Citation Nr: 21063103 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 16-51 205 DATE: October 13, 2021 REMANDED Entitlement to a rating higher than 10 percent from February 9, 2015 to April 16, 2015 and from September 1, 2015 onward for metatarsalgia of the feet is remanded. Entitlement to a rating higher than 30 percent for painful scars of the feet is remanded. Entitlement to an initial compensable rating for linear scars of the feet is remanded. Entitlement to Special Monthly Compensation (SMC) based on aid and attendance, or by reason of being housebound with the exception of the period from April 17, 2015 to October 1, 2015 due to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran had active service from October 1984 to October 1986. The issues regarding higher ratings for the feet arise from rating decisions dated in September 2013 and November 2015. As for the claim of entitlement to SMC based on aid and attendance, VA has a "well-established duty" to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to SMC under 38 U.S.C. § 1114. See Bradley, 22 Vet. App. at 294 (finding that SMC "benefits are to be accorded when a veteran becomes eligible without need for a separate claim"). During the June 2021 Board hearing the Veteran testified that he had total loss of use of his feet and was confined to his house. Given this obligation, the derivative SMC claim based on aid and attendance has been added to the current appeal. The Board notes that during the appeal SMC by reason of being housebound due to service-connected disabilities was in effect from April 2015 to October 2015. The Board notes that in June 2019 a Statement of the Case was issued regarding entitlement to automobile or other conveyance and adaptive equipment or for adaptive equipment only and in July 2021 an unsigned Form 9 Appeal was received for the automobile allowance claim. The Board refers this matter to the Regional Office for appropriate action. Issues 1-4: Entitlement to: a rating higher than 30 percent for painful scars of the feet; a rating higher than 10 percent from February 9, 2015 to April 16, 2015 and from September 1, 2015 onward for metatarsalgia of the feet; an initial compensable rating for linear scars of the feet; and, SMC based on aid and attendance or by reason of being housebound with the exception of the period from April 17, 2015 to October 1, 2015. The Veteran was afforded VA examinations for the feet and scars in April 2015. Although the Veteran was afforded a VA foot examination in June 2019, the examiner noted that the purpose of the examination was to evaluate the Veteran's service-connected bilateral bunionectomy, which is not currently in appellate status. Subsequently during the June 2021 Board hearing the Veteran testified that for the last year he has been confined to a wheelchair as a result of his service-connected disabilities. He stated that he currently constantly experiences numbness and tingling along with shooting pain. The Veteran stated that sometimes the skin around his scars breaks open. Thus the Veteran should be afforded a VA examination to determine the current level of severity of the service-connected metatarsalgia and scars of the feet. As for SMC based on aid and attendance, the Veteran in June 2021 testified that he had total loss of use of his feet and if he didn't have a wheelchair it would be too painful from him to walk to the bathroom. He also stated that he was confined to his house. The Board finds that there is insufficient evidence of record to adjudicate the SMC claim based on aid and attendance or by reason of being housebound, and a VA examination is therefore needed. The Board notes that VA amended the criteria for rating skin disabilities during the claim period, effective from August 13, 2018. With regard to the effective date of the new criteria, VA indicated in the Supplementary Information to the Final Rule that its "intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied." 83 FR 32592 (July 13, 2018). The Veteran's claims in this case were pending prior to August 13, 2018 and thus both the old and new criteria are applicable. On remand, the Veteran should be given notice of the rating criteria effective August 13, 2018. Lastly, in June 2021 the Veteran indicated that there may be outstanding pertinent VA treatment records from 2010 to the present from the VA medical facility in Columbia, South Carolina. On remand, any outstanding records need to be associated with the claims file. By this remand the Board makes no determination, expressed or implied, as to the credibility of any statements on file. The matters are REMANDED for the following action: 1.) Obtain any outstanding VA treatment records from 2010 to the present from the VA medical facility in Columbia, South Carolina. All attempts associated therewith should be memorialized in the Veteran's claims file. 2.) Schedule the Veteran for a VA examination to determine the severity of his service-connected metatarsalgia of the feet. The claims file must be made available to the examiner for review in conjunction with conducting the examination of the Veteran. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the disability under the rating criteria. The examiner is asked to address all neurologic abnormalities associated with the Veteran's service-connected metatarsalgia of the feet. The examiner should identify all the nerves affected and determine whether the findings represent complete paralysis of each affected nerve or nerves; or, mild, or moderate, or moderately severe, or severe incomplete paralysis of each affected nerve or nerves. If there is overlapping symptomatology among multiple nerves, the examiner should to the extent possible identify the impaired nerve that is most analogous to the Veteran's symptoms. 3.) Schedule the Veteran for a VA examination to determine the severity of his service-connected painful and linear scars of the feet. The claims file must be made available to the examiner for review in conjunction with conducting the examination of the Veteran. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the disabilities under the rating criteria. Specifically, the evaluation of residual scars should address the severity of each scar, including the size of each scar, whether it is deep, superficial, linear, nonlinear, unstable (with frequent loss of covering of skin), painful, has underlying soft tissue damage, causes limitation of motion, and any other findings that are relevant. The examiner is asked to address all neurologic abnormalities associated with the Veteran's service-connected painful and linear scars of the feet. The examiner should identify all the nerves affected and determine whether the findings represent complete paralysis of each affected nerve or nerves; or, mild, or moderate, or moderately severe, or severe incomplete paralysis of each affected nerve or nerves. If there is overlapping symptomatology among multiple nerves, the examiner should to the extent possible identify the impaired nerve that is most analogous to the Veteran's symptoms. 4.) Schedule the Veteran for a VA examination to determine whether SMC is warranted based on aid and attendance or housebound status. The claims file must be made available to and reviewed by the examiner in conjunction with the examination. Any necessary testing should be accomplished. The examiner should address whether the Veteran's service-connected disabilities have resulted in any of the following: a.) An inability to dress or undress himself, or to keep himself ordinarily clean and presentable; b.) Frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid; c.) Inability to feed himself through loss of coordination of upper extremities or through extreme weakness; d.) Inability to attend to the wants of nature; e.) 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; f.) The anatomical loss or loss of use of both feet. A full rationale should be provided for all opinions expressed. The examiner also is asked to render an opinion as to whether the Veteran is substantially confined as a direct result of service-connected disabilities to his dwelling and the immediate premises. In providing the requested information, the examiner should consider and discuss all pertinent medical and lay evidence, to include the Veteran's statements regarding his need for aid and attendance. 5.) Afterwards, readjudicate the issues being remanded herein and provide the Veteran with the applicable criteria for rating skin disabilities, effective from August 13, 2018. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mac, 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.