Citation Nr: 21067534 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 18-50 669 DATE: November 4, 2021 ORDER Entitlement to special monthly compensation based on a need for aid and attendance is granted. FINDING OF FACT The Veteran requires the aid and assistance of another person due to his service-connected disabilities. CONCLUSION OF LAW The criteria for special monthly compensation based on a need for aid and attendance have been met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.350, 3.352. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1963 to August 1966. This case comes to the Board of Veterans' Appeals (Board) from a March 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office. This issue was remanded by the Board in August 2019 for further development. The Veteran contends that due to his service-connected disabilities, he requires the regular aid and attendance of another person. He has written that he cannot walk and requires help with all activities of daily living. The Veteran's wife submitted a May 2014 statement describing how the Veteran is unable to walk without a walker and assistance, that she has to help him bathe and dress, and that she prepares his meals and handles all finances. The Veteran's granddaughter wrote in May 2014 that she helps her grandfather with errands, cooking, cleaning, and activities of daily living. The Board finds that entitlement to special monthly compensation based on a need for aid and attendance is warranted. Special monthly compensation is payable when a veteran is permanently bedridden or so helpless as to be in need of the regular aid and attendance of another person. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). A veteran shall be considered to be in need of regular aid and attendance if he is blind or nearly blind, is a patient in a nursing home because of mental or physical incapacity; or establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352. Determinations as to the need for aid and attendance are based on the actual requirements of personal assistance from others. In determining the need for regular aid and attendance, consideration will be given to the inability of the veteran to dress or undress himself, or to keep himself clean; frequent need of adjustment of any prosthetic which by reason of the disability cannot be done without aid; inability of the veteran to feed himself; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect himself from the hazards or dangers of his daily environment. 38 C.F.R. § 3.352; see also Turco v. Brown, 9 Vet. App. 222 (1996). The Veteran is service-connected for right knee arthritis (40 percent), left knee degenerative changes (30 percent), and right knee injury with subluxation (10 percent), which totals 70 percent. He was also awarded a total disability rating based on individual unemployability since August 31, 2007. There is adequate, probative medical evidence which demonstrates that the Veteran's knee disabilities do greatly impact his ability to care for himself and cause him to require the aid and attendance of another person. A January 2016 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance completed by a physician stated that the Veteran was not able to prepare his own meals, required assistance in bathing and hygiene needs, and needed help with medications, but he wrote that this was due to degenerative arthritis, hypertension, irritable bowel disorder, urinary incontinence, and severe arthritis. A December 2016 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance completed by a VA nurse practitioner stated that the Veteran could not prepare his own meals and that his wife assisted him with bathing and hygiene needs. She wrote that his wife managed his medications and his finances, but did not write that these needs were due solely to his service-connected knee disabilities. A January 2020 examination found that the Veteran was not able to prepare his own meals, he needed assistance in bathing and tending to other hygiene needs, and he required medication preparation and reminders. The Veteran also attended a VA examination in August 2021. The examiner found that the Veteran was not able to prepare his own meals, and he needed assistance in bathing and tending to other hygiene needs, including getting in and out of the bathtub. He also needed assistance with medication management. The examiner also addressed whether the Veteran's need for aid and attendance was due to his knee disabilities alone. She wrote that she had reviewed the prior examinations and was in agreement with their findings. She wrote that "While the claimant has other health conditions, it is my [opinion] that the service-connected knee disabilities alone render the Veteran unable to prepare his own meals, require assistance with bathing and hygiene, manage his medications and travel to and from appointments." While the Board acknowledges that the Veteran has additional disabilities which are not service-connected and which contribute to his functional limitations and inability to care for himself, it finds that there is adequate medical evidence indicating that the Veteran's knee disabilities alone do cause severe impairment, requiring him to need aid and attendance to perform his activities of daily living. The Board finds that the preponderance of the evidence weighs in favor of the Veteran's claim, and the criteria for special monthly compensation based on the need for aid and attendance have been met. The Veteran's service-connected physical disabilities prevent him from being able to cook for himself, he needs assistance with bathing and getting dressed, he has limited ability to walk or get around the house, he is unable to shop for necessities, and he is unable to manage his medications. The evidence indicates that his wife does need to protect him from the hazards or dangers of his daily environment on a regular basis, and he is therefore in need of aid and attendance from another person due to his service-connected disabilities, and the claim for special monthly compensation based on a need for aid and attendance pursuant to 38 C.F.R. § 3.352(a) is granted. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mary E. Rude, 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.