Citation Nr: 1319729 Decision Date: 06/19/13 Archive Date: 06/27/13 DOCKET NO. 09-48 631 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to special monthly compensation based on a need for the regular aid and attendance of another person or by reason of being housebound. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Anthony M. Flamini, Counsel INTRODUCTION The Veteran served on active duty from October 1968 to May 1970. This case comes before the Board of Veterans' Appeals (Board) on appeal from a June 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND A review of the claims file shows that the Veteran received outpatient treatment at the Santa Rosa VA Clinic in Santa Rosa, California. The most recent record associated with the file is dated in March 2002, which is over one decade ago. The Board notes that the Veteran subsequently moved from Santa Rosa, California, and currently resides in Thomaston, Georgia. As such, the possibility exists that additional treatment records exist either at the Santa Rosa VA Clinic or another VA facility. Decisions of the Board must be based on all of the evidence that is known to be available, and VA has a duty to assist the Veteran to obtain all relevant evidence known to be in the possession of the federal government. Thus, updated VA treatment records should be obtained. The Veteran is service connected posttraumatic stress disorder (PTSD), currently rated as 70 percent disabling; meniscectomy of the right medial meniscus, currently rated as 20 percent disabling; degenerative joint disease of the left knee with laxity, currently rated as 10 percent disabling; and degenerative joint disease of the left knee with painful motion, currently rated as 10 percent disabling. The Board notes that he was last provided a VA PTSD examination in April 2002, and a VA joints examination in May 2002. To substantiate his current claim for entitlement to special monthly compensation based on a need for the regular aid and attendance of another person or by reason of being housebound, the Veteran was afforded VA medical examinations in August 2006 and December 2008 to assess whether he required the regular aid and attendance of another person and to determine whether he was housebound. As pointed out by his representative in May 2013, the most recent examination is now nearly five years old. In correspondence dated in July 2011, the Veteran's spouse indicated that she married the Veteran in 2008 and was forced to quit her job in 2009 due to the Veteran's disabilities. She claimed that the Veteran frequently fell due to his knee disabilities, and required daily assistance with bathing and dressing. The Veteran's spouse additionally claimed that the Veteran could not be trusted to take his correct medications and was unable to prepare meals for himself, as he had set the stove on fire on more than one occasion due to his forgetfulness. This correspondence suggests that the Veteran's physical and psychiatric state has deteriorated since the December 2008 VA examination, and certainly since the April 2002 VA PTSD examination and the May 2002 VA joints examination. When the evidence indicates that there has been a "material change" in a disability since a claimant was previously examined, VA is generally required to obtain a new medical examination to evaluate the current degree of impairment. 38 C.F.R. § 3.327(a) (2009); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (holding that a new examination is required where the claimant complained of increased hearing loss two years after his most recent audiology examination). Therefore, the Board feels that the Veteran should be afforded another VA examination for the purpose of determining the severity of each disability and the effect each disability has on his daily life. Accordingly, the case is REMANDED for the following action: 1. Obtain all records of treatment of the Veteran from the San Francisco VA Medical Center in San Francisco, California, as well as the Atlanta Vet Center in Atlanta, Georgia, in addition to any associated outpatient clinics, to include the Santa Rosa VA Clinic, since March 2002. If no such records are available, document that fact in the claims file. 2. Schedule the Veteran for a general medical examination to determine the nature and severity of all disabilities present and their effect on his activities of daily life and his need for aid and attendance of another person. The claims file should be made available to the examiner for review before the examination. The examiner is requested to consider factors such as (1) whether the Veteran's disabilities prevent him from caring for his daily personal needs without the assistance of others on a regular basis which includes: inability of claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment; (2) whether he is required to remain in bed; and (3) whether the Veteran's disabilities substantially confine him to his dwelling or immediate premises. All indicated studies should be performed, and the examiner is asked to describe all manifestations of each current disability. 3. After the foregoing development has been completed, readjudicate the Veteran's claim of entitlement to special monthly compensation based on a need for the regular aid and attendance of another person or by reason of being housebound, including reviewing all newly obtained evidence and assigning disability evaluations to all disabilities found to be present on examination. If any benefit sought on appeal remains denied, furnish the Veteran and his representative a supplemental statement of the case and return the case to the Board. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ ROBERT C. SCHARNBERGER Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).