Citation Nr: 21066318 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 20-05 365 DATE: October 29, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder is granted. Entitlement to a rating of 100 percent for service-connected delusional disorder with major depressive order for the entire appeal period is granted. Entitlement to special monthly compensation (SMC) based on aid and attendance is granted. Entitlement to a total disability for individual unemployability (TDIU) is dismissed. FINDINGS OF FACT 1. The Veteran has an acquired psychiatric disorder that began in service. 2. The Veteran's delusional disorder with major depressive disorder is manifested by symptoms which more nearly approximate total occupational and social impairment.. 3. The Veteran is in need of the regular aid and attendance of another person based on the acquired psychiatric disability. 4. The award of a 100 percent disability rating for delusional disorder with major depressive disorder for the entire period on appeal with no additional compensable rated disabilities rendered the issue of entitlement to a TDIU moot. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria for a rating of 100 percent for service-connected delusional disorder with major depressive order have been met for the entire appeal period. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9208-9434. 3. The criteria for SMC based on aid and attendance have been met. 38 U.S.C. § 1114; 38 C.F.R. §§ 3.350, 3.351, 3.352. 4. The issue of entitlement to TDIU is moot. 3 8 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 4.14, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 2012 to June 2016. A hearing was held before undersigned Veterans Law Judge in October 2021. Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The record indicates that service connection is in effect for delusional disorder and major depressive disorder. The Veteran contends that service connection is also warranted for bipolar disorder. After consideration of the record, the Board finds the Veteran's psychiatric disability is best characterized as acquired psychiatric disability. The record indicates that an acquired psychiatric disability, which has been diagnosed as various conditions with overlapping symptoms, began during service and persists. Accordingly, the Board finds service connection is warranted for acquired psychiatric disability. The service-connected delusional disorder with major depressive order is evaluated under the General Rating Formula for Mental Disorders, which provides a 100 percent rating for total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The symptoms listed are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). After looking to the frequency, severity, and duration of the Veteran's impairment, specifically as competently and credibly reported by the Veteran and his father and as noted in clinical records during and after service, and having resolved all reasonable doubt in favor of the Veteran, the Board finds that the Veteran's delusional disorder with major depressive order is manifested by symptoms that more nearly approximates total occupational and social impairment. The record includes evidence that the Veteran has persistent suicidal ideation with past attempt (with an April 2017 finding of chronic high risk for suicide attempt), impairment of ability to maintain personal hygiene and other activities of daily living and findings of "significant" and "severe" mental disorder with potential to cause severe mental, emotional, and physical harm and "large functional impairment across work, social, and emotional domains" due to obsessional beliefs. The record also indicates that the Veteran does not drive or work due to his disability. Resolving all doubt in favor of the Veteran, the Board finds that the delusional disorder with major depressive order is productive of total occupational and social impairment. In making this determination, the Board notes that only one rating is warranted for the psychiatric symptoms. Although the record includes multiple diagnoses, the record does not clearly differentiate the specific psychiatric etiology of the symptoms and the Board has considered all findings and histories in determining a total rating is warranted. 38 C.F.R. § 3.102; Mittleider v. West, 11 Vet. App. 181, 182 (1998). Regarding the Veteran's claim for a total disability rating based on individual unemployability (TDIU), as found above, the Veteran is now in receipt of a 100 percent disability rating for his service-connected psychiatric disability for the entire appeal period. The receipt of a 100 percent schedular rating for a service-connected disability does not necessarily render moot a pending claim for a TDIU, as a separate award of a TDIU predicated on another single disability may serve as the basis for an award of special monthly compensation. See Bradley v. Peake, 22 Vet. App. 280, 293 (2008). However, in this case, the Veteran has no other service-connected disabilities. As such, his TDIU claim is moot. 38 C.F.R. § 4.16(a). The issue of entitlement to SMC based on the need for the aid and attendance of another person is reasonably raised where evidence suggests that a veteran needs assistance with daily living due to his service-connected symptoms. See Akles v. Derwinski, 1 Vet. App. 118, 121 (1991) (observing that entitlement to SMC is an "inferred issue" in the context of an increased rating claim); Bradley v. Peake, 22 Vet. App. 280 (2008) (finding that SMC "benefits are to be accorded when a Veteran becomes eligible without need for a separate claim"); Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2011). With respect to claims of entitlement to SMC based on the need for the regular aid and attendance of another person, such claims will be granted when the Veteran, due to a service-connected disability, has the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. See 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). The record does not reflect that the Veteran has the anatomical loss or loss of both feet or one hand and one foot or is blind in both eyes due to service-connected disability. Thus, the question is whether the Veteran is permanently bedridden or so helpless as to be in need of regular attendance due to his service-connected disabilities. Determinations as to the need for aid and attendance must be based on actual requirements of personal assistance from others. In making such determinations, consideration is given to the following: inability of the veteran to dress or undress himself/herself or to keep himself/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; inability of the veteran to feed himself/herself 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 veteran from the hazards or dangers inherent in his/her daily environment. "Bedridden" will be a proper basis for the determination, and is defined as that condition which, through its essential character, actually requires that the veteran remain in bed. It is not required that all of the disabling conditions listed above be found to exist before a favorable rating may be made. The particular personal functions that a veteran is unable to perform should be considered in connection with his/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 be a constant need. 38 C.F.R. § 3.352(a). After review of the record, the Board finds the Veteran has a factual need for aid and attendance based on service-connected psychiatric disability. The record, notably the statements from the Veteran's father and the clinical records, indicate that the Veteran is unable to drive independently and requires care or assistance on a regular basis, such as reminders to perform activities of daily living such as eating and personal hygiene, reminders of appointments, and management of personal items. The record indicates that the Veteran's parents are currently providing daily aid and assistance for the Veteran. Resolving all reasonable doubt in favor of the Veteran regarding degree of disability, the Board finds the competent and credible evidence of record reflects it is at least as likely as not the Veteran requires the regular aid and attendance of another person due to his service-connected disability. Thus, he is entitled to SMC on this basis in accord with 38 U.S.C. § 1114 and 38 C.F.R. §§ 3.350, 3.351, 3.352. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Snyder, 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.