BVA9401373 DOCKET NO. 91-46 743 ) DATE ) ) ) THE ISSUES 1. Permanence of a 100 percent schedular disability rating for post- traumatic stress disorder (PTSD). 2. Entitlement to special monthly compensation based on the veteran's housebound status or his need for regular aid and attendance. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL N. T. and J. T., Jr. ATTORNEY FOR THE BOARD M. W. Greenstreet, Counse INTRODUCTION The veteran had active service from January 1967 to May 1970. The veteran has appealed from a March 1991 decision by the Montgomery, Alabama, Department of Veterans Affairs (VA) Regional Office (RO). The RO received the veteran's notice of disagreement in April 1991; it issued a statement of the case in May 1991; and it received the veteran's substantive appeal in June 1991. In January 1992, the veteran's wife, Nancy, and his son, Joe, Jr., offered testimony in support of the veteran's claim at a hearing before a member of the Board of Veterans' Appeals (Board) sitting in Montgomery, Alabama. In August 1992, the Board of Veterans' Appeals remanded this case for additional evidentiary development. The RO completed that development, confirmed its prior denial and returned the case to the Board, where it was docketed in November 1993. In November 1993, the veteran's representative, the Disabled American Veterans, submitted an informal hearing presentation. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the disability resulting from his PTSD should be considered permanent in character under 38 C.F.R. § 3.327(b)(2) (1993). He emphasizes that he necessarily is very heavily medicated and that his private physician believes that he will never be vocationally functional. The veteran also contends that he is entitled to special monthly compensation based on his housebound status and his need for regular aid and attendance. He avers that he is prone to frequent dissociative states during which he thinks that he is back in Vietnam and that he also experiences uncontrollable rage with homicidal and suicidal ideation. His wife emphasizes that she must attend to the veteran at all times for his safety and the safety of others, and that she must supervise his medication regimen. She avers that the veteran cannot leave the house without her and that they very rarely go out. DECISION OF THE BOARD For the following reasons and bases, the Board concludes that the disability resulting from the veteran's PTSD is permanent in character and that he is entitled to special monthly compensation based on his need for regular aid and attendance. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for the correct resolution of the veteran's claims. 2. The disability resulting from the veteran's PTSD is permanent in character and of such nature that there is no likelihood of improvement. 3. The veteran's psychiatric disorder is of such severity that he is so helpless as to require the regular aid and attendance of another person. CONCLUSIONS OF LAW 1. The veteran's 100 percent disability rating for PTSD is permanent in character. 38 U.S.C.A. § 5107(a) (1992); 38 C.F.R. § 3.327(b)(2) (1991). 2. The veteran meets the criteria for special monthly compensation based on his need for regular aid and attendance. 38 U.S.C.A. § 5107(a) (1992); 38 C.F.R. §§ 3.102, 3.350, 3.352 (1993). With respect to the "permanence" of the veteran's 100 percent disability rating for PTSD, 38 C.F.R. § 3.327(b)(2) provides that periodic future examinations will not be requested in those cases where the disability resulting from the disease is permanent in character and there is no likelihood of improvement. The evidence shows that the veteran's 100 percent disability rating has been in effect since March 1989 and that he has been hospitalized a number of times during the last several years for treatment of PTSD. It is established that he takes numerous and varied prescribed medications for PTSD, a regimen which his private physician reports was developed over a period of years. His treating physician also reported in June 1991 that, while he hoped that the veteran's symptomatology would diminish in the future, he believed that there was no likelihood of improvement to the point that the veteran would be vocationally functional. Although a VA physician stated that he was unable to give an opinion as to the permanence of the veteran's disability following a period of observation and evaluation in October 1992, the veteran's physician stated in January 1993 that his conclusion remained that the veteran was severely and permanently impaired by his PTSD. While the United States Court of Veterans Appeals (Court) has declined to adopt the "treating physician rule," see Guerrieri v. Brown, 4 Vet.App. 467 (1993); Chisem v. Principi, 3 Vet.App. 322 (1992), in view of the close therapeutic relationship which exists between this veteran and his physician, we find his physician's assessment to be especially probative. Over the years of his treatment, he clearly has become very knowledgeable about the veteran's socioeconomic functioning and so is in a better position to assess that functioning than perhaps anyone else. Given his assessment that the veteran will never be employable, and in view of all the other evidence of record, we find that the greater weight of the evidence shows that the 100 percent disability rating for PTSD is "permanent" under 38 C.F.R. § 3.327(b)(2). As to the veteran's claim for special monthly compensation based on the need for regular aid and attendance, the evidence shows that he experiences periods of depression with suicidal thoughts which alternate with outbursts of rage and aggression, despite the considerable amount of medication prescribed for him. His wife has testified that she quit her job to stay home with the veteran to ensure that he takes his medication properly and to prevent confrontations with others. Again, we find that the observations of his private physician are especially probative. In April and June 1991 letters, his physician stated that it was absolutely necessary for the veteran's spouse to be with him to, in effect, protect him from himself, and he recently reiterated that view in a January 1993 letter. In view of the foregoing, the Board concludes that the veteran is manifestly unable to tolerate or cope with the ordinary frictions and frustrations of everyday life which, given his propensity for aggressive acting-out, would constitute a hazard or danger incident to his everyday environment. 38 C.F.R. § 3.352(a) provides that when, because of incapacity, either physical or mental, the regular care or assistance of another on a regular basis is necessary to protect the veteran from hazards or dangers incident to his daily environment, the permanent need for regular aid and attendance is established. Therefore, accordingly, we find that the veteran is entitled to special monthly compensation based on his need for regular aid and attendance. ORDER The veteran's 100 percent disability rating for PTSD is permanent within the meaning of 38 C.F.R. § 3.327(b)(2). The veteran is entitled to special monthly compensation based on the need for regular aid and attendance. The benefits sought on appeal are granted.