Citation Nr: 18144360 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 16-24 521 DATE: October 24, 2018 ORDER Entitlement to an initial rating in excess of 60 percent for arteriosclerotic heart disease (coronary artery disease) is denied. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to special monthly compensation benefits, pursuant to 38 U.S.C. § 1114 (l) based on the need for aid and attendance, and 38 U.S.C. § 1114 (s) by reason of being housebound, are denied. FINDINGS OF FACT 1. The Veteran’s arteriosclerotic heart disease (coronary artery disease) did not result in chronic congestive heart failure; a workload of 3 METs (metabolic equivalent) or less resulting in dyspnea, fatigue, angina, dizziness, or syncope; left ventricular dysfunction with an ejection fraction of less than 30 percent; hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia; or hospital admission for ventricular aneurysmectomy with an automatic implantable Cardioverter-Defibrillator (AICD) in place. 2. The Veteran’s PTSD was not shown to cause occupational and social impairment with deficiencies in most areas. 3. The Veteran’s service-connected disabilities do not render him in need of regular aid and attendance of another person; moreover, he is not permanently housebound by reason of his service connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess 60 percent for arteriosclerotic heart disease (coronary artery disease) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.104, Diagnostic Codes 7011, 7005. 2. The criteria for an initial rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.125, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for special monthly compensation based on aid and attendance and housebound rate have not been met. 38 U.S.C. § 1114 (l), (s); 38 C.F.R. §§ 3.102, 3.350, 3.352(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the Army from January 1969 to November 1970. This matter is on appeal to the Board of Veterans’ Appeals (Board) from a December 2014 rating decision of a regional office of the Department of Veterans Affairs (VA). Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). With the initial rating assigned with the award of service connection for a disability, “staged” ratings to reflect distinct periods when different levels of impairment were shown are for consideration. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Arteriosclerotic Heart Disease (Coronary Artery Disease) In December 2014, service connection was granted for the Veteran’s arteriosclerotic heart disease (claimed as ischemic heart disease and coronary artery disease), and assigned an initial evaluation of 60 percent disabling from March 14, 2014, the date of claim. Thereafter, in April 2016, the RO granted an earlier effective date one year prior to when the claim was received based on liberalizing law, effective March 14, 2013. The Veteran continues to disagree with the initial rating and is seeking a higher evaluation. The Veteran’s arteriosclerotic heart disease (coronary artery disease) is rated under 38 C.F.R. § 4.104, Diagnostic Codes 7011- 7005. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. Although heart disabilities are listed under different Diagnostic Codes, the criteria are essential identical. Diagnostic Code 7005 provides ratings for arteriosclerotic heart disease (coronary artery disease) and Diagnostic Code 7011 provides for ventricular arrhythmias (sustained). Under each Code, a 60 percent rating contemplates more than one episode of acute congestive heart failure in the past year, or workload of greater than 3 METs but not greater than 5 METs which results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction (LVEF) of less than 30 percent to 50 percent. A 100 percent rating is warranted for chronic congestive heart failure; or, workload of 3 METs or less which results in dyspnea, fatigue, angina, dizziness, or syncope; or, there is LVEF of less than 30 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005, 7011. As to arrhythmias, a 100 percent is also warranted for indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for indefinite period from date of hospital admission for ventricular aneurysmectomy, or; with an AICD in place. See Diagnostic Code 7011. A November 2014 VA examination report reflects findings of no history of congestive heart failure. The VA physician indicated the Veteran’s ejection fraction as normal, estimated at 50 to 55 percent. Based on interview, the physician estimated the Veteran’s METs level to be greater than 3 but less than 5, which was consistent with activities such as light yard work (weeding), mowing lawn (power mower), and brisk walking (4mph). Regarding the functional impact on his ability to work, the VA physician commented that the Veteran “is able to do sedentary work but not physically demanding work.” Based on the evidence described above, the Board finds that the Veteran is adequately compensated by the assigned 60 percent evaluation for the entire appeal period, and a higher rating is not warranted. There is no competent evidence to show that the Veteran has chronic congestive heart failure, or that he has an ejection fraction of 30 percent or less. 38 C.F.R. § 4.104, Diagnostic Code 7005. In fact, a November 2014 VA examiner expressly found that congestive heart failure was not present. As for ejection fraction, cardiac testing in 2014 showed ejection fraction of 50 to 55 percent, which the examiner indicated was normal. With regard to METs levels, the Veteran’s METs level are estimated to be greater than 3 but less than 5, which does not meet those levels required to meet the criteria for the next higher 100 percent rating. In summary, when viewed in the context of contemporaneous medical evidence, the Board finds that the evidence is insufficient to show that the Veteran has chronic congestive heart failure, a workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope; or that he has an ejection fraction of less than 30 percent, required for a 100 percent rating. Accordingly, the criteria for an evaluation in excess of 60 percent under Diagnostic Code 7005 are not shown to have been met, and the claim must be denied. Moreover, a higher rating is also not warranted on the basis of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia; or hospital admission for ventricular aneurysmectomy with an AICD in place, as such have not been shown during the pendency of the appeal. See Diagnostic Code 7011. No additional higher or alternative ratings under different Diagnostic Codes are warranted in this case, as the Veteran’s service-connected disability has consistently been characterized as arteriosclerotic heart disease (coronary artery disease). 38 C.F.R. § 4.104, Diagnostic Codes 7000-7123. The Board notes that the Veteran has a history of myocardial infarction which occurred in 1993. However, the rating criteria for myocardial infarction are the same as those used to rate coronary artery disease. 38 C.F.R. § 4.104, Diagnostic Codes 7005, 7006. Therefore, an increased rating under Diagnostic Code 7006 for myocardial infarction is not warranted for the same reasons that an increased rating for coronary artery disease is not warranted. Further, the Board has considered whether staged ratings would be warranted. However, the evidence shows no distinct periods of time during which the Veteran has demonstrated a level of impairment in excess of the 60 percent to warrant staged ratings. See Hart, 21 Vet. App. at 505. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the Veteran’s arteriosclerotic heart disease (coronary artery disease) symptomatology does not more nearly approximate the criteria required for the next higher 100 percent rating under Diagnostic Codes 7011-7005. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). PTSD In March 2014, the Veteran filed a claim for special monthly compensation based on his service-connected disabilities. By rating decision of December 2014, the RO continued the Veteran’s PTSD evaluation of 50 percent disabling. The Veteran disagrees and seeks a higher evaluation. The Veteran’s PTSD has been rated under Diagnostic Code 9411, which is rated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula for Mental Disorders, a 50 percent rating requires occupational and social impairment, but with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete task); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for even greater occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Id. When rating a mental disorder, VA must consider the frequency, severity, and duration of the Veteran’s psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. The rating agency must assign a rating based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. When rating the level of disability from a mental disorder, the rating agency must consider the extent of social impairment, but cannot assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. The Veteran’s actual symptomatology, and resulting social and occupational impairment, will be the primary focus when assigning a disability rating for a mental disorder, and the Veteran may qualify for a particular rating by demonstrating the particular symptoms associated with that percentage, or other symptoms of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). As explained below, the competent evidence of record, to include the Veteran’s treatment records, VA examination report, private medical opinion, and lay statements, do not establish findings consistent with higher ratings. In November 2014, the Veteran was afforded a VA psychiatric examination. He reported no history of suicidal attempts and expressly denied any current suicidal ideation, intent, or plan. He denied significant current depressed mood or significant anxiety, but reported having chronic sleep impairment and recurrent distressing recollections or dreams. He also noted having a panic attack one year ago. He described having a “great” relationship with his wife of 19 years. He has one adult stepson that lives at home with whom he has an “alright” relationship. He maintains contact with his four surviving siblings, and stated he sees a friend about every two weeks. On examination, the examiner noted that the Veteran was clean, well groomed, with logical thought and goal directed. The examiner found no obsessive rituals or inappropriate behavior, or delusions or hallucinations. The examiner noted that the Veteran drove himself to the examination. With regards to his functional level, the examiner indicated “occupational and social impairment with reduced reliability and productivity”. See VA Examination for PTSD dated November 12, 2014. In February 2018, the Veteran’s attorney submitted a private opinion rendered by a licensed psychologist H.H.G., Ph.D., based on an interview of the Veteran on September 7, 2016. On clinical interview, the Veteran reported suffering from chronic sleep impairment, disturbances of motivation and mood, hypervigilance and mild memory loss. He reported having difficulty establishing and maintaining relationships and adapting to stressful circumstances. He reported residing with his wife of 20 years and one adult child. He stated being socially isolated and withdrawn. His longest job was a pipefitter for over 40 years until 2014. He reported receiving treatment from a VA psychiatrist and counselor every two months. The Veteran denied suicidal or homicidal ideation or hallucinations. Based on the above assessment, the private psychologist indicated that the Veteran had occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking and/or mood. See PTSD Disability Benefits Questionnaire and Statement by H.H.G., Ph.D., dated September 2016. Upon review of the evidence, the Board finds that the preponderance of the evidence is against a finding of entitlement to an evaluation exceeding 50 percent at any time during the appeal period. As chronicled above, the Veteran clearly experienced psychiatric symptomatology as a result of his PTSD with symptoms such as chronic sleep impairment, distressing recollections, and mild memory loss. However, the objective evidence of record does not establish that his PTSD was manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood. Significantly, the Veteran consistently denied any history of suicidal attempts and expressly denied any passing/active suicidal ideations or homicidal ideation. He also denied any intent and/or plan to hurt himself or others. In fact, there is no evidence to show that at any time during the appeal period the Veteran exhibited or resorted to violence or acted upon such impulses. Additionally, the Board observes that the Veteran’s relevant mental history and material evidence of record were specifically considered by the medical professionals in formulating their assessments in 2014 and 2016. Further, it is not just the presence of psychiatric symptoms that mandates the assignment of a higher rating, but rather, the Board must evaluate how the reported symptoms impact the Veteran’s occupational and social functioning. Vazquez-Claudio, 713 F.3d at 117. Additionally, the Board has taken into consideration the frequency, severity, and duration of the Veteran’s reported severity of his PTSD symptoms. However, the symptoms present here, and their resulting effects, do not rise to the level of the next higher ratings. That is, for instance, simply because the Veteran has panic attacks, and because the 70 percent level contemplates panic, does not mean his psychiatric disorder rises to the 70 percent level. Indeed, the 30 percent, 50 percent, and 70 percent criteria each contemplate some form of panic attacks. Moreover, the record does not show any episodes of neglect of personal hygiene, disorientation, irritability with periods of violence, which is indicative of impaired impulse control, contemplating a 70 percent rating. In fact, the November 2014 VA examiner that personally examined the Veteran observed him to be well groomed with good hygiene, and clear and logical thought processes. A similar opinion was indicated by the September 2016 private psychologist that noted the Veteran’s thought processes were goal directed and organized. Clearly, such findings are not consistent with a higher 70 percent rating which requires symptoms of obsessional rituals, speech intermittently illogical, obscure, or irrelevant; impaired impulse control, spatial disorientation, neglect of personal appearance and hygiene or an inability to establish and maintain effective relationships. With regard to occupational functioning, the record reflects that during clinical interview in 2014, the Veteran indicated he last worked in March 2014 as a contractor in construction. He stated he had heart problems and was unable to return to work. Similarly, in 2016, he reported having worked over 40 years as a pipefitter since 2014. He reported difficulty remembering events, requests and occasionally forgetting details or sequencing that would affect his employment. As for the Veteran’s heart condition’s functional impact on his ability to work, a November 2014 VA physician that evaluated the Veteran for his service-connected coronary artery disease found that the Veteran “is able to do sedentary work but not physically demanding work.” A similar opinion was reflected by the November 2014 VA examiner finding that the Veteran’s PTSD symptomatology resulted in “occupational and social impairment with reduced reliability and productivity”. Indeed, the Board acknowledges the September 2016 private opinion indicating that the Veteran’s “troubling PTSD symptoms are preventing him from maintaining substantially gainful employment.” However, the Board finds the private opinion carries significantly less probative value as the assessment does not address the conflicting November 2014 VA examinations of record, and the private assessment is generally unsupported and inconsistent with what is presented during in-person VA examinations and clinical interviews. See Prejean v. West, 13 Vet. App. 444 (2000). Thus, the Board assigns great probative value to the opinions of VA examiners that indicated the Veteran’s symptoms did not appear to be of such severity to render him unemployable. Consequently, the Veteran’s PTSD was not shown to cause occupational impairment with deficiencies in most areas. Likewise, contrary to the private opinion, at no time does the record reflect that the Veteran had an inability to establish and maintain effective relationships. Rather, according to the Veteran, he has a “great” relationship with his wife of over 20 years and is able to maintain a relationship with his adult son, four siblings, and friends. As such, findings of social isolation and inability to sustain any relationship are inconsistent with the Veteran’s own reports and admissions during clinical interview. In fact, the record shows that the Veteran is able to maintain relationships with family, friends or acquaintances and lives at home with a supportive family. Thus, it cannot be concluded that the Veteran totally socially impaired. In short, the Board finds that the Veteran’s PTSD symptoms during the entire appeal period do not impact his social and occupational functionality in such a way to result in social and occupational impairment with deficiencies in most areas. For these reasons, the Board finds that the Veteran’s PTSD has not been manifested by symptomatology more nearly approximating the criteria for a 70 percent disability rating under 38 C.F.R. § 4.130, Diagnostic Code 9411. The benefit-of-the-doubt doctrine is not for application, and an increased rating under this code is not warranted. See 38 U.S.C.§ 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the claim must be denied. Special Monthly Compensation Generally, an award of special monthly compensation provides for additional levels of compensation above the basic levels of compensation afforded by the schedular rating criteria in 38 C.F.R. Part 4. These additional levels of compensation are awarded for various types of losses or levels of impairment, due solely to service-connected disabilities, and for specific combinations of such impairments. The different types of special monthly compensation available are commonly referred to by their alphabetic designations, such as (k), (l), etc., which correspond to the paragraphs of 38 U.S.C. § 1114 which provides the statutory authority for special monthly compensation benefits. These same paragraphs are codified in VA regulation predominantly at 38 C.F.R. § 3.350(a) - (i). Aid and Attendance Special monthly compensation is payable at the aid and attendance rate specified under special monthly compensation (l) if a veteran has anatomical loss or loss of use of both feet, or loss of use of one hand and one foot; if he or she is blind or is so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less; if the veteran is a patient in a nursing home because of mental or physical incapacity; or if he or she 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). The benefit is also warranted if the evidence establishes a factual need for aid and attendance status under the criteria set forth in 38 C.F.R. § 3.352(a). The following will be accorded consideration in determining the need for regular aid and attendance: inability of claimant to dress or undress himself (herself), or to keep himself (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; inability of claimant to feed himself (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). A veteran will be found to be “bedridden” if the condition actually requires that he remain in bed, but not if he voluntarily stays in bed or if a physician merely recommends bed rest. It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions that the 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 the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Id. 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 claimant’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. Id. The critical question to be determined is whether the Veteran’s service-connected schizoaffective disorder has resulted in the need for regular aid and attendance of another person because of resultant helplessness due to mental and/or physical impairment. Here, the critical question to be determined is whether the Veteran’s service-connected disabilities have resulted in the need for regular aid and attendance of another person because of resultant helplessness due to mental and/or physical impairment. The record does not show and the Veteran does not allege that he is blind or nearly blind or that he is a patient in a nursing home because of mental or physical incapacity. Likewise, he is not permanently bedridden as he has reported traveling outside his home for medical appointments, walking around the house, and capable of performing all activities of daily living. See VA examination report of November 2014. Turning to the question of whether there is a factual need for aid and attendance, the Board observes that the Veteran is not rendered so helpless as to need regular aid and attendance due to his service-connected disabilities. At a VA examination in November 2014, the Veteran reported that on a typical day he drives where he wants to go. He might go fishing, or drive to the forest to observe or go get a bite to eat. He is able to perform all activities of daily living. The Veteran reported avoiding walking long distances but when possible, he walks slowly. The VA examiner commented that the Veteran is able to walk in and out of his home independently. The evidence of record shows that the service-connected disabilities do not preclude the Veteran from tending to the wants of nature and caring for his daily personal without the regular assistance of another person. For instance, he has not shown the inability to feed oneself through loss of coordination of upper extremities or through extreme weakness. In fact, the Veteran successfully navigates his daily environment and the hazards or dangers incident to that environment. He has no special prosthetic or orthopedic appliances requiring adjustment. As such, the evidence of record shows that the Veteran is not rendered so helpless as to need regular aid and attendance due to his service-connected disabilities. There is no other medical opinion, private or VA, in support of the Veteran’s claim. Thus, the type of situation contemplated by the criteria for an award of special monthly compensation based on a need for regular aid and attendance have not been met. Accordingly, entitlement to special monthly compensation (l) is not warranted. Housebound Special monthly compensation is payable at the (s) or “housebound” rate when a veteran has a single service-connected disability rated as 100 percent and, either (1) has additional service-connected disabilities independently ratable at 60 percent, or (2) is permanently housebound by reason of service-connected disabilities. 38 C.F.R. § 3.350 (i). See 38 U.S.C. § 1114 (s). For the purpose of meeting the first criterion, a rating of 100 percent may be based on any of the following grants of total disability: on a schedular basis, on an extraschedular basis, or on the basis of a temporary total rating pursuant to 38 C.F.R. §§ 4.28 (pre-stabilization rating), 4.29 (temporary total hospital rating) or, 4.30 (temporary total convalescence rating). Additionally, a total disability rating based on individual unemployability (TDIU) may meet the criterion, but only if assigned for a single disability. See Bradley v. Peake, 22 Vet. App. 280 (2008); Buie v. Shinseki, 24 Vet. App. 242 (2011). With regard to the permanently housebound requirement, this is met where a veteran is substantially confined as a direct result of a service-connected disability to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinic areas, and it is reasonably certain that the disability or disabilities and resulting confinement will continue throughout his or her lifetime. Id. Here, the Veteran does not have a single, permanent service-connected disability rated 100 percent disabling; therefore, he does not meet the legal criteria for payment of compensation at the housebound rate under that criterion. See 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350. The only disabilities for which the Veteran is rated 50 percent or greater are coronary artery disease (rated as 60 percent disabling) and posttraumatic stress disorder (rated as 50 percent disabling). Thus, the statutory requirements for special monthly compensation at the housebound rate are not met because there is no single disability evaluated as totally disabling. Furthermore, the evidence does not show that the Veteran is permanently and substantially confined to his home as a result of his service-connected disabilities as he has had medical visits at medical facilities and reported regularly traveling outside his home. Accordingly, benefits at the special monthly compensation (s) rate are not warranted. (Continued on the next page) Based on the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for special monthly compensation based on the need for regular aid and attendance of another person and by reason of housebound status. Thus, his appeal for special monthly compensation is denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. An, Associate Counsel