Citation Nr: 18144014 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 15-18 231 DATE: October 22, 2018 ORDER Special monthly compensation (SMC) based on the need for aid and attendance is granted. FINDING OF FACT The competent and probative evidence is at least in equipoise as to whether the Veteran’s service-connected disabilities render him so incapable of performing the activities of daily living that he requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. CONCLUSION OF LAW The criteria for SMC based on the need for regular aid and attendance have been met. 38 U.S.C. §§ 1114, 5107(b); 38 C.F.R. §§ 3.350, 3.352. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1969 to September 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a Board hearing in his Form 9 substantive appeal. The RO scheduled a hearing and sent notice to the Veteran in August 2018. However, he did not appear for the hearing, and the hearing request is deemed withdrawn. Entitlement to SMC based on the need for aid and attendance. “SMC is available when, ‘as the result of service-connected disability,’ a veteran suffers additional hardships above and beyond those contemplated by VA’s schedule for rating disabilities.” Breniser v. Shinseki, 25 Vet. App. 64, 68 (2011) (citing 38 U.S.C. §1114(k)-(s)). Section 1114(l) provides five distinct ways for a veteran, “as the result of service-connected disability,” to qualify for this rate of SMC: (1) anatomical loss or loss of use of both feet; (2) anatomical loss or loss of use of one hand and one foot; (3) blindness in both eyes with 5/200 visual acuity or less; (4) being permanently bedridden; or (5) having “such significant disabilities as to be in need of regular aid and attendance.” 38 U.S.C. § 1114(l). The following basic considerations are critical in determining the need for the regular aid and attendance of another person: inability of a veteran to dress or undress him or herself, or to keep him or herself 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 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.); inability of claimant to feed him or herself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352(a). Determinations as to the need for aid and attendance must be based on actual requirements of personal assistance from others. Id. It is not required that all of the disabling conditions enumerated in 38 C.F.R. § 3.352(a) be found to exist before a favorable rating may be made. The particular personal functions which a veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that a veteran is so helpless as to need regular aid and attendance, not that there is a constant need. Id. After review of the record, the Board finds that the criteria for SMC based on the need for aid and attendance have been met. The Veteran currently has the following service-connected disabilities: posttraumatic stress disorder (PTSD) (100 percent); prostate cancer (100 percent); ischemic heart disease (60 percent); diabetic nephropathy (60 percent); peripheral neuropathy of the bilateral lower extremities (both rated as 40 percent disabling); diabetes (20 percent); peripheral neuropathy of the bilateral lower extremities (both rated as 10 percent disabling); stasis dermatitis (10 percent); and non-Hodgkin’s lymphoma (noncompensable). Additionally, the Veteran has been found not competent to handle disbursement of VA funds. A May 2015 private examination indicates that the Veteran’s service-connected disabilities result in functional impairment regarding the Veteran’s ability to perform his activities of daily living (ADLs) safely and independently. The Veteran requires assistance in preparing meals, feeding himself, bathing and tending to hygiene needs, medication management, and financial affairs, largely due to impaired function of the arms and legs caused by service-connected peripheral neuropathy of the bilateral upper and lower extremities. 05/18/2015, VA 21-2680. A statement from the Veteran’s spouse explains that her assistance is required for almost all of the Veteran’s ADLs, including medication management, preparing meals, feeding, bathing, and other hygiene needs due to impaired control, strength, and stability of the arms and legs. The Veteran’s children assist him when his spouse has to be away from the house. 05/22/2015, Form 9. Service-connected disabilities also result in limited mobility, as the Veteran requires a cane or walker to walk, his right foot drags, at times he is unstable, and he cannot climb stairs without assistance. In light of the foregoing, the Board finds that the competent and probative evidence is at least in equipoise as to whether the Veteran’s service-connected disabilities render him so incapable of performing the activities of daily living that he requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment; thus, SMC based on the need for aid and attendance is warranted. See 38 U.S.C. § 1114; 38 C.F.R. § 3.352. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.A. Gelber, Associate Counsel