Citation Nr: 18156377 Decision Date: 12/11/18 Archive Date: 12/07/18 DOCKET NO. 15-15 589 DATE: December 11, 2018 REMANDED Entitlement to additional accrued benefits in excess of $741.34, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1945 to April 1946. He died in July 1997. The Veteran’s surviving spouse was awarded aid and attendance allowance effective from March 2011. The surviving spouse died in June 2012. The Appellant was the companion and caregiver of the Veteran’s surviving spouse. In July 2015, the Appellant was awarded $741.34, in accrued benefits for last illness expenses for the surviving spouse. The Appellant presented testimony before the Board in August 2017. The matter was before the Board in March 2018 and remanded for further development. Entitlement to additional accrued benefits in excess of $741.34, is remanded. The Board cannot make a fully-informed decision on this issue at this time. The Appellant contends that he paid more than $741.34, for last illness expenses for the surviving spouse. The regulations do not provide for the reimbursement of all expenses related to a last illness. Rather, the regulations provide that if “accrued benefits” are owed, and if a person has paid for either burial expenses or last illness expenses, then reimbursement may be authorized, but only up to the amount of the accrued benefits owed. Here, accrued benefits were owed at the time of the surviving spouse’s death in the amount of $10,988.66 ($11,730.00 less 741.34 (accrued benefits paid)). See user calculcations. As such, the reimbursement of any money spent on last illness expenses cannot exceed that amount. In pertinent part, on VA Form 21- 601, Application for Accrued Amounts due a Deceased Beneficiary, received in September 2012, the Appellant reported paying $8,057.87, in nursing home/assisted living expenses. Attached to the form was an accounting and receipts for payments made by the Appellant to the nursing home/assisted living facility. The Appllant asserts that the surviving spouse’s death was the result of lingering or prolonged illness due to multiple disabilities, to include but not limited to, cerebrovacular accident and coronary artery disease. He further contends that her period of last illness began in March 2011, when she was found to be so ill as to require the regular and daily attendance of another person and thus, payments he made for her care should be reimbursed. See VA Form 9 received in April 2015. The term “last sickness” is not defined in VA law or regulations, a similar term is defined in the VA Adjudication Procedures Manual Rewrite. See M21-1MR, Part V, Subpart 1, Chapter 3, Section D, para. 3(b), which is entitled, “Developing for Unreimbursed Funeral and Other Final Expenses.” Paragraph 3(b) of this section defines the term “last illness” as “the period from the onset of the acute attack causing death up to the date of death.” However, “[i]f death resulted from a lingering or prolonged illness instead of an acute attack, the period of last illness is considered to have begun at the time the person became so ill as to require the regular and daily attendance of another person.” An April 2015 letter from the surviving spouse’ primary care provider shows that he cared for her from March 2011 to June 2012 for multiple medical issues that included cerebrovascular accident, mitral valve stenosis, malignant hypertensive heart disease, atrial fibrillation, chronic obstructive pulmonary disease, dementia, and psychogenic paranoid psychosis. The surving spouse’s death certificate is not of record and must be obtained as there is insufficinet information to determine the cause of death, as well as the approximate interval between onset of last sickness and death. Thus, the Board is unable to determine whether assisted living/nursing home expenses paid by the Appellant are considered to be related to her last sickness. The matter is REMANDED for the following action: 1. Obtain a copy of the surviving spouse’s death certificate. 2. If necessary, complete any additional development action deemed warranted to determine the approximate interval between onset of last sickness and death of the surviving spouse. (Continued on the next page)   3. Thereafter, the issue of entitlement to accrued benefits in excess of $741.34, for last illness expenses for the surviving spouse must be readjudicated taking into consideration the amounts set forth by the Appellant in VA Form 21-601 received in September 2012 and attached receipts. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. L. Wallin, Counsel