Citation Nr: 18140210 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 18-04 423 DATE: ORDER Special monthly compensation (SMC) based on the need for regular aid and attendance, or at the housebound rate, is denied. FINDINGS OF FACT 1. The Veteran is service connected for posttraumatic stress disorder (PTSD), rated 70 percent disabling; macular hole, right eye, residuals of intraretinal hemorrhage, rated 10 percent disabling; lichen simplex chronicus, claimed as pimples on buttocks, to include foot fungus, rated 10 percent disabling; and tinnitus, rated 10 percent disabling. A total disability rating based upon individual unemployability due to service-connected disability (TDIU) has been in effect since May 2002. 2. The Veteran’s service-connected disabilities are not manifested by anatomical loss or loss of use of both feet, or one hand and one foot; he is service connected for only one eye. 3. The Veteran is not shown to be permanently bedridden or so helpless as to be in need of the regular aid and attendance of another person as a result of his service-connected disabilities. 4. The Veteran does not have a single service-connected disability rated 100 percent disabling, with additional service-connected disability or disabilities independently ratable at 60 percent or more; nor is he shown to be permanently housebound by reason of his service-connected disabilities. CONCLUSION OF LAW The criteria for SMC based on the need for regular aid and attendance, or at the housebound rate, have not been met. 38 U.S.C. § 1114 (2012); 38 C.F.R. §§ 3.350, 3.352 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the U.S. Army from August 1968 to August 1970 and from January 1980 to September 1991. His decorations include the Southwest Asia Service Medal. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico. Entitlement to SMC based on the need for regular aid and attendance, or at the housebound rate. Under 38 U.S.C. § 1114(l), SMC is payable if, as the result of service-connected disability, the Veteran has anatomical loss or loss of use of both feet, or of one hand and one foot; has blindness in both eyes with visual acuity of 5/200 or less; is permanently bedridden; or is so helpless as to be in need of regular aid and attendance of another person. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). Under 38 C.F.R. § 3.352(a), the following factors will considered in determining whether the Veteran is in need of regular aid and attendance of another person: inability of the claimant to dress and undress himself or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliance; inability of the claimant to feed himself through loss of coordination of the upper extremities or through extreme weakness; inability to tend to the wants of nature; or incapacity, physical or mental, which requires care and assistance on a regular basis to protect the claimant from the hazards or dangers incident to his daily environment. All of the disabling conditions enumerated in 38 C.F.R. § 3.352(a) do not have to exist before a favorable rating may be made. The particular personal functions which the Veteran is unable to perform should be considered in connection with his condition as a whole. The evidence need only establish that the Veteran is so helpless as to need regular aid and attendance; not that there is a constant need. 38 C.F.R. § 3.352(a); see also Turco v. Brown, 9 Vet. App. 222, 224 (1996) (holding that at least one factor listed in section 3.352(a) must be present for a grant of special monthly compensation based on need for aid and attendance). Determinations that the veteran is so helpless as to need regular aid and attendance must be based on the actual requirement of personal assistance from others. 38 C.F.R. § 3.352(a). For the purposes of 38 C.F.R. § 3.352(a), “bedridden” will be a proper basis for the determination of whether the Veteran is in need of regular aid and attendance of another person. “Bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. 38 C.F.R. § 3.352(a). In addition, under 38 U.S.C. § 1114(s), special monthly compensation at the housebound rate is payable if, in addition to having a single permanent service-connected disability rated 100 percent disabling under the VA’s Schedule for Rating Disabilities, the Veteran: has additional service-connected disability or disabilities independently ratable at 60 percent or more, separate and distinct from the permanent disability rated as 100 percent disabling and involving different anatomical segments or bodily systems, or, is “permanently housebound” by reason of service-connected disability. Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, a separate award of a TDIU predicated on a single disability may form the basis for an award of special monthly compensation. See Bradley v. Peake, 22 Vet. App. 280 (2008). The requirement of “permanently housebound” is met when the Veteran is substantially confined to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical area, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. 38 C.F.R. § 3.351(d). In his notice of disagreement (NOD), the Veteran advanced argument to the effect that VA failed to take several of his conditions into account in adjudicating his claim, including hearing loss, diabetes mellitus, voiding dysfunction, and neuropathies of the upper and lower extremities. In his NOD and substantive appeal, he advanced additional argument to the effect that a TDIU predicated on a single disability could satisfy the requirement that a single disability be rated as 100 percent disabling. See Bradley, supra. The evidence reflects that the Veteran is service-connected for PTSD, rated 70 percent disabling; macular hole, right eye, residuals of intraretinal hemorrhage, rated 10 percent disabling; lichen simplex chronicus, claimed as pimples on buttocks, to include foot fungus, rated 10 percent disabling; and tinnitus, rated 10 percent disabling. A TDIU has been in effect since May 2002. An April 2017 examination report for housebound status or permanent need for regular aid and attendance reflects that the Veteran reported that he was confined to bed for 12 hours a day, from 9 p.m. to 9 a.m., and that he had problems with forgetfulness that he attributed to PTSD. The examining physician described impairments relating to blurred vision, functional losses of the left knee and right leg, slow grip, chronic back pain, and diabetes mellitus. The examiner also noted diagnoses of PTSD, diabetes mellitus, poor vision, and insomnia. The examiner noted that the Veteran was unable to prepare his own meals and needed assistance in bathing and taking care of other hygiene needs, but that he was able to feed himself, could manage his own financial affairs, was not legally blind, and did not require nursing home care or medication management. An April 2017 VA PTSD examination report and June 2017 VA treatment record reflect that the Veteran lives alone, can travel independently, needs no assistance with his activities of daily living, and helps care for an elderly friend from church. He reported that he attended church regularly, and walked a great deal due to car problems. The April 2017 PTSD examiner further noted that the Veteran had recent memory impairment, but was oriented, with normal speech, normal thought processes and association, and exhibited no unusual thought content or perceptual disturbances. The Veteran emphatically denied suicidal/homicidal ideation, intent, or plans, and “no significant interpersonal relation difficulties [were] reported.” Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim. His service-connected disabilities are not shown to be manifested by anatomical loss or loss of use of both feet, or of one hand and one foot. While VA treatment records reflect decreased visual acuity, he is service connected for only one eye. In addition, he is not shown to be permanently bedridden as a result of service-connected disability. Moreover, the record does not reflect that the Veteran’s service-connected disabilities render him so helpless as to be in need of regular aid and attendance of another person. Although the report of the April 2017 examination indicates that the Veteran requires assistance preparing his own meals and bathing and taking care of other hygiene needs, it appears from the face of that report that his limitations in that regard are due to non-service-connected functional losses of the left knee and right leg, slow grip, chronic back pain, and diabetes mellitus. The remainder of the evidence, including the April 2017 VA PTSD examination report and June 2017 VA treatment record, reflects that the Veteran is capable of living independently and does not require assistance with activities of daily living. Regarding entitlement to SMC at the housebound rate, the Board notes that the Veteran does not have a single disability rated at 100 percent. Moreover, even assuming for purposes of argument that he is entitled to a TDIU on the basis of PTSD alone (as he appears to imply), he does not have additional service-connected disability or disabilities independently ratable at 60 percent or more. Moreover, there is no persuasive evidence that he is permanently housebound by reason of his service-connected disabilities. For all the foregoing reasons, the Board finds that special monthly compensation based on need for regular aid and attendance, or at the housebound rate, is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). DAVID A. BRENNINGMEYER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel