Citation Nr: 18140813 Decision Date: 10/05/18 Archive Date: 10/05/18 DOCKET NO. 16-12 353 DATE: ORDER Special monthly compensation (SMC) based on the need for aid and attendance is granted. FINDING OF FACT Throughout the appeal period, the Veteran has required the regular assistance of his wife with bathing and personal hygiene as well as dressing. CONCLUSION OF LAW The criteria for entitlement to SMC based on the need for aid and attendance have been met. 38 U.S.C. § 1114 (2012); 38 C.F.R. §§ 3.350, 3.352 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran initially served on active duty from November 1995 to July 1997 with the United States Air Force, then served on active duty from April 2005 to June 2006 with the United States Army. 1. The issue of entitlement to SMC based on the need for aid and attendance. The Veteran contends that he is entitled to SMC based on the need for aid and attendance. See October 2012 Veteran’s Supplemental Claim for Compensation. SMC is payable if, as a result of the veteran’s service-connected disability(ies), he is helpless as to require regular aid and attendance. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b)(3). Need for aid and attendance means being so helpless as to require the regular aid and attendance of another person as determined under the criteria delineated in 38 C.F.R. § 3.352(a). Under 38 C.F.R. § 3.352(a), the following factors are accorded consideration: (1) the veteran’s inability to dress or undress himself, or to keep himself ordinarily clean and presentable; (2) the frequent need of adjustment of any special prosthetic or orthopedic appliances which, by reason of the particular disability, cannot be done without aid; (3) inability to feed himself through loss of coordination of the upper extremities or through extreme weakness; (4) inability to attend to the wants of nature; or (5) incapacity, whether physical or mental, which requires care or assistance on a regular basis to protect the veteran from hazards or dangers incident to his daily environment. The particular personal function, which the veteran is unable to perform, is to be considered in view of his condition as a whole. Not all the conditions enumerated need to be met. See Turco v. Brown, 9 Vet. App. 222, 224 (1996). Further, the evidence need only establish the veteran is so helpless as to need regular aid and attendance, not that there is a constant need for aid and attendance. In March 2012, the Veteran and his wife submitted a VA Application for Comprehensive Assistance for Family Caregivers Program. In May 2012, a VA licensed clinical social worker (LSCW) determined the eligibility requirements were met for participation in the Family Caregivers Program. May 2012 VA Caregiver Certificate. In doing so, the VA LCSW found that while the Veteran maintained complete independence with eating, grooming and mobility, he required total assistance with dressing and undressing himself; total assistance with bathing and personal hygiene; moderate assistance toileting; and total assistance with devices. Further, he required total assistance with planning and organizing, such as medication management, financial management or other household affairs; minimal assistance with sleep regulation; moderate assistance due to difficulty with recent memory; and minimal assistance with self-regulation, such as moderation of his mood. Overall, the LSCW determined his scores put him at a high dependence level. Subsequent VA Caregiver Certificates suggest some improvement in the Veteran’s ability to engage in his daily living activities. See February 2015 VA Caregiver Certificate (noted the Veteran required minimal assistance with eating, maximal assistance, but not total assistance, with bathing; minimal assistance with difficulty with recent memory); June 2016 VA Caregiver Certificate (noted the Veteran needed assistance only with bathing and personal hygiene, and dressing); June 2017 VA Caregiver Certificate (noted the Veteran needed assistance only with bathing and personal hygiene, and dressing). Even so, the VA Caregiver Certificates confirm they continued to remain eligible for and participate in the Family Caregivers Program. Between April 2012 an August 2015, the Veteran has submitted multiple VA Form 21-2680s, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, in support of this claim. Each reiterated he required assistance with bathing and tending to his other hygiene needs. For the most part, they also indicated he required assistance with medication management due to his memory issues. In the most recent VA Form 21-2680, Dr. S.A., found the Veteran’s mild cognitive difficulties owing to his service-connected TBI contributed to his need for assistance with medication management. August 2015 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. His TBI also caused some postural instability as well as dysequilibrium. He had marked limitations of both upper extremities due to trauma to his cervical spine. Specifically, he had diminished grip strength in both hands as well as paresthesia, which impaired his ability to perform his daily living activities significantly. His lumbar spine and bilateral knee problems prohibited him from performing physically demanding activities, such as crouching, climbing, reaching, pulling, pushing, etcetera. This, in turn, limited his ability to perform his daily living activities. Considering the above, the Board finds the preponderance of the evidence demonstrates the Veteran is helpless or so nearly helpless as to require regular aid and attendance of another person. 38 U.S.C. § 1114(l); 38 C.F.R. §§ 3.350(b), 3.352(a). Accordingly, SMC based on the need for aid and attendance is granted. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Suh, Associate Counsel