Citation Nr: 20006502 Decision Date: 01/27/20 Archive Date: 01/27/20 DOCKET NO. 18-38 735 DATE: January 27, 2020 ORDER Entitlement to special monthly compensation (SMC) based on aid and attendance or housebound criteria is denied. FINDING OF FACT The Veteran’s service-connected disabilities did not necessitate the care or assistance of another person on a regular basis, to protect him from the hazards or dangers of his daily environment, substantially confine him to his dwelling or immediate premises, or require institutionalization. CONCLUSION OF LAW The criteria for SMC based on aid and attendance or housebound criteria have not been met. 38 U.S.C. §§ 1114 (l), 5107; 38 C.F.R. §§ 3.102, 3.350(b), 3.352(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1969 to May 1972. This matter comes before the Board from an August 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The Veteran died in February 2016. The Appellant was substituted in September 2017. The Appellant appeared before the undersigned Veterans Law Judge at a Board hearing in November 2018. A transcript has been associated with the record. The Appellant provided testimony regarding her separate claim for SMC, which was granted in a December 2018 RO rating action. The RO notified the Appellant that she may schedule a hearing to present testimony in relation to the current issue on appeal. The Appellant sent a written response withdrawing her hearing request in October 2019. Entitlement to special monthly compensation based on aid and attendance or housebound criteria. “Special monthly compensation” is payable to a person who is permanently bedridden or so helpless as a result of service-connected disability that he is in need of the regular aid and attendance of another person. 38 U.S.C. § 1114; 38 C.F.R. § 3.350(b). The following will be accorded consideration in determining the need for regular aid and attendance: Inability of a claimant to dress or undress him or herself, or to keep him or herself 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 a claimant to feed him or herself through loss of coordination of the 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 a claimant from the hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352 (a). 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 or her 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. See Turco v. Brown, 9 Vet. App. 222 (1996). “Bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant 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). If a veteran does not qualify for increased benefits for aid and attendance, increased compensation benefits may still be payable if the veteran has a single service-connected disability rated as 100 percent and: (1) Has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) Is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the veteran is substantially confined as a direct result of service-connected disabilities to his or her 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 or her lifetime. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). The critical question to be determined in this case is whether the Veteran’s service-connected disabilities resulted in the need for regular aid and attendance of another person because of resultant helplessness due to mental and/or physical impairment. The Veteran was service connected for coronary artery disease. Service connection for the cause of death of the Veteran (due to metastatic adenocarcinoma of lung) was also established. A November 2013 examiner noted that the Veteran was not hospitalized, confined to bed, legally blind, nor needed nursing home care. Although he was unable to prepare his meals, he was capable of feeding himself after setup. The Veteran required monitoring during bathing and medication. He required the assistance of an aid for locomotion and was capable of walking 5 or 6 blocks. A March 2014 VA examiner noted that the Veteran was unable to drive and used a wheelchair. He suffered short-term memory loss which impacted his ability to ambulate. The examiner stated that the Veteran could not protect himself from the daily environment because a cerebrovascular accident (CVA) resulted in right side weakness and memory problems. The Appellant reported that the Veteran required assistance blending food due to difficulty swallowing. It was noted that the Veteran only walks within the home and has instability when walking without the aid of a walker. He could only leave his home with medical care. The functional impairments were found to be permanent. The examiner opined that the Veteran’s condition was related to his nonservice-connected CVA and ongoing residuals. A May 2015 VA examiner noted that the Appellant prepared the Veteran’s meals and managed his medication and finances. The Veteran was able to grip objects without assistance, feed himself, and button his clothing. However, the Appellant monitored him to ensure he put everything on correctly. Home health aides assisted the Veteran three days per week with bathing and dressing him. The Veteran has an unsteady gait, weakness in his legs, and falls while walking if he is without a wheelchair, cane or walker. He required a manual wheelchair to ambulate and prevent injury. The Veteran had incontinence, poor short-term memory, and poor balance. The Veteran was unable to drive; and, he was unable to walk/ travel more than 1 block. Private medical records note the that Veteran had a history of alcohol abuse, alcohol dependency, and seizure disorder related to alcohol use. Physicians opined that the Veteran’s ataxia was secondary to an old brainstem stroke and alcohol use. Medical records clearly indicate that the Veteran’s ataxia was secondary to brain stem injury or ethanol toxicity to the cerebellum. VA Medical records in June 2015 note that the Veteran’s gait ataxia was due to his CVA. Based on the foregoing, there is no evidence demonstrating that the Veteran was permanently bedridden or so helpless as a result of a service connected disability(ies) that he was in need of the regular aid and attendance of another person. To the contrary, the evidence establishes that the Veteran’s debilitated condition was the result of multiple non-service connected disabilities - alcohol addiction and abuse, seizure disorder, ethanol toxicity of the cerebellum, old brainstem stroke, and CVA caused the Veteran’s condition. There is also no evidence linking the nonservice-connected CVA or its residuals as having been caused or aggravated by a service-connected disability. Accordingly, the Board finds that the preponderance of the evidence is against the claim, and the claim must be denied. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mohammad Mahmoudi, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.