SMC-O: Two or more L through N rates, specified deafness with blindness, or both arms preventing a prosthesis

What this level is

SMC-O is the basic rate in 38 U.S.C. § 1114(o) and 38 CFR § 3.350(e). It is not loss of one hand and one foot with aid and attendance. One hand and one foot is an SMC-L basis. Combining two SMC rates into SMC-O requires separate conditions, and § 3.350(e) limits when helplessness can be one of them.

How it is paid

SMC-O is a basic rate. It is paid instead of the schedular 10 to 100 percent table. It is not added on top of a 100% schedular rate. VA.gov’s rate table effective December 1, 2025 says SMC-K is not added to SMC-O.

Criteria

• Conditions entitling the veteran to two or more of the rates in § 1114(l) through (n), with no condition considered twice.
• Bilateral deafness rated at 60 percent or more disabling, when the hearing impairment in one or both ears is service-connected, together with service-connected total blindness with bilateral visual acuity of 20/200 or less.
• Service-connected total deafness in one ear, or bilateral deafness rated at 40 percent or more disabling when the hearing impairment in one or both ears is service-connected, together with service-connected blindness of both eyes having only light perception or less.
• Anatomical loss of both arms with factors that prevent the use of prosthetic appliances. Section 1114(o) uses that wording after Public Law 111-275. Section 3.350(e) still says anatomical loss of both arms so near the shoulder as to prevent use of a prosthetic appliance.
• Section 3.350(e)(2): paralysis of both lower extremities together with loss of anal and bladder sphincter control entitles the veteran to the maximum rate under § 1114(o), through the combination of loss of use of both legs and helplessness. The sphincter-control requirement is met even when incontinence has been overcome under a strict regimen of bowel and bladder training and other auxiliary measures.

Section 3.350(e)(3) requires separate and distinct disabilities. When loss or loss of use of two extremities is considered for the maximum rate on account of helplessness requiring regular aid and attendance, that helplessness must result from pathology other than the extremities. If the loss or loss of use of two extremities, or being permanently bedridden, itself leaves the person helpless, an increase is not in order on account of that helplessness. The combination of being permanently bedridden and needing regular aid and attendance, without separate and distinct anatomical loss or loss of use of two extremities, or blindness, is not the maximum benefit. Two qualifying disabilities may still come from one injury or one disease, such as one injury or rheumatoid arthritis.