Citation Nr: 18161088 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 16-31 562 DATE: December 28, 2018 REMANDED Entitlement to special monthly compensation at the rate provided by 38 U.S.C 1114(r) is remanded. Entitlement to specially adapted housing is remanded. REASONS FOR REMAND The Veteran had active duty from August 1967 to August 1970, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from April 2009 and June 2014 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In December 2013, the Board granted entitlement to special monthly compensation based on the need for regular aid and attendance, under 38 U.S.C. § 1114 (l). The Veteran appealed this Board decision to the United States Court of Appeals for Veterans Claims (Court), arguing that he was entitled to a higher rate of special monthly compensation, specifically the rate described under subsection (r). In a January 2015 Order the Court remanded the case to the Board for development consistent with a joint motion for remand. In April 2015, the Board denied the claim for a higher rate of special monthly compensation, and the Veteran again appealed to the Court. Again, the parties filed a joint motion for remand requesting that the April 2015 Board decision be vacated and remanded. An October 2015 Court order granted the joint motion. In June 2016 and March 2017, the Board remanded the case for further development. In September 2018 the Board remanded the case again finding the two previous VA examinations to be inadequate. The appeal has been returned to the Board with no action taken with respect to the remand directives issued in the September 2018 Board decision. Hence, the appeal is once again remanded to VA for further development. Special monthly compensation at the rate provided by 38 U.S.C 1114(r) The Veteran seeks special monthly compensation at the at the rate described in 38 U.S.C. § 1114 (r). Service connection has been established for right upper extremity peripheral neuropathy, rated as 30 percent disabling; depression, rated as 30 percent disabling; diabetes mellitus, rated as 20 percent disabling; left upper extremity peripheral neuropathy, rated as 20 percent disabling; bilateral lower extremity sciatic peripheral neuropathy, each extremity rated as 20 percent disabling; and bilateral lower extremity femoral peripheral neuropathy, each extremity rated as 20 percent disabling. The appellant has been in receipt of a total disability rating based on individual unemployability due to service connected disorders since October 18, 2005, as well as special monthly compensation under 38 U.S.C. § 1114(1) due to being so helpless as to be in need of regular aid and attendance while not hospitalized. In the October 2015 joint motion, the parties noted that special monthly compensation is warranted under (r)(1) where a veteran is entitled to special monthly compensation under (o) and is in need of regular aid and attendance. special monthly compensation is warranted under (o) where two or more rates under (l) through (n) are warranted, with no condition considered twice. The parties explained that this Veteran may be entitled to (r)(1) if the evidence shows that his service-connected lower extremities result in loss of use of the lower extremities and his other service-connected disabilities (depression, diabetes mellitus, and upper extremity peripheral neuropathy) necessitate regular aid and attendance. A VA examiner attempted, unsuccessfully, to address this issue in opinions dated September 2017 and June 2018. After finding further development warranted the Board remanded this claim in September 2018. Unfortunately, absolutely no action was taken. Hence, this claim must again be remanded. Specially adapted housing is remanded. As noted in the September 2018 remand the Veteran's claim for entitlement to specially adapted housing is inextricably intertwined with his claim for a higher level of special monthly compensation. Hence, given the lack of any action following the September 2018 remand, this claim is again remanded. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination, by a clinician that has not previously examined the Veteran, to address the questions below: (a.) Do the Veteran’s service-connected lower extremity neuropathies impact functions of balance or propulsion so as to preclude locomotion without the 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? (b.) In answering this question, the examiner must only consider signs and symptoms of the Veteran’s service-connected left and right sciatic and femoral peripheral neuropathy, without regard to the impact of any other service-connected or nonservice-connected condition, to include upper extremity peripheral neuropathy, obesity, arthritis, and age. In other words, address the question above as if the Veteran only suffers from the service-connected lower extremity neuropathies. (c.) How do the Veteran’s service-connected upper extremity peripheral neuropathy, depression, and diabetes mellitus impact his ability to dress himself, keep clean, feed himself, tend to the wants of nature, and protect himself from hazards or dangers of his daily environment? In answering this question, the examiner must only consider signs and symptoms of the Veteran’s service-connected upper extremity peripheral neuropathy, depression, and diabetes mellitus, without regard to the impact of any other service-connected or nonservice-connected condition, to include lower extremity peripheral neuropathy, obesity, arthritis, or age. In other words, the examiner is to address this question as if the Veteran only suffers from the service-connected upper extremity peripheral neuropathy, depression, and diabetes mellitus. A full and complete explanatory rationale must be provided for any opinion offered. If any requested opinion cannot be answered 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 to offer an opinion. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Allen M. Kerpan, Associate Counsel