d. Determining the Extent of Examinations in Claims Involving SMC Under 38 U.S.C. 1114(l) Through (n) Exercise considerable care when requesting examinations in connection with claims involving SMC under . Example: A prior examination clearly established LOU of both lower extremities at a level preventing natural knee action. Do not request a complete medical examination if the only issue in question is the extent of involvement of one or both of the upper extremities. Instead, request an examination with a notation that the examination be restricted to the degree of functional impairment of the upper extremities. e. Considering Amputation or LOU of Extremities A determination as to LOU of a hand or foot is not restricted to organic loss; it includes functional LOU as well. The relevant inquiry concerning entitlement to SMC is not whether amputation is warranted. Instead, question whether the effective function remaining is other than that which would be equally well served by an amputation with the use of a suitable prosthetic appliance. Reference: For more information on determining entitlement to SMC based on LOU that is equivalent to amputation, see , 11 Vet.App. 369, 374 (1998). f. Showing Entitlement to SMC in Rating Decisions Entitlement to SMC must be reflected in the Coded Conclusion section of the rating decision by noting entitlement to SMC and statutory awards immediately following citation of the combined evaluation of all SC disabilities (if more than one exists) listing any anatomical loss as the first entitlement in order of preference over all LOUs, and citing separately each additional specific disability if entitlement under is shown for more than one anatomical loss, or LOU. References: For more information on the rating decision codesheet in SMC decisions, see M21-1, Part III, Subpart iv, 6.D.5.a, and two-signature requirements for SMC ratings, see M21-1, Part III, Subpart iv, 6.D.7.c.
f. Example 1: Rating Decision Involving SMC for Total SC Deafness in One Ear and Bilateral Blindness Situation: The Veteran has bilateral SC blindness with LPO, and total SC hearing loss in the left ear no separate and distinct disability evaluated as 100-percent disabling, and no separate and distinct disability evaluated as 50-percent disabling. Result: Since the Veteran has LPO bilaterally, and total SC loss of hearing in the left ear, entitlement to SMC is warranted under , and . Coded Conclusion: The appropriate SMC paragraph code is OB-2. The appropriate SMC coding is 37-37-21-00-0. g. Example 2: Rating Decision Involving SMC for Total SC Deafness in One Ear and Bilateral Blindness Situation: The Veteran has bilateral SC blindness with no light perception (NLP) in the left eye, and visual acuity of 5/200 (1.5/60) in the right eye total SC hearing loss in the left ear no separate and distinct disability evaluated as 100-percent disabling, and no separate and distinct disability evaluated as 50-percent disabling. Result: The Veteran is entitled to SMC under for the degree of bilateral blindness alone, but an additional one-half step in the level of SMC (“m½”) is warranted, based on the degree of hearing loss, under the provisions of . Coded Conclusion: The appropriate SMC paragraph code is PB-1. The appropriate SMC coding is 20-20-21-00-0. h. SMC for Bilateral Blindness With Bilateral Hearing Loss Considered 10 or 20-Percent Disabling A Veteran is entitled to an additional one-half step in the level of SMC under if he/she has SC bilateral blindness with LPO or less bilateral hearing loss, considered 10-or 20-percent disabling, and SC hearing loss in at least one ear. Note: If visual acuity in either of the eyes is better than LPO, entitlement to the additional one-half step does not exist.