Citation Nr: 18141650 Decision Date: 10/11/18 Archive Date: 10/11/18 DOCKET NO. 15-57 698A DATE: October 11, 2018 REMANDED Entitlement to an annual clothing allowance, including consideration of two separate clothing allowances, for the year of 2014 is remanded. REASONS FOR REMAND The Veteran served a period of honorable active duty service from September 1975 to May 1988. [The Veteran also served on active duty from May 1988 to September 1990 and received a bad conduct discharge for this period; this period has been found to be dishonorable for VA purposes.] The Veteran is service connected for posttraumatic stress disorder, low back strain, and right wrist ganglion cyst. She contends that her back brace and right wrist brace have exposed metal tabs that tear holes in her clothing, and she should be entitled to an annual clothing allowance. The law provides for payment of an annual clothing allowance for each veteran who, because of a service-connected disability, wears or uses a prosthetic or orthopedic appliance which VA determines tends to wear out or tear the clothing, or uses prescribed medication for a service-connected skin disability which causes irreparable damage to the outer garments. 38 U.S.C. § 1162. Under 38 C.F.R. § 3.810, a veteran may be eligible for an annual clothing allowance when the Chief Medical Director or designee certifies that due to a service-connected disability, a qualifying prosthetic or orthopedic appliance is worn or used which tends to wear or tear the veteran’s clothing. 38 C.F.R. § 3.810(a)(1)(ii)(A). The Veteran requested a clothing allowance in 2014 due to damage caused by her back brace and wrist brace. The Veteran’s claim was denied on the basis that her braces were elastic wrap-around orthoses with aluminum polycentric hinges and no exposed joints or surfaces which would cause damage or would wear or tear on clothing. The Board notes that the claim was initially characterized as entitlement to an annual clothing allowance, but it actually appears that the Veteran may be requesting two separate clothing allowances, one for clothing damage caused by her back brace and one for clothing damage done by her wrist brace. A second clothing allowance can be granted to a veteran for each prosthetic or orthopedic appliance used if that prosthetic or appliance (i) satisfies the requirements of 38 C.F.R. § 3.810(a)(1), above; and, (ii) affects a distinct type of article of clothing or outer garment. See 38 C.F.R. § 3.810(a)(2). In readjudicating the appeal, the agency of original jurisdiction should consider whether two separate clothing allowances can be assigned. The controlling regulation pertaining to clothing allowance does not require that a brace be of a certain type or construction to be found eligible for clothing allowance; it simply indicates that it must tend to wear and tear clothing. 38 C.F.R. § 3.810(a)(1). The Veterans Health Administration (VHA) handbook indicates that fabric-covered braces, hinges covered in fabric, elastic/flexible braces, and soft orthotics are examples of items that generally do not tend to tear or wear clothing. VHA Handbook 1173.15, “Clothing Allowance,” sec. 8(b). However, the list is not dispositive, but instead is only a guide in making the ultimate determination in a clothing allowance claim. The VHA Handbook also indicates that when there is insufficient medical evidence to grant a claim, a clinical review and/or physical evaluation of the prosthetic is warranted. VHA Handbook 1173.15, “Clothing Allowance,” sec. 6(a). The Board finds that an adequate medical opinion must be obtained which is sufficient to determine whether the Veteran is entitled to an annual clothing allowance, and possibly a second clothing allowance. For the appellant to be found eligible for a clothing allowance, a certification is needed from the Chief Medical Director or designee that the orthopedic appliance tends to wear or tear the Veteran’s clothing. In this case, there is no medical finding of record from Prosthetic Services regarding whether the Veteran’s braces cause wear and tear to her clothing. The January 2015 statement of the case only states that the Veteran’s braces are elastic wrap-around orthoses with no exposed joints, but it does not address the Veteran’s contentions regarding getting holes in her clothing from the exposed metal tabs in her braces or her photographs showing the exposed metal tabs. There is no indication that any evaluation was made of the actual impact of the Veteran’s braces on her clothes. A medical determination must be made which addresses the Veteran’s braces and their impact on her clothes specifically, rather than a finding that these types of braces, in the abstract, do not tend to tear clothing. It is also unclear to the Board whether the Veteran’s right wrist brace is medically necessary for treatment of her service-connected ganglion cyst. The January 2015 statement of the case indicates that the Veteran was issued a back brace on May 22, 2013 and a right wrist brace on July 25, 2013. These VA medical records are not currently of record. The Board therefore requests that these VA treatment records be obtained to assist in determining whether the Veteran’s right wrist brace was issued for treatment of a service-connected disability. The medical opinion obtained should also consider these records and provide a determination on whether the Veteran’s use of a right wrist brace is medically necessary for the treatment of her service-connected ganglion cyst. Lastly, it does not appear that all of the files relating to this claim have been placed in the paper claims file or in the electronic record, VBMS. The August 2014 decision letter has not been associated with the claims file. The statement of the case also indicates that in August 2014, the Veteran’s service connections were verified through Prosthetic Services and a review was conducted, but there is no record of any determinations made by Prosthetic Services. The Board therefore remands this issue to obtain all relevant records and procedural documents, and to obtain an adequate medical opinion regarding the effect of the Veteran’s back and wrist braces on her clothing. The matter is REMANDED for the following action: 1. Associate all folders or other paper files pertaining to the Veteran’s claims of entitlement to an annual clothing allowance with the current claims file. All relevant documents must be located and associated with the claims file, including, but not limited to, the August 2014 decision notice letter and any findings or determinations by Prosthetics Services. 2. Obtain all outstanding, pertinent VA treatment records from the Augusta VA Medical Center since May 2013. 3. Perform a clinical prosthetic review of the Veteran’s back brace and right wrist brace. If a physical examination of the braces is found to be necessary, schedule the Veteran for an evaluation of the devices. The Veteran’s claims file as well as all medical records in Virtual VA and VBMS should then be reviewed by the Chief Medical Director or appropriate designee, for a determination on whether the Veteran meets the criteria for a clothing allowance in 2014 in accordance with VHA directives. The designee must specify in the report that the claims file, VBMS, and Virtual/Legacy VA records have been reviewed. The reviewer must address the following: (a) Is the use of i) a back brace and ii) a right wrist brace medically necessary and related to the Veteran’s service-connected low back strain and right wrist ganglion cyst? (b) Do any of the braces include hard edges which may tend to wear out, tear, or otherwise cause irreparable damage to the Veteran’s clothing? In answering this question, the examiner must specifically address the Veteran’s contentions that her braces each have an exposed metal tab which tears holes in her clothing, regardless of whether she wears the braces over or under her clothing and the photographs provided by the Veteran. It is noted that the reviewer must specifically address how this Veteran’s braces have affected her clothing. It is not sufficient to rely solely on the VHA Handbook’s general finding that elastic/flexible braces tend to not cause wear and tear on clothing. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mary E. Rude, Counsel