Citation Nr: 18123766 Decision Date: 08/03/18 Archive Date: 08/02/18 DOCKET NO. 15-19 892 DATE: August 3, 2018 ORDER Entitlement to special monthly compensation (SMC) based on the need for aid and attendance or being housebound is denied. FINDINGS OF FACT 1. The Veteran is not in a nursing home, has not lost the use of both feet, or of one hand and one foot and is not in need of regular aid and attendance as a result of his service connected disabilities. 2. The Veteran is not bedridden, helpless or permanently housebound as a result of his service connected disabilities. CONCLUSION OF LAW The criteria for the award of SMC have not been met. 38 U.S.C. §§ 1114, 5107 (2012), 38 C.F.R. §§ 3.102, 3.350, 3.351, 3.352 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from August 1991 to April 1992. 1. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance or being housebound SMC as provided by 38 U.S.C. § 1114 (l) is payable for anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less or being permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). If the Veteran has a service-connected disability rated as total, and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or, (2) by reason of such veteran’s service-connected disability or disabilities, is permanently housebound, then monthly compensation shall be awarded. For the purpose of this subsection, the requirement of “permanently housebound” will be considered to have been met when the veteran is substantially confined to such veteran’s house (ward or clinical areas, if institutionalized) or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout such veteran’s lifetime. 38 U.S.C. § 1114 (s). The following will be accorded consideration in determining the need for regular aid and attendance: inability of claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352 (a) (2017). It is not required that all of the disabling conditions enumerated in 38 C.F.R. § 3.352 (a) be found to exist before a favorable rating may be made. The particular personal functions which the Veteran is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establish that the Veteran is so helpless as to need regular aid and attendance, not that there is a constant need. 38 C.F.R. § 3.352 (a); see also Turco v. Brown, 9 Vet. App. 222, 224 (1996) (noting that at least one factor listed in § 3.352(a) must be present for a grant of special monthly pension based on need for aid and attendance). For the purposes of 38 C.F.R. § 3.352 (a), “bedridden” will be a proper basis for the determination of whether the Veteran is in need of regular aid and attendance of another person. “Bedridden” will be that condition which, through its essential character, actually requires that the Veteran remain in bed. The fact that the Veteran has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. 38 C.F.R. § 3.352 (a). Here, the Board is considering the issue of entitlement to SMC based upon the need for aid and attendance and based upon housebound status. The Veteran underwent VA examinations to assess the need for aid and attendance or housebound status in December 2012, April 2014, and September 2015. At his December 2012 examination, the examiner found that the Veteran’s need for assistance in bathing and other hygiene due primarily to degenerative joint disease (DJD) of the bilateral knees. The Veteran could feed himself, prepare his own meals, and required no nursing home care or medication management. The examiner noted that the Veteran had extreme mobility problems due to worsening arthritis of the knees. At the April 2014 examination, the examiner found that the Veteran required assistance in bathing in the form of a bar or window ledge to hold. The examiner noted this was due to the Veteran’s severe knee arthritis. At his September 2015 examination, the examiner stated that the Veteran has difficulty making himself meals and needs assistance with bathing and hygiene due to knee arthralgia. The Veteran reported leaving home two times per week for physical therapy and that he has difficulty shopping and running errands due to pain in the knees when walking. To be eligible for SMC for aid and attendance or housebound status, the Veteran’s impairments must be due to a service-connected disability. 38 U.S.C. § 1114 (l). The Veteran is service-connected for chronic dysthymia and an undiagnosed illness manifested by joint pain. The disabilities are rated 70 percent and 10 percent respectively. TDIU has been granted. The Veteran asserts that his knee pain is due to his service-connected undiagnosed illness manifested by joint pain. Service connection for an undiagnosed illness was granted in a September 2004 rating decision. The decision stated that the Veteran’s bilateral elbow pain and bilateral heel pain were due to an undiagnosed illness. The Veteran’s bilateral knee pain was not service-connected, as a medical opinion stated the pain in the left knee was musculoskeletal, and the pain in the right knee was due to cartilage abnormalities, chondrocalcinosis, and chondromalacia. As a medical diagnosis was rendered, the Veteran’s knee pain was not determined to be due to an undiagnosed illness. The Veteran’s knee disabilities are not part of the grant of service connection for an undiagnosed illness manifested by joint pain. The Veteran’s VA examinations noted above all stated that the Veteran’s limitations are due to bilateral arthritis of the knees. As the Veteran is not service-connected for his knee disabilities, he is not eligible for SMC for aid and attendance or housebound status due to his knee disabilities. Furthermore, the Veteran does not have disabilities rated as total with a separate disability rated as 60 percent. Furthermore, there is no lay or medical evidence that establishes the need for SMC based upon the psychiatric disorder. His service   connected disabilities do not render him bedridden or housebound. The disabilities do not factually establish the need for aid and attendance within the meaning of the regulation. The preponderance of the evidence is against the claim and there is no doubt to be resolved. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Creegan, Associate Counsel