Citation Nr: 18142777 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 15-10 131A DATE: October 17, 2018 ORDER Entitlement to special monthly compensation based upon the need of aid and attendance of another person is granted. FINDING OF FACT The Veteran's service-connected disabilities alone render him in need of regular aid and attendance of another person. CONCLUSION OF LAW The criteria for an award of special monthly compensation (SMC) by reason of the need for regular aid and attendance of another person are met. 38 U.S.C. § 1114 (2012); 38 C.F.R. §§ 3.350, 3.352(a) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from December 1978 to June 1995. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In October 2018, the Veteran testified in front of the undersigned Veterans’ Law Judge. The Veteran asserts that he should be granted SMC for aid and attendance benefits due to service-connected disabilities. SMC may be granted to a Veteran on the basis of the need for regular aid and attendance from another person or of being housebound. In other words, a Veteran may receive SMC for either needing the regular aid and attendance of another person or for being housebound but not for both simultaneously. SMC by reason of the need for regular aid and attendance of another person is a greater monthly benefit than SMC by reason of being housebound. 38 U.S.C. §§ 1114(l), (s). SMC by reason of the need for regular aid and attendance of another person is payable if a Veteran, as the result of service-connected disability, either: (1) has suffered the anatomical loss or loss of use of both feet, (2) has suffered the anatomical loss or loss of use of one hand and one foot, (3) is blind in both eyes, (4) is permanently bedridden, or (5) is with such significant disabilities/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 should be on the basis of a Veteran being permanently bedridden rather than needing regular aid and attendance to avoid reduction during hospitalization where aid and attendance is provided in kind. 38 C.F.R. § 3.350(b)(4). Bedridden means that the Veteran is actually required to remain in bed. 38 C.F.R. § 3.352(a). The fact that the Veteran 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. Id. In determining the need for regular aid and attendance of another person, several factors are for consideration. Id. These include: (1) the inability of the Veteran 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 Veteran's particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.), (3) the inability of the Veteran to feed himself through loss of coordination of his upper extremities or through extreme weakness, (4) the inability of the Veteran to attend to the wants of nature, (5) incapacity, physical or mental, which requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment, and (6) the Veteran being bedridden. Id. Granting SMC by reason of the need for regular need for aid and attendance of another person requires that at least one of the above disabling factors be met. Turco v. Brown, 9 Vet. App. 222 (1996). Regarding being bedridden, however, a favorable determination will not be based solely upon an opinion that the Veteran's condition is such as would require him to be in bed. 38 C.F.R. § 3.352(a). Such a determination instead must be based on the actual requirement of personal assistance from others. Id. Here, the Board finds that the Veteran meets the criteria for SMC for aid and attendance of another. The relevant facts include that the Veteran is service-connected for the following disabilities: migraine headaches with photophobia rated as 50 percent disabling; an adjustment disorder with depression and anxiety rated as 30 percent disabling; left shoulder strain with arthritis rated as 20 percent disabling; onychomycosis rated as 10 percent disabling; left fifth finger arthritis rated as noncompensable; and a keloid scar on the chest, rated as noncompensable. He has also been granted entitlement to individual unemployability due to his service-connected disabilities (TDIU). The Veteran had VA aid and attendance examinations in December 2012 and August 2013. It was noted that he needed assistance with dressing due to his left shoulder disorder. He needed his wife’s assistance in managing his medication, in that she provided reminders for him and set the medication out for him to take. He had short-term memory problems and irritability as a result of his psychiatric disorder. He was able to feed himself and attend to the needs of nature, except when he was experiencing a migraine. He also had dizziness and balance problems, as well as difficulty focusing on tasks and loss of vision in his left eye, when he was experiencing a migraine. Also of record is an August 2013 letter from the Veteran’s VA medical provider stating that the Veteran had constant, unrelenting headaches that render him unable to be out of his house due to light sensitivity and require oxygen therapy. She noted that the Veteran had to wear dark glasses to all appointments due to chronic light sensitivity. He also needed help with grooming and dressing due to his chronic left shoulder pain that required a shoulder sling. As a result of his chronic anxiety and depression, he experienced anger and irritability. His wife helped to monitor his coping skills. Further, the Veteran needed a driver due to his vision difficulties. Given the above, the Board finds that entitlement to SMC by reason of the need for regular aid and attendance from another person is warranted. The evidence of record demonstrates that the Veteran needs assistance with activities of daily living including grooming, dressing, ambulation and medication management due to his service-connected disabilities. Thus, he meets the prerequisite for aid and attendance from another. See generally Turco v. Brown, 9 Vet. App. 222 (1996). As implied from above, it is not required that all of the disabling factors be found to exist before a favorable determination is made for regular need for aid and attendance of another person. 38 C.F.R. § 3.352(a). The particular personal functions that the Veteran is unable to perform should be considered in connection with his condition as a whole. Id. It is only necessary that the evidence establish that the Veteran is so helpless as to need regular aid and attendance, not that there is a constant need. Id. The performance of the necessary aid and attendance service by a relative or other member of the Veteran's household will not prevent a favorable determination. 38 C.F.R. § 3.352(c). In sum, the medical evidence of record supports the Veteran's statements that his service-connected disabilities render him unable to perform daily activities of   living without the assistance of another. Accordingly, the claim for SMC for aid and attendance from another is granted. P. M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Denton, Buck