Citation Nr: 18148715 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 17-67 636 DATE: November 8, 2018 ORDER Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is granted. FINDING OF FACT The Veteran requires regular aid and attendance due to his service-connected disabilities. CONCLUSION OF LAW The criteria for SMC for aid and attendance have been met. 38 U.S.C. §§ 1114, 5107 (2012); 38 C.F.R. §§ 3.352, 3.350 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION SMC SMC is payable at the (l) rate if a Veteran, as the result of service-connected disability, 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 following will be accorded consideration in determining the need for regular aid and attendance: inability of 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 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 himself 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 daily environment. 38 C.F.R. § 3.352 (a). 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 which the Veteran is unable to perform should be considered in connection with his 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. Entitlement to SMC for aid and attendance The Veteran contends that he should be afforded SMC for aid and attendance. The Board initially notes that the Veteran is currently receiving SMC under 38 U.S.C. 1114(k) for loss of use of a creative organ and anatomical loss of one foot; as well as SMC under 38 U.S.C. 1114(s). The Veteran is currently service connected for coronary artery disease, diabetes mellitus, type 2; right leg below the knee amputation, bilateral lower extremity peripheral artery disease, tinnitus, bilateral lower extremity diabetic neuropathy, erectile dysfunction, bilateral hearing loss, hypertension, and diabetic retinopathy. In July 2013, Dr. M.J. MD provided a VA 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance on behalf of the Veteran. It was noted that the Veteran was able to feed himself, was not able to prepare his own meals, needed assistance in bathing and tending to other hygiene needs, was not legally blind, did not require nursing home care but did require medication management. No restrictions of the spine, trunk, neck or upper extremities were noted, but it was indicated there were restrictions of the lower extremity owing to peripheral neuropathy, right foot fracture and diabetic feet. No description of the restrictions or other explanation was offered on this document. The Veteran also was noted as being able to leave his home daily, but needed assistance for locomotion after 5 or 6 blocks. The Veteran was afforded an additional VA aid and attendance examination in May 2016. Upon examination, it was noted that he is able to feed himself, had limited ability to prepare meals, and needed assistance with transfers, mobility, laundry, cleaning, showering and hygiene after commode use. He was able to sit up in a wheel chair and has good strength and range of motion in the left and right upper extremities. Medication and financial management was required due to cognitive and memory deficits and residuals of multiple strokes. In addition, the examiner noted that the Veteran needed assistance to leave his home and for locomotion at all distances. An August 2017 VA Physical Medicine Rehab Note indicates that the Veteran functional level index for his right leg amputation was “ambulatory over all community distances/uses variable cadence.” Based on the foregoing evidence of record, the Board finds that with the resolution of reasonable doubt in the Veteran’s favor, SMC based on the need for aid and attendance is warranted. While the record documents significant impairment owing to the Veteran’s cognitive and memory deficits arising from non-service connected disability, at the same time it has been indicated that his service connected disabilities cause him to require assistance in transfers, laundry, cleaning, showering and hygiene after commode use. Given these fundamental needs that require assistance to accomplish, the Board finds the evidence to be at least in equipoise on the question of the Veteran’s entitlement to the benefits sought. Resolving that balance in favor of the Veteran, entitlement to SMC based on the need of aid and attendance is granted. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R.A. Elliott II, Associate Counsel