequence of the 1977 decision, and in         |
|  c. Conseq | > conjunction with the adjustment necessitated by the   |
| uences of  | > rate increase mandated by *PL 95-117*, effective      |
| the Reinte | > October 1, 1977, write-outs were generated for each   |
| rpretation | > SMC code 15 or 28, "n+3k" and "n½ +k" respectively.   |
|  of Genera | >                                                       |
| l Counsel  | > The affected cases were to be reviewed to determine   |
| Opinion 9- | > whether the veteran required A&A, in order to justify |
| 63 in 1977 | > continued entitlement under 38 U.S.C. 1114(r).        |
|            | >                                                       |
|            | > ***Note***: A liberal interpretation was to be        |
|            | > applied in making this determination, and no          |
|            | > veteran's benefit was to be reduced below the rate    |
|            | > payable under 38 U.S.C. 1114(r) without review of the |
|            | > veteran's case by CO.                                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > After the 1977 decision, entitlement under 38 U.S.C.  |
| # d. Deter | > 1114(r) for any veterans receiving SMC under 38       |
| mining Ent | > U.S.C. 1114(o), or the maximum rate under 38 U.S.C.   |
| itlement t | > 1114(p), was to be based on whether a factual need    |
| o SMC unde | > for A&A existed.                                      |
| r 38 U.S.C | >                                                       |
| . 1114(r)  | > ***Important***: This is the criterion currently in   |
| after 1977 | > effect.                                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e    | > The need for A&A may be based on one of the same      |
| . Disabili | > disabilities that is used to establish entitlement to |
| ties Warra | > SMC under either 38 U.S.C. 1114(o) or to the maximum  |
| nting Cons | > rate under 38 U.S.C. 1114(p).                         |
| ideration  | >                                                       |
| Under 38 U | > ***Example***:                                        |
| .S.C. 1114 | >                                                       |
| (o) or (p) | > ***Situation***: The veteran is entitled to           |
| , as well  |                                                         |
| as 38 U.S. | -   SMC at the "n½" level, based on amputation of the   |
| C. 1114(r) |     left arm at the shoulder and amputation of the      |
|            |     right arm above the elbow, and                      |
|            |                                                         |
|            | -   SMC under 38 U.S.C. 1114(p) to (o), based on the    |
|            |     existence of a separate disability rated 50 percent |
|            |     disabling.                                          |
|            |                                                         |
|            | > ***Result***: If evidence shows the veteran requires  |
|            | > A&A by reason of the bilateral amputations, award     |
|            | > entitlement to SMC under 38 U.S.C. 1114(r), using SMC |
|            | > code 55.                                              |
|            | >                                                       |
|            | > ***Note***: Because veterans entitled to SMC at these |
|            | > levels are, by definition, very seriously disabled,   |
|            | > apply a liberal interpretation of the law in          |
|            | > determining the need for A&A.                         |
+------------+---------------------------------------------------------+