Citation Nr: 18140924 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 16-30 812 DATE: October 9, 2018 ORDER Entitlement to special monthly compensation based on the need for regular aid and attendance or by reason of being housebound is granted. FINDING OF FACT The regular assistance of another person is required to protect the Veteran from hazards or dangers incident to the daily environment and when caring for the daily personal needs of meal preparation, bathing, tending to hygiene needs, and medicine management, as the result of service-connected coronary artery disease (CAD). CONCLUSION OF LAW The criteria for special monthly compensation based on the need for aid and attendance have been met. 38 U.S.C. §§ 1114, 5107 (2012); 38 C.F.R. §§ 3.350, 3.352 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1972 to April 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision. The Veteran submitted additional evidence after the May 2016 statement of the case with a waiver of initial RO review; however, such waiver is not necessary, as the Veteran perfected his appeal after February 2013. See 38 U.S.C. § 7105 (e) (2017). Entitlement to special monthly compensation based on the need for regular aid and attendance or by reason of being housebound Compensation at the aid and attendance rate is payable when the Veteran, due to service-connected disability, has the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). Determinations as to the need for regular aid and attendance are factual and must be based upon the actual requirements for personal assistance from others. In making such determinations, consideration is given to such conditions as: the inability of the 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 assistance; the inability of the claimant to feed himself through loss of coordination of upper extremities or through extreme weakness; the inability to attend to the wants of nature; or incapacity, either physical or mental, which requires care or assistance on a regular basis to protect a claimant from hazards or dangers incident to one’s daily environment. It is not required that all of the disabling conditions enumerated be present before a favorable rating is made. The particular personal functions that the claimant is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the claimant be so helpless as to be in need of regular aid and attendance, not that there is a constant need. “Bedridden” constitutes a condition which, through its essential character, actually requires that an individual remain in bed. The fact that a claimant has voluntarily taken to bed, or that a physician has prescribed bed rest for a lesser or greater portion of the day will not suffice. 38 C.F.R. § 3.352(a). Eligibility for special monthly compensation by reason of regular need for aid and attendance requires that at least one of the factors set forth in VA regulation is met. Turco v. Brown, 9 Vet. App. 222, 224 (1996). In addition, determinations that the veteran is so helpless as to be in need of regular aid and attendance will not be based solely upon an opinion that the veteran’s condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others. See Turco, 9 Vet. App. at 224. In this case, the Veteran’s service-connected disabilities include CAD, rated 100 percent from August 2012; depressive disorder, rated as 50 percent from September 2011; and hypertension, rated noncompensable from November 2010. The combined rating is 100 percent disabling, effective from August 2012. The Veteran has also been rated permanent and total for nonservice-connected pension from July 1995. Disabilities considered for pension purposes are left arm amputation (100 percent) and disfiguring burn scars to the right arm, face, chest, and back, status post skin graft surgery (50 percent). The combined evaluation for pension purposes is 100 percent. The pension rate includes aid and attendance allowance. While the Board is aware the Veteran has multiple nonservice-connected disabilities, the Board finds that the evidence shows that the Veteran requires the regular aid and attendance of another person to protect him from hazards or dangers incident to his daily environment and when caring for the daily personal needs of meal preparation, bathing, tending to hygiene needs, and medicine management, because of the service-connected CAD, rather than nonservice-connected factors. The evidence includes an October 2015 aid and attendance examination wherein the examiner indicated the Veteran needed help preparing meals and needed assistance in bathing and tending to other hygiene needs because of limited endurance due to CAD. The examiner also noted the Veteran had difficulty with medication regimen due to his CAD. He also had poor balance, endurance, and fatigue due to CAD. He was only able to leave his house with assistance. Aid and attendance examinations dated in June 2016 and September 2017 revealed the Veteran also needed help preparing meals and assistance in bathing and tending to other hygiene needs as result of limited endurance due to CAD. He again required medication management and had poor balance and fatigued easily due to CAD. The examiner noted the Veteran was only able to leave the house with assistance as he had limited ambulation due to CAD. Based on the above, the evidence shows that the Veteran needs regular aid and attendance of another person to protect him from hazards or dangers incident to his daily environment and when caring for his daily personal needs at least in part due to the service-connected CAD. Thus, warranting special monthly compensation based on the need for regular aid and attendance. The Board’s grant of special monthly compensation benefits based on aid and attendance renders moot the claim for benefits based on housebound status because benefits based on aid and attendance are payable at a higher rate. See 38 U.S.C. § 1114. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. L. Wallin, Counsel