Citation Nr: 18151798 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 15-43 471 DATE: November 20, 2018 ORDER Special monthly compensation (SMC) based upon the need for regular aid and attendance, from October 31, 2013, to September 9, 2016, is granted. FINDING OF FACT From October 31, 2013, to September 9, 2016, the Veteran’s service-connected disabilities left him so helpless as to be in need of the regular aid and attendance of another person. CONCLUSION OF LAW From October 31, 2013, to September 9, 2016, the criteria for SMC based upon need for regular aid and attendance are met. 38 U.S.C.§ 1502, 1521; 38 C.F.R. § 3.350, 3.351, 3.352. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1970 to January 1972. The need for aid and attendance is defined as helplessness or being so nearly helpless as to require the regular aid and attendance of another person. 38 C.F.R. § 3.351 (b). A veteran will be considered in need of aid and attendance if he or she is (1) blind or 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; (2) is a patient in a nursing home because of mental or physical incapacity; or (3) establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352 (a). 38 C.F.R. § 3.351 (c). Under 38 C.F.R. § 3.352 (a), the following criteria will be accorded consideration in determining the need for regular aid and attendance: the inability of a 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 such aid, such as supports, belts, lacing at the back, etc.); the inability of a 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. It is not required that all of the disabling conditions enumerated be found to exist before a favorable ruling 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 be a constant need. Determinations that a veteran is so helpless, as to be in need of regular aid and attendance will not be based solely on an opinion that a veteran’s condition is such that it would require him or her to be in bed. They must be based on the actual requirements of personal assistance from others. 38 C.F.R. § 3.352 (a); Turco v. Brown, 9 Vet. App. 222 (1996). A veteran will be determined to be permanently housebound when he is substantially confined to his house (or ward or clinical areas, if institutionalized) or immediate premises due to disability or disabilities which it is reasonably certain will remain throughout his lifetime. 38 U.S.C. § 1502 (c); 38 C.F.R. § 3.351 (d)(2). To establish entitlement to SMC based on housebound status under 38 U.S.C. § 1114 (s), the evidence must show that a Veteran has a single service-connected disability evaluated as 100 percent disabling and an additional service-connected disability, or disabilities, evaluated as 60 percent or more disabling that is separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or, the Veteran has a single service-connected disability evaluated as 100 percent disabling and due solely to service-connected disability or disabilities, the Veteran is permanently and substantially confined to his or her immediate premises. 38 C.F.R. § 3.350 (i). In this case, from October 31, 2013, to September 9, 2016, the Veteran did not meet the schedular criteria for an award of SMC under 38 C.F.R. § 3.350 (i)(1). He was in receipt of a 100 percent rating for coronary artery disease with history of congestive heart failure and noncompensable residual scar, and a 20 percent rating for diabetes mellitus. Beginning on September 9, 2016, the Veteran was in receipt of service connection for additional disabilities resulting in the award of SMC, to include motor ataxia related to a stroke rated at 30 percent, and diabetic neuropathy of the right and left upper and lower extremities each rated at 20 percent. After a review of the evidence, the Board finds that the Veteran met the criteria for SMC based upon the need for aid and attendance from October 31, 2013, September 9, 2016, on a factual basis, pursuant to 38 C.F.R. § 3.350 (b)(3). Significantly, although the Veteran was not in receipt of separate ratings for peripheral neuropathy of the upper and lower extremities for this time period, he was in receipt of service connection for diabetes mellitus. Given that under the rating schedule diabetic residuals are considered to be part of the diabetic disease process, the Board finds it to be appropriate to consider such residuals, to include diabetic peripheral neuropathy, when determining whether the Veteran is entitled to SMC. To that extent, the medical evidence reflects that the Veteran suffered from the same neurological symptoms prior to and since September 9, 2016, necessitating constant care by his spouse related to completing most activities of daily living. An October 2013 SMC examination demonstrated that the Veteran was unable to independently eat, groom, or complete basic activities due to his neurological symptoms. He left the home only for medical appointments and with his spouse. In December 2016, he was found to have moderate sensory neuropathy in all extremities. While his loss of strength was attributed to his stroke, for which he was not in receipt of service connection during this period, his other symptoms were not delineated between the two disabilities. Moreover, in December 2016, the Veteran’s coronary artery disease was shown to cause significant symptoms with even slight exertion. When considering the lay statements submitted by the Veteran’s spouse, as well as the medical evidence, the Board finds that the criteria for SMC based upon the need for regular aid and attendance have been met from October 31, 2013, September 9, 2016. (Continued on the next page)   The Board does not find that the Veteran was housebound however, as the VA treatment records demonstrate that the Veteran was encouraged to leave the home to take walks, and the evidence does not demonstrate that he was confined to the home. The evidence shows that he was able to leave the home at least for medical appointments. Significantly, his diabetes mellitus and coronary artery disease, on their own, were not shown to cause him to be confined to his home. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Erdheim, Counsel