Citation Nr: 20048907 Decision Date: 07/22/20 Archive Date: 07/22/20 DOCKET NO. 16-24 217 DATE: July 22, 2020 REMANDED SMC based on the need for aid and attendance is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Navy from October 1986 to March 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from multiple rating decisions. The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in August 2019. In January 2020, the Board issued a decision addressing various claims on appeal. This decision addresses an additional issue that was reasonably raised by the record at the time of the January 2020 decision, and does not affect the outcome of the issues previously decided or remanded. The Board has also considered SMC for housebound status. The law provides two avenues through which to receive this benefit: “statutorily housebound,” under 38 C.F.R. § 3.350(i)(1), and “housebound-in-fact,” under 38 C.F.R. § 3.350(i)(2). Under both avenues, a claimant must first have a single service-connected disability rated as 100 percent disabling. 38 C.F.R. § 3.350(i). Because the Veteran does not have a single disability rated at 100 percent, the claim for SMC for housebound status has not been reasonably raised by the record and will not be addressed.   SMC based on the need for aid and attendance is remanded. SMC based on the need for aid and attendance is payable if, as the result of service-connected disability, the Veteran has suffered anatomical loss or loss of use of both feet, of one hand and one foot, is blind in both eyes with 5/200 visual acuity or less, is permanently bedridden, is a patient in a nursing home because of mental or physical incapacity, or is established on a factual need for aid and attendance pursuant to the criteria in 38 C.F.R. § 3.352(a). 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b), (c). In assessing whether there is a factual need for aid and attendance, the United States Court of Appeals for Veterans Claims (Court) has held that it is mandatory that VA considers the factors set forth in § 3.352(a) and that at least one of those factors must be present. Turco v. Brown, 9 Vet. App. 222, 225 (1996). Factors considered to determine whether regular aid and attendance is needed include: inability to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need to adjust special prosthetic or orthopedic appliances which by reason of the particular disability requires aid (this does not include adjustment of appliances that persons without any such disability would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to 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 daily environment. 38 C.F.R. § 3.352(a). Although the evidence of record addresses some of the Veteran’s limitations, a medical examination is necessary to determine the full extent of his impairment as it relates to the above factors. The matters are REMANDED for the following action: Schedule the Veteran for a VA aid and attendance examination. The claims file must be made available to the examining clinician in conjunction with the examination. All pertinent symptoms and findings must be reported in detail. Following review of the evidence of record, the clinical examination results, and the Veteran’s statements, the examiner must address the following: Identify the extent to which the Veteran’s service-connected disabilities impact his capability for self-care. The examiner’s assessment must include, but is not limited to, evaluation of such conditions as: the Veteran’s ability or inability to dress or undress himself or to keep himself ordinarily clean and presentable; his ability or inability to feed himself; his ability or inability to attend to the wants of nature; and any incapacity, physical or mental, which requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. The examiner should note that the Veteran is service-connected for left upper extremity paresis, left lower extremity paresis, urinary frequency, and hypertension. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shamil Patel, 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.