Citation Nr: 18156830 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 15-13 194 DATE: December 11, 2018 ORDER Entitlement to a special home adaptation grant is denied. REMANDED Entitlement to special monthly compensation based on need for aid and attendance or housebound status is remanded. Entitlement to specially adapted housing is remanded. FINDINGS OF FACT 1. The Veteran is only service connected for L5 sacralization and spondylosis, rated 60 percent disabling. The Veteran is in receipt of a total disability rating based on individual unemployability due to that service-connected disorder. 2. The Veteran’s L5 sacralization and spondylosis does not result in blindness in both eyes, the anatomical loss or loss of use of both hands, deep partial thickness burns, full thickness or subdermal burns, and it is not due to an inhalation injury. CONCLUSION OF LAW The criteria for establishing eligibility for financial assistance for a special home adaptation grant is not met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.809a. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from February 4 to March 18, 1974. Special home adaptation The Veteran contends that a special home adaptation grant is warranted based on his service-connected L5 sacralization and spondylosis. A veteran can qualify for a grant for a special home adaptation grant if he has a service-connected disability that results in blindness in both eyes with 20/200 visual acuity or less in the better eye with the use of a standard correcting lens or a limitation in fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees; such a disability need not be permanent and total in nature. Additionally, a special home adaptation grant is available for a veteran who has a permanent and total disability which: (1) includes the anatomical loss or loss of use of both hands; (2) is due to deep partial thickness burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk; (3) is due to full thickness or subdermal burns that have resulted in contractures of one or more extremities or the truck; or, (4) is due to residuals of an inhalation injury (including, but not limited to, pulmonary fibrosis, asthma, and chronic obstructive pulmonary disease.) 38 U.S.C. § 2101 (b); 38 C.F.R. § 3.809a (b). The Veteran is only service connected for L5 sacralization and spondylosis, rated 60 percent disabling. He is in receipt of a total disability rating based on individual unemployability due to that service-connected disorder alone. As such, the Veteran does not have a service-connected disability related to impaired vision, the upper extremities, or a severe burn injury. The Veteran is also not service connected for an inhalation injury or any respiratory disorder. The provisions under 38 C.F.R. § 3.809a (b) therefore do not apply and cannot be the basis for a special home adaptation grant. In sum, the weight of the competent and probative evidence preponderates against finding that the Veteran’s service-connected disability results in blindness in both eyes, an anatomical loss or loss of use of both hands, deep partial thickness burns, full thickness or subdermal burns, or an inhalation injury. There is no indication that he is eligible for home adaptation based on any criteria pursuant to 38 C.F.R. § 3.809a. The Board has afforded the Veteran the benefit of the doubt, but as the preponderance of the evidence is against the claim, it must be denied. See 38 U.S.C. § 5107 (b). REASONS FOR REMAND Aid and attendance or housebound status and specially adapted housing VA requested an opinion as to whether the Veteran’s service-connected L5 sacralization and spondylosis caused him to require the aid and attendance of another person. In a July 2014 opinion, an examiner essentially declined to answer that question, and instead disputed the basis for the Veteran’s initial grant of service connection for the L5 sacralization and spondylosis. In an August 2014 addendum, the examiner opined that the disability did not require aid and attendance, but apparently based her opinion entirely on her finding that the Veteran had been able to maintain physically strenuous employment prior to 1988. Because that rationale fails to address the period relevant to this appeal, remand is necessary to obtain an adequate medical opinion. Additionally, the Veteran has not been provided an in-person examination of his spine since June 2008, over ten years ago. On remand, a new in-person examination must be provided to address the current nature and severity of L5 sacralization and spondylosis, particularly in relation to the claims on appeal. Accordingly, the matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from June 2015 to the present. If the RO cannot locate such records, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The RO must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claims. The claimant must then be given an opportunity to respond. 2. Thereafter, schedule the Veteran for an examination to determine the current nature and extent of any disability due to L5 sacralization and spondylosis. To the extent possible, the examiner must identify symptoms and functional impairments due to L5 sacralization and spondylosis alone and discuss the effect of the disability on any occupational functioning and activities of daily living. The examiner must opine whether L5 sacralization and spondylosis alone results in a loss of use of both lower extremities such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, or loss of use of one lower extremity together with residuals of organic disease or injury that so affects the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. The examiner is advised that the term “precludes locomotion” means the necessity for regular and constant use of a wheelchair, braces, crutches or canes as a normal mode of locomotion although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809 (c). The examiner must opine whether, as a result of the L5 sacralization and spondylosis alone, the Veteran is bedridden (or actually required to remain in bed), unable to dress or undress himself, unable to keep himself ordinarily clean and presentable, needs frequent adjustment of any special prosthetic or orthopedic appliances which, by reason of the particular disability, cannot be done without such aid, is unable to feed himself or attend to the wants of nature, or experiences incapacity which requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. The examiner must state whether, due to his single service connected disorder alone, the Veteran needs a higher level of care or personal health-care services provided on a daily basis in his home by a licensed health care professional or someone under the supervision of a licensed health care professional. Finally, the examiner must address whether, because of the appellant’s single service connected disorder alone he is substantially confined to his dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disabilities and resultant confinement will continue throughout his lifetime. A complete, well-reasoned rationale must be provided for any opinion offered. If any requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Paul J. Bametzreider, Associate Counsel