Citation Nr: 18151867 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-37 266 DATE: November 20, 2018 REMANDED Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance of another person or by reason of being housebound is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1989 to March 2009. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an August 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The issue was remanded by the Board in March 2018. 1. Entitlement to SMC based on the need for regular aid and attendance of another person or by reason of being housebound is remanded. In March 2018, the Board remanded the Veteran’s claim of entitlement to special monthly compensation for aid and attendance for development, to include a VA examination determining whether the Veteran’s service-connected disabilities require the need for aid and attendance. In June 2018 the Veteran was afforded a VA examination for such. At that time the Veteran reported that he did not drive and that he had unpredictable muscle spasms in his back. Additionally, he reported that he sits for most of the day, and that he has a personal friend who he pays to clean himself after his bowel movements, and clean him during his baths. He also reports paying a person to come in and cook his meals daily and do laundry. He reported that he was able to watch TV and read during the day, but only for short times due to extreme sleepiness. The examiner noted that the Veteran’s balance and memory loss and dizziness did not affect his ability to protect himself from daily hazards or dangers. The Veteran stated he was unable to perform bathing and toileting because he could not reach around to do so. The examiner noted during the examination that the Veteran did not need aid for ambulation, and that he could leave the house unrestricted. The Board finds that the examiner failed to appropriately identify the extent to which the Veteran’s service-connected disabilities impact his activities of daily living and his capability for self-care. Although the examiner discussed the Veteran’s reports of difficulty with daily tasks, he failed to address whether only the Veteran’s service-connected disabilities limit his abilities. As such, the claim for entitlement to special monthly compensation for aid and attendance must be remanded to obtain an addendum opinion to complete the development requested in the March 2018 Board remand. See Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: Obtain an addendum to the June 2018 VA examination clarifying if the Veteran is limited in his ability to bathe and toilet as the result of a service-connected disability. The examiner should specifically address what limits his ability to do so. The Veteran should be scheduled for another VA examination if determined necessary. The examiner must note that service connection is in effect for: obstructive sleep apnea (rated 50% disabling); adjustment disorder with mixed emotional features including anxiety, depression, irritability, and dyssomnia (rated 30% disabling); left knee osteoarthritis (rated 10 percent disabling); right ankle strain with degenerative changes (rated 10 percent disabling); right shoulder osteoarthritis status-post surgery (rated 10 percent disabling); left hip strain (rated 10 percent disabling); left ankle strain (rated 10 percent disabling); right wrist strain and ulnar styloid cyst (rated 10 percent disabling); right hip strain (rated 10 percent disabling); right elbow strain (rated 10 percent disabling); left shoulder strain (rated 10 percent disabling); right knee strain (rated 10 percent disabling); lumbar spine strain and degenerative disc disease with osteoarthritis at L3-4 (rated 10 percent disabling); cervical spine strain with degenerative disc disease C5-6 (rated 10 percent disabling); tinnitus (rated 10 percent disabling); hiatal hernia and duodenal ulcers (rated 10 percent disabling); left elbow dislocation with residual fragmentation (rated 10 percent disabling); right foot metatarsophalangeal joint osteoarthritis, foreign body of the fifth metatarsal, opacity of plantar surface, and gout of the right great toe (rated non-compensable); fracture of the right long (third) finger (rated non-compensable); hypertension (rated non-compensable); hemorrhoids (rated non-compensable); status-post laceration of the right thigh with residual scar (rated non-compensable); right shoulder surgical scar associated with right shoulder osteoarthritis status-post surgery (rated non-compensable); pilonidal cyst and scar, status-post previous pilonidal cyst removal (rated non-compensable); tension headaches (rated non-compensable); and right thigh subcutaneous nerve injury with decreased sensation (rated non-compensable). The examiner should identify the extent to which the Veteran’s service-connected disabilities impact his activities of daily living and his capability for self-care. The examiner’s assessment must include, but not be limited to, evaluation of such factors as: the Veteran’s ability or inability to dress or undress himself or to keep himself clean and presentable; ability or inability to feed himself; ability or inability to attend to the wants of nature; any need of adjustment of any special prosthetic or orthopedic appliance (to include dressing or bandage changes); and any incapacity, whether physical or mental, that requires care or assistance on a regular basis to protect the Veteran from hazards or dangers incident to his daily environment. (Continued on the next page)   The examiner’s opinions must be accompanied by a complete and detailed rationale with reference to supporting evidence in the record and supporting medical principles. If the examiner is unable to reach the opinions being sought without resort to speculation, he or she should explain the reasons for that inability and comment on whether further tests, evidence, or information would be useful in rendering the opinion being sought. The examiner’s opinions and rationale should be expressed in a report that is associated with the record. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Kamal, Associate Counsel