Citation Nr: 20052975 Decision Date: 08/10/20 Archive Date: 08/10/20 DOCKET NO. 17-57 118 DATE: August 10, 2020 ORDER Eligibility for a special home adaptation grant is denied. REMANDED Entitlement to a compensable initial disability rating for bowel incontinence is remanded. Entitlement to a compensable initial disability rating for bladder incontinence is remanded. Eligibility for assistance in acquiring specially adapted housing is remanded. Eligibility for financial assistance in the purchase of one automobile or other conveyance and/or automobile adaptive equipment is remanded. FINDING OF FACT The Veteran does not have permanent and total service-connected disability which includes the anatomical loss or loss of use of both hands, or is due to burn injuries or residuals of an inhalational injury, nor does he have a service-connected disability due to blindness in both eyes, with corrected central visual acuity of 20/200 or less in the better eye. CONCLUSION OF LAW The criteria for eligibility for a special home adaption grant have not been met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. §§ 3.102, 3.809a. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from August 1981 to February 1985. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by a Department of Veterans Affairs (VA) regional office (RO). The Board acknowledges that the Veteran submitted a Rapid Appeals Modernization Program (RAMP) opt-in election form that was received by VA in April 2018. However, the appeal had already been certified to the Board and was therefore no longer eligible for the RAMP program. The Board remanded these matters for further development in July 2019. They have since been returned to the Board for appellate review. Eligibility for a special home adaptation grant is denied. A veteran may qualify for a grant for necessary special home adaptations if he has a service-connected disability that results in blindness in both eyes with 20/200 visual acuity or less in the better eye with the use of a standard corrective lens or a limitation in fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees; such a disability need not be permanent and total in nature. Additionally, a special home adaptation grant is available for a veteran who has a permanent and total disability which: (1) includes the anatomical loss or loss of use of both hands; (2) is due to deep partial thickness burns that have resulted in contracture(s) with limitation of motion of two or more extremities or of at least one extremity and the trunk; (3) is due to full thickness or subdermal burns that have resulted in contracture(s) of one or more extremities or the trunk; or, (4) is due to residuals of an inhalation injury (including, but not limited to, pulmonary fibrosis, asthma, and chronic obstructive pulmonary disease (COPD)). 38 C.F.R. § 3.809a(b). The Veteran is currently in receipt of a combined 90 percent disability rating for the following service-connected disabilities : posttraumatic stress disorder (PTSD); degenerative joint disease with lumbar stenosis; causalgia and intermittent neuropathy, right leg, muscle group XX, residuals of gunshot wound; peripheral radiculopathy, left lower extremity; residuals, through and through gunshot wound to abdomen, muscle group XIX; left liver lobe laceration status post laparotomy with healed surgical scar, residuals of gunshot wound; erectile dysfunction; bowel incontinence; and bladder incontinence. Although the Veteran has been awarded a permanent and total disability rating, via a total disability rating based on unemployability due to service-connected disability based upon his service-connected PTSD, the Veteran has not been awarded permanent and total service connection benefits for disabilities involving the bilateral hands, burn or inhalational injuries, or blindness. The Veteran thus does not meet any of the necessary criteria for eligibility for a special home adaptation grant. REASONS FOR REMAND 1. Entitlement to compensable initial disability ratings for bowel incontinence and bladder incontinence is remanded. In a December 2019 statement, the Veteran asserted that his bladder and bowel incontinence require him to use 3-4 absorbent materials daily. He further indicated that this could be confirmed through the Portsmouth City Jail’s medical unit. On remand, the Agency of Original Jurisdiction (AOJ) should request the Veteran’s medical records from this facility, obtaining any authorization needed from the Veteran, as necessary. In the July 2019 remand, the Board directed that the Veteran was to be scheduled for a VA examination to assess the current severity and manifestations of his service-connected bowel and bladder incontinence. The record reflects that the Veteran was scheduled for such examinations, but that they were cancelled when the Veteran was a no show. The Veteran telephoned VA in September 2019 requesting that the examinations be rescheduled, as he asserted he did not receive notice of the prior missed examinations. On remand, the Veteran should be scheduled for examination(s) to assess the current severity and manifestations of his service-connected bowel and bladder incontinence. 2. Eligibility for assistance in acquiring specially adapted housing and eligibility for financial assistance in the purchase of one automobile or other conveyance and/or automobile adaptive equipment is remanded. As noted above, the Veteran has requested that the examinations ordered per the July 2019 remand be rescheduled. As the Board is remanding these appeals for further development, the Veteran should be given another opportunity to report for an examination to assess the severity of his service-connected disabilities as they affect his ability to use is feet and lower extremities. As the Board is remanding these matters for further development, on remand, the AOJ should take action to ensure updated records of the Veteran’s treatment with VA are obtained and added to the file. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from November 2019 to the Present and associate them with the claims file. 2. Request the Veteran’s treatment records during his time in the Portsmouth City Jail, obtaining any authorization from the Veteran, as necessary. 3. After associating all records responsive with the prior remand directives with the claims file, schedule the Veteran to undergo an examination with an appropriate medical professional to determine the current severity of his service-connected bowel and bladder incontinence. The examiner must be provided access to the claims file and this remand, and must specify in the report that these records have been reviewed. Any indicated evaluations, studies, and/or tests should be conducted. In assessing the severity of these disorders, the examiner must consider the lay statements of the Veteran and his spouse concerning his use and frequency of changing absorbent materials, daily. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered 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. 4. After completing the above, schedule the Veteran for a VA examination to determine the current severity and manifestations of his service-connected disabilities as they relate to his ability to use his feet and lower extremities. The examiner should be provided with a list of the Veteran’s service-connected disabilities. Considering the evidence of record, including but not limited to any findings and observations made at the time of the examination and the Veteran’s lay statements, the examiner should address the following: a. Whether it is at least as likely as not that the Veteran’s service-connected disabilities, alone, limit his ability to use one or both feet to such an extent that he would be equally well-served by amputation with use of appropriate prosthetic. In responding to this question, the examiner should question the Veteran in detail about his usual daily activities, and how he moves about (around and outside the home), and address any observations and/or relevant test findings from the examination. If answered in the negative, the examiner should state in what way(s) the Veteran’s remaining functional capacity to use his feet is superior to how he would be served by a prosthetic. b. Whether it is at least as likely as not that the Veteran’s service-connected disabilities, alone, are of such severity as to preclude the Veteran from walking without the use of an ambulatory device. What, if any, ambulatory aid(s) does the Veteran use for locomotion, and with what frequency? The examiner is asked to address this question with specificity, rather than with a broad statement such as occasional, regular, or constant. How far, if at all, is the Veteran able to walk independently? Does the Veteran use ambulatory devices inside the home, and if so, what type and how frequently? The examiner should only consider the severity of the Veteran’s service-connected disabilities in addressing these questions, rather than any impairment from nonservice-connected disability. The examiner should indicate whether and to what extent any relevant symptoms/functional impairment can more likely than not be attributed to a nonservice-connected rather than to a service-connected disability or disabilities. If the examiner is unable to distinguish between the source of particular manifestations with this degree of confidence, the examiner should so state. 5. After completing the above, and any additional development deemed necessary in light of the expanded record, readjudicate the issues of entitlement to initial compensable disability ratings for bladder and bowel incontinence, eligibility for assistance in obtaining specially adapted housing, and eligibility for financial assistance in the purchase of one automobile or other conveyance and/or automobile adaptive equipment. If any of the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a supplemental statement of the case and allow them a reasonable opportunity to respond before returning the appeal to the Board, if in order. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Solomon, 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.