Citation Nr: 18140396 Decision Date: 10/03/18 Archive Date: 10/02/18 DOCKET NO. 16-08 414 DATE: October 3, 2018 REMANDED Entitlement to service connection for traumatic brain injury (TBI) is remanded. Entitlement to special monthly compensation (SMC) for aid and attendance is remanded. REASONS FOR REMAND The Veteran had active service from October 1971 to July 1973 and from December 1990 to May 1991. 1. Entitlement to service connection for traumatic brain injury (TBI) is remanded. VA has a duty to assist, which includes providing a medical examination when necessary to make a decision on a claim. 38 C.F.R. § 3.159 (c)(4)(i). VA will provide a medical examination or obtain a medical opinion if the record, including lay or medical evidence, contains competent evidence of a disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease that occurred in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 86 (2006). According to a July 2015 disability benefits questionnaire (DBQ), it was noted that the Veteran had Alzheimer’s disease as result of exposure to multiple blast explosions as a part of the Veteran’s military service. However, the examiner did not review the Veteran’s claims file. VA examination reports dated in March 2016 and December 2017 both note that the Veteran has TBI; however multiple etiologies are listed including head trauma during military service, boxing, explosion, and football. Further, it is unclear whether the examiners were merely reciting the Veteran’s report that such symptoms are related to his military service, or whether it was their opinion that such were in fact a result of his service. Service treatment records dated in December 1972 reflect that the Veteran was in an “auto wreck” and that his head was thrown forward and back. The impression at that time included a neck injury. Service records confirm that the Veteran also served in Southwest Asia and that his military occupational specialty (MOS) was of a combat engineer. In light of the above, the Veteran is entitled to an examination to evaluate whether he has any residual conditions that are attributable to an in-service traumatic brain injury. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to special monthly compensation (SMC) for aid and attendance is remanded. The Veteran is already in receipt of SMC under 38 U.S.C. § 1114, subsection (s) and 38 C.F.R. § 3.350(i). He requests special monthly compensation for aid and attendance, to include based on his lower extremity disabilities. The Veteran has given several statements that he requires assistance in bathing and tending to other hygiene needs. See July 2015 VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance). However, the July 2015 VA Form 21-2680 reflects that the Veteran’s need for assistance is due to his cognitive impairment and memory loss which has been attributed to his TBI. Thus, the issue of entitlement to aid and attendance is inextricably intertwined with the issue of entitlement to service connection for a TBI. Thus, it is also remanded. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from November 2017 to the present. 2. Then, schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any residuals of a traumatic brain injury. The entire claims file must be provided to and reviewed by the examiner, and the examiner must carry out any and all special studies or tests necessary for proper evaluation. Thereafter, the examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran has any current residuals of a traumatic brain injury related to his active military service. The examiner is asked to consider, and discuss as necessary, the July 2015 DBQ and the 2016 and 2017 VA psychiatric examinations noting diagnoses of Alzheimer’s disease and TBI and that the Veteran incurred in-service traumatic brain injury. 3. Obtain a clinical opinion as to whether the Veteran is in need of regular aid and attendance due to his service-connected disabilities, and if so, which disabilities require regular aid and attendance. The examiner is asked to consider, and discuss as necessary, the July 2015 VA Form 21-2680. If an adequate rationale cannot be provided without an examination, schedule the Veteran for such. Any opinion should include a complete rationale. The examiner is requested to consider each existing condition and its impact on the Veteran’s ability to perform acts of daily living; including keeping himself clean and presentable; feeding, dressing and undressing herself; attending to the needs of nature; and incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from the hazards or dangers incident to his daily environment. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Williams, Counsel