Citation Nr: 18110482 Decision Date: 06/12/18 Archive Date: 06/12/18 DOCKET NO. 12-31 508A DATE: June 12, 2018 ORDER Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance or being housebound, for substitution purposes is denied. FINDINGS OF FACT 1. Since March 22, 1990, the Veteran had a single disability rated as 100 percent disabling but did not have an additional service-connected disability or disabilities independently rated as 60 percent disabling. 2. The Veteran was not permanently or substantially confined to his home as a result of his service-connected disability, nor was he unable to protect himself from the hazards and dangers incident to his daily environment due to his service-connected disability or to perform self-care activities without the aid and assistance of another. CONCLUSION OF LAW The criteria for entitlement to SMC based on the need for regular aid and attendance or being housebound, for substitution purposes have not been met. 38 U.S.C. §§ 1114, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.350, 3.352 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active duty service from January 1971 to December 1972. He died in May 2014 and the appellant, his surviving spouse, has been substituted as the claimant for the purposes of processing the claim to completion. See 38 U.S.C. § 5121A (2012). Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance or being housebound, for substitution purposes The appellant, by way of substitution, seeks entitlement to SMC based on the Veteran’s need for aid and attendance or being housebound prior to his May 2014 death. SMC is payable when a Veteran has a single service-connected disability rated as 100 percent and either (a) has additional service-connected disability or disabilities independently rated as 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems or (b) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). The “housebound” requirement is met when a Veteran is substantially confined as a direct result of service-connected disabilities to his dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. A factual need for aid and attendance will be accorded consideration by the following criteria: (1) inability of claimant to dress or undress self, or to keep self ordinarily clean and presentable; (2) frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid; (3) inability of claimant to feed self through loss of coordination of upper extremities or through extreme weakness; (4) inability to attend to the wants of nature; or (5) 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. See 38 C.F.R. § 3.352(a). In this case, the Veteran’s service-connected posttraumatic stress disorder (PTSD) was rated as 100 percent disabling since March 22, 1990, which is the maximum schedular rating available. Service connection was not in effect for any other disability. Therefore, the Veteran did not have an additional service-connected disability or disabilities independently rated as 60 percent separate and distinct from the 100 percent service-connected PTSD. As a result, the Board next considers whether the Veteran was permanently or substantially confined to his home as a result of his service-connected disability to warrant SMC at the housebound rate or whether the Veteran was so helpless to warrant SMC based on the need for aid and attendance. In his application for SMC, the Veteran indicated that he was unable to prepare his own meals and needed assistance in bathing and tending to other hygienic needs. In March 2012, his private physician noted that the Veteran has PTSD, as well as severe septic and rheumatoid arthritis, which causes him to be wheelchair-bound. The Veteran also included several lay statements in support of his claim from his son-in-law and daughter. His son-in-law indicated that he assists the Veteran with activities like driving him to appointments, yardwork, and errands like going to the store. The Veteran’s daughter also stated that her husband assists the Veteran when he has panic attacks. The Veteran underwent a VA examination in November 2012. The examiner confirmed the Veteran’s diagnosis of PTSD and noted that it results in total occupational and social impairment. Upon examination, the examiner reported that the Veteran is capable of managing his own financial affairs, but needs assistance with dressing, bathing, making his bed, and keeping his personal area clean. However, the examiner remarked that the Veteran is independent in toileting, feeding, and transferring himself from his wheelchair to bed without falling. The examiner also reported that the Veteran’s mood was appropriate, and he was completely oriented to time, place, and person. The examiner noted that the Veteran understood instructions, could carry on extended meaningful conversation, managed a bank account, and was able to integrate past events with recent events. The examiner found that the Veteran was cognitively intact, with no deficits in advanced and/or instrumental activities of daily living. He concluded that “aid and attendance/housebound benefits were not indicated at this time.” The Board observes a February 2013 VA outpatient treatment report from the Veteran’s orthopedic surgeon, who stated that “In August 2005, while [the Veteran] was under my care as inpatient at Togus VAMC, I informed [the Veteran] that I would not discharge [him] to home unless [he] had a viable caregiver. Otherwise, [the Veteran] would have had to remain in the nursing home.” The Board has considered the Veteran’s reported symptomatology related to his service-connected PTSD, including his March 2013 testimony that he suffered from severe panic attacks and paranoia, and its effect on his reported need for SMC pursuant to seeking VA compensation benefits. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Nevertheless, his statements do not rise to a level of competency to identify the specific level of impairment required to establish SMC. In this case, such competent evidence has been provided in the medical evidence of record. As such, the Board finds these records to be more probative than the Veteran’s subjective statements. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). After a review of the pertinent evidence discussed above, the Board finds that the Veteran was not permanently or substantially confined to his home or bed nor was he so helpless as to need regular aid and attendance as a result of his service-connected PTSD prior to his death. While acknowledging the November 2012 VA examiner’s conclusion that the Veteran needed some assistance with activities like dressing, bathing, making his bed, and keeping his personal area clean, the Veteran’s overall service-connected disability picture does not show that he required such assistance on a daily basis. The Board acknowledges that the Veteran’s PTSD resulted in total occupational and social impairment. Despite this, it appears that the Veteran was wheelchair-bound due to severe arthritis, for which he was not service-connected. This fact is reasserted by the February 2013 statement from the Veteran’s orthopedic surgeon, who apparently treated the Veteran for complications of arthritis and would not discharge him unless he had a viable caregiver. Thus, the Veteran’s functional impairment was brought about by nonservice-connected factors. Likewise, the Veteran was not shown to be housebound solely due to his service-connected PTSD. In view of the above, there was no basis for aid and attendance or housebound benefits to be established. For the above reasons, the appellant’s claim is denied. In reaching this decision the Board   considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. 38 U.S.C. § 5107. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Miller, Associate Counsel