Citation Nr: 18155118 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 16-41 661 DATE: December 4, 2018 ORDER Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is granted. FINDING OF FACT The Veteran requires the regular aid and attendance of another as a result of mental incapacity due to service-connected disability. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, the criteria for SMC based on aid and attendance have been met. 38 U.S.C. § 1114 (2012); 38 C.F.R. §§ 3.350, 3.352 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1975 to April 1978. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Honolulu, Hawaii. Jurisdiction of the Veteran’s claims was subsequently transferred to the RO in Cleveland, Ohio. A 2014 rating decision denied, in pertinent part, the Veteran’s claim of entitlement to SMC. In November 2015, the Veteran submitted additional evidence pertaining to his pending claim—namely, a private examination addressing his need for regular aid and attendance. As such, this additional evidence was received within the one-year appeal period before the December 2014 rating decision became final the claim remained pending, and therefore, the Veteran’s claim is considered from the date of his original claim for SMC, i.e., July 2014. Finally, the Veteran was scheduled to appear with his representative for a videoconference hearing in early November 2018. Prior to the scheduled hearing, the Veteran was provided notice via letter dated in October 2018 and telephonic message. However, the Veteran failed to appear for that hearing and has not provided good cause for such failure. Thus, the Board may proceed to adjudicate the claim on appeal. Entitlement to SMC based on the need for regular aid and attendance Special monthly compensation is payable if the 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) (2012); 38 C.F.R. § 3.350(b) (2018). 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 or her daily environment. “Bedridden” will be a proper basis for the determination. 38 C.F.R. § 3.352 (2018). Service connection is currently in effect for chronic undifferentiated schizophrenia, rated as 100 percent disabling from May 1, 1978, and bilateral hearing loss, rated as noncompensable from March 28, 2016. A June 2015 rating decision found the Veteran incompetent due to mental capacity. The Veteran’s spouse was appointed his fiduciary; however, she died in April 2017. Based on a review of the evidence, the Board finds that entitlement to SMC based on aid and attendance is warranted. As indicated above, mental incapacity which requires care or assistance on a regular basis to protect the Veteran from hazards or dangers incident to his or her daily environment is a basis for SMC. In this case, the Board finds that the criteria are met. In making this finding, the medical records of the Veteran’s ongoing psychiatric treatment are particularly persuasive. VA medical treatment records dated between March 2000 and August 2017 reflect, in pertinent part, psychiatric symptoms such as auditory hallucinations and chronic paranoia despite compliance with medication. In particular, the Veteran has longstanding delusions of wealth and paranoia that his family is trying to steal his money and have him committed. As such, he has developed a deep mistrust of his family. A VA physician’s statement dated in April 2017 reflects the Veteran suffers from delusions with auditory hallucinations—namely, God and his angels are speaking to the Veteran. The physician noted the Veteran has been delinquent in paying his bills over the past several months “because he believes angels are paying [his] bills from ‘heavenly account,’ and [that] he is a billionaire.” As a result, he risks foreclosure and other financial disasters. The examiner concluded that the Veteran’s psychiatric disorder is refractory, i.e., resistant to treatment, and the Veteran is unlikely to regain mental capacity. VA medical treatment records dated that same month reflect the Veteran encountered legal trouble, to include temporary restraining orders, stemming from his delusions. VA medical treatment records dated in May 2017 reflect the Veteran’s admission regarding constantly approaching random women at restaurants and offering them money. The Veteran takes a taxi or Uber to travel to restaurants twice a day for meals because he is unable to prepare meals for himself. Similarly, records dated in August 2017 reflect the Veteran approaches women in hopes to “find someone who will cook and clean for [him] in exchange for room and board.” VA medical treatment records dated in June 2017 reflect the physician’s concerns about the Veteran’s autonomy level and competency in self-management of medication due to cognitive barriers. To that extent, the Board notes private treatment records as early as May 1979 reflect the physician’s assessment that only long term marginal adjustment to society could ever be achieved due to the unpredictability of the Veteran’s schizophrenia. VA medical treatment records dated in August 1989 reflect poor judgement and impaired insight. The Veteran’s psychiatric disorder significantly impairs his judgement and produces grossly inappropriate behavior creating a danger to himself due to his paranoia and delusions, and care or assistance on a regular basis is required to protect the claimant from hazards or dangers incident to his daily environment. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that SMC based on aid and attendance is warranted in this case. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the appeal is granted. The grant of SMC at the aid and attendance rate renders the housebound issue moot. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Kalolwala, Associate Counsel