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Are you asking about the effective date or about smc "p' awards?  If you are asking about the correct effective date, there is no way for anyone to answer that based on the information given.  In fact, it probably can't be accurately answered by anyone who isn't both well versed in the effective date regulations and evaluating disabilities in addition to actually having your file in front of them to look at everything. 

Determining an effective date is seldom as simple as many here present it.  Often more than one date is possible with the correct one being determined by the specific facts in that case.

If you are asking about "p" awards, say so and I'll try to answer in a nutshell; however, I don't want to get into this if this isn't what you are asking about.

Cruiser

Ivac wrote:

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You are entitled to the M rate for loss of use of both lower extremities. Having a loss of use of the right arm at 100%, brings you up a full step to N.

The additional ratings for PTSD, buttocks, etc combine to over 50% so that gets you another 1/2 step to N and 1/2. (This is the P rating, that I made a poor effort to explain in an earlier post.)

Cruiser, where did I go wrong?

You erred in a couple of places.  First, loss of use of both lower extremities would normally be L.  The exception would be when there is loss of knee action in which case it would be M.  This particular case looks like L to me, but without seeing the actual Rating Decision Code Sheet it's hard to say.

Your second error, assuming that you were wrong above and I'm not sure of that, was when you gave the 1/2 step increase for the combined 50 percent. You can only do one 50 or 100 percent step increase.  This means that after you gave the full step for the 100, you could no longer give the 1/2 step for the 50.

Having said all of that, what I get out of what was posted would be either M 1/2 + K or N + K, depending on whether the starting point for the loss of use of the legs was L or M.   Also there is no 100 percent evaluation for Diagnostic Code 8515.  This would be 70 or 60 at most, depending on whether it was the dominant hand.  The final evaluation would be the same either way.

Also I might add that Rating Specialists don't normally assign separate evaluations for the legs or arms when there is loss of use of both legs, both arms, or one leg and one arm.  There are specific codes for this.  For example, Diagnostic Code 5110 provides for a single 100 percent evaluation for loss of use of both feet.  Separate evaluations such as separate 100 percents for the legs are normally only assigned when there is a specific reason to do so, as there might be in this case.

In this case we have loss of use of three extremities, both legs and an arm.  While both legs or one arm and one leg are both SMC L,  it would be to this man's advantage to give him a single 100 percent under Dx Code 5111 for loss of use of one arm and one leg, thereby leaving the single 100 percent for the other leg free to give him a full step increase.  If we granted L for loss of use of both legs that would only leave the 60 or 70 for the arm which would only warrant a half step increase.

So let's say that we have given L for loss of use of one arm and one foot.  We can then give a full step to M for the other leg if it is actually 100 percent, and quite frankly I question that each leg is 100 percent; but we'll assume that for now.  OK, we can now go another half step because we are dealing with a triple extremity loss or loss of use.  This puts us at M 1/2.

Now we must deal with those pesky Ks.  Since we used two of those losses of use (in this case an arm and a leg) for the L rate, we lose those two Ks; however, we get to keep the K for the other leg since it wasn't part of the L rate.  This puts us at M 1/2 + K.

Now having said all of that, it could be higher than M 1/2 + K if the losses of use have been deemed to leave no natural knee action in one or both knees.  There is really no way to tell without actually reading the Rating Decision Code Sheet like I mentioned above.  The Code Sheet would explain exactly how they arrived at the final SMC level.

To be honest, even using the worst case scenario I can't get the SMC level any higher than N + K using the referenced disabilities.  If SMC O has actually been granted in this case I have a feeling that an error was made because I just don't see it.  I would certainly take the O and not mention a word about it to anyone.

Cruiser