b. Criteria for Entitlement to SMC at the (m) Rate The SMC rate payable under is authorized for the following disabilities anatomical L/LOU of both hands anatomical L/LOU of both legs at a level, or with complications, preventing natural knee action with prostheses in place anatomical L/LOU of one arm and one leg preventing natural elbow and knee action with prostheses in place, due to the level of involvement or with complications blindness in both eyes having LPO, or blindness in both eyes leaving the Veteran so significantly disabled as to be in need of regular A&A. c. General Criteria for Entitlement to SMC for Blindness With Hearing Loss or L/LOU of an Extremity Additional SMC is payable to Veterans with bilateral blindness who are already entitled to SMC under who also have varying degrees of SC hearing loss or SC L/LOU of an extremity. d. SMC for Bilateral Deafness Evaluated as 60-Percent or More and Bilateral Visual Acuity of 20/200 or Less A Veteran is entitled to SMC under if the Veteran has a combination of bilateral deafness rated at 60-percent or more (and the hearing loss in either ear is SC), and SC blindness with bilateral visual acuity of 20/200 (6/60) or less. Note: Before the enactment of PL 110-157 on December 26, 2007, SC blindness with bilateral visual acuity of 5/200 (1.5/60) or less was required for entitlement to SMC . e. SMC for SC Deafness in One Ear and Bilateral Blindness A Veteran with total SC deafness in one ear, such as that numerically designated as “XI,” and SC blindness with LPO or less, bilaterally, is entitled to SMC under and , or visual acuity of 5/200 (1.5/60) or less bilaterally, is entitled to an additional half-step in the level of SMC, under the provisions
If the Veteran does not have… And … Then … a single disability evaluated as 100 percent disabling, but the combined disability evaluation is 100 percent on the disease processes noted in M21-1, Part IV, Subpart ii, 2.H.8.b) the disability is so severe as to demonstrate a need for A&A award A&A. . a single disability evaluated as 100 percent (regardless of the combination) the disability is so severe as to demonstrate the need for A&A refer the case to Compensation Service (211B) for an advisory opinion requesting consideration for entitlement to A&A on an extra-schedular basis. Reference: For more information on requesting an advisory opinion, see M21-1, Part III, Subpart vi, 1.A.2. a single disability evaluated as 100 percent (regardless of the combination) the disability does not demonstrate a need for A&A dispose of the issue by explaining how this conclusion was reached in the Narrative of the rating decision. d. Considering Entitlement to A&A as an Inferred If a single disability is evaluated as 100-percent disabling, consider entitlement to A&A or the Housebound rate as an inferred issue only if the evidence shows that the benefit may be awarded. If the evidence does not show entitlement to SMC at the A&A or Housebound rate, do not raise either issue merely to deny it. e. Importance of Reasoning in Awarding SMC Under 38 U.S.C 1114(l) When Considering Entitlement to A&A Under 38 U.S.C. 1114(o) Make determinations of entitlement to SMC under on the basis of need of regular A&A in light of the criteria contained in . Fully explain the reasoning in the Narrative of the rating decision. The need to explain the reasoning is especially important in situations in which, under the rate under based on the need for A&A is to be used as one of the conditions that entitles the claimant to two or more of the rates (no