Citation Nr: 18157858
Decision Date: 12/13/18	Archive Date: 12/13/18

DOCKET NO. 18-30 374
DATE:	December 13, 2018
REMANDED
The issue of entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance is remanded.
REASONS FOR REMAND
The Veteran served on active duty from February 1967 to February 1970.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) regional office (RO).
The issue on appeal must be remanded for additional medical inquiry.  
Since June 2003, the Veteran has been rated as 70 percent disabled due to service-connected posttraumatic stress disorder (PTSD).  He has been in receipt of a total disability rating based on individual unemployability (TDIU) since then.  He asserts entitlement to SMC based on his need for aid and attendance due to PTSD.  
The record indicates that the Veteran is severely disabled by dementia.  Court documents indicate that he has been assigned a conservator to assist in his care.  In a November 2018 rating decision, the RO proposed finding the Veteran incompetent for managing his own affairs due to dementia.  
In denying the claim here, the RO stated that disability from dementia is not service connected.  The record is unclear on this question, however.  A 100 percent rating may be awarded for PTSD for symptomology similar to dementia – i.e., gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.  38 C.F.R. § 4.130, Diagnostic Code 9411 (2018).  Inasmuch as these symptoms could be similar to symptoms from dementia, additional medical inquiry should be conducted here.  See Mittleider v. West, 11 Vet. App. 181 (1998) (holding that the Board is precluded from differentiating between symptomatology attributed to service-connected disability and nonservice-connected disability in the absence of medical evidence which does so).
The matter is REMANDED for the following action:
1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claim.  Include in the record any outstanding VA treatment records, the most recent of which are dated in October 2018.  
Also attempt to obtain medical records pertaining to any private care the Veteran has received.  The record indicates that he is a resident in an assisted care senior living facility.  
All records/responses received must be associated with the claims file.
2. Schedule an examination to determine the nature and severity of service-connected PTSD.  After reviewing the claims folder, interviewing the Veteran, and examining the Veteran, the examiner should answer the following question: 
Is it likely (i.e., more than 50 percent probable) that the disabling effects of dementia in this case – which have rendered the Veteran incompetent according to a physician’s report of record – can be differentiated from the disabling effects of PTSD in this case?  
Please explain in detail any opinion provided

 
G. A. WASIK
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Christopher McEntee, Counsel