Citation Nr: 21068591 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 11-16 606 DATE: November 10, 2021 ORDER Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance of another person or by reason of being housebound is denied. FINDING OF FACT 1. The Veteran's service-connected disabilities do not render him so helpless as to be in need of regular aid and attendance of another person and he is not bedridden. 2. The Veteran is assigned 100 percent disability rating for schizophrenia but does not have an additional service-connected disability or disabilities independently ratable at 60 percent or more nor does the Veteran's service-connected disability make him permanently housebound. CONCLUSION OF LAW 1. The criteria for SMC based on aid and attendance have not been met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.102, 3.350(b), 3.352(a). 2. The criteria for entitlement of SMC based on housebound have not been met. 38 U.S.C. §§ 1114(s), 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 3.350(i), 4.16. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1981 to March 1983. This matter came before the Board of Veterans Appeals (Board) on appeal from October 2009 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). In October 2014, the Veteran testified at a Travel Board hearing before a Veterans Law Judge (VLJ); a transcript is of record. The hearing was before a now-retired VLJ. In an August 2017 correspondence, the Veteran was given the opportunity to request another hearing. The Veteran did not respond to this letter within thirty days, so the Board will move forward with adjudication. In January 2015, February 2017 and December 2017, the Board remanded this matter for further development. Ultimately, in a February 2020 decision, the Board denied the Veteran's claim for entitlement to SMC based on the need for regular aid and attendance of another person or by reason of being housebound. The Veteran appealed to the Court of Appeals for Veterans Claims (CAVC). In March 2021, CAVC issued a decision, which set aside the Board's February 2020 decision and remand the matter for further action. Entitlement to SMC The Veteran seeks entitlement to special monthly compensation (SMC) based on the need for the regular aid and attendance of another person or by reason of being housebound. SMC for aid and attendance is payable if, as the result of service-connected disabilities, the Veteran has an anatomical loss or loss of use of both feet, or of one hand and one foot; has blindness in both eyes with visual acuity of 5/200 or less; is permanently bedridden; or is so helpless as to be in need of regular aid and attendance of another person. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). The record does not reflect that the Veteran had loss of use of hands or feet or was blind; thus, his claim can only be premised on that he was bedridden or so helpless that he required the aid and attendance of another due to his service-connected disability. Determinations as to need for aid and attendance due to service-connected disabilities must be based on actual requirements of personal assistance from others. In making such determinations, consideration is given to such conditions as: inability of the Veteran to dress or undress himself or to keep himself 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 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 claimant from hazards or dangers incident to his daily environment. It is not required that all of the disabling conditions enumerated above be found to exist before a favorable rating may be made; 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). In addition, special monthly compensation is payable at a specified rate if the Veteran, as the result of service-connected disability, has a service-connected disability rated as total, and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or (2) by reason of such veteran's service-connected disability or disabilities, is permanently housebound. For the purpose of this subsection, the requirement of "permanently housebound" will be considered to have been met when the veteran is substantially confined to such veteran's house (ward or clinical areas, if institutionalized) or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout such veteran's lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(b). The Veteran is currently service connected for schizophrenia paranoid type. He argues that even though his disability has gotten better, he was in need of assistance on a regular basis in the past and should be awarded SMC for that time period. The Veteran also contends that he is 100 percent disabled and cannot get a suitable job because the degree requirement for the job he seeks is a Bachelor's Degree, not an Associate's Degree. In a July 1986 psychiatric examination, the Veteran's psychiatrist noted that the Veteran still goes to his local mental health center and that he is taking his prescribed medication. The Veteran reported feeling "bad and sluggish and that his nervousness comes and goes". The Veteran's father reported that the Veteran stays in his room most of the time, plays the radio and at times seems to be talking to himself or to the people on the radio. The psychiatrist stated that the Veteran appeared competent for VA purposes at the time. In an October 1986 statement, Dr. J.G.M. stated that the Veteran is a chronic paranoid schizophrenic who is incapable of working because of his mental illness. The Veteran was admitted to psychiatry service in December 1986. The Veteran's mother reported that she gives him his medication twice a day, and that if she does not do it he forgets to take it. Medical records from the Social Security Administration (SSA) from March 1987, note that the Veteran experienced marked restriction of activities of daily living, and difficulties in maintaining social functioning, as well as frequent deficiencies of concentration. An August 1990 psychiatric examination noted that the Veteran appeared competent for VA purposes at the time. In SSA records from February 1998, the Veteran reported being able to walk without help and being able to dress and bathe himself. A February 2001 examination noted that the Veteran spends his time at the pool hall, watching television, and working around the house. The examiner noted that the Veteran was trainable for work. The Veteran's capacity to manage funds was corroborated by his mother. In SSA records from May 2001, the Veteran reported that lives with his parents and that he helps his father work around the house every once in a while. The Veteran further reported being able to dress and bathe himself. In an August 2009 examination, the examiner noted that the Veteran has had numerous hospitalizations throughout the years and that he was last hospitalized in June 2009. The examiner noted that the Veteran has not been able to maintain any type of employment and did not have a driver's license. The examiner noted that the Veteran was married and had two children. A mental status examination indicated that the Veteran was a reliable historian, and oriented to person, place, time, and person. His appearance and hygiene were slightly unkempt. His behavior was appropriate, and his affect and mood were anxious. The Veteran had delusions about the television talking to him as well as hallucinations. His thought process and judgment were normal. The examiner opined that the Veteran was able to manage his own benefits and perform his own activities of daily living. Additionally, the examiner indicated that the Veteran was not a danger to himself or others. In a December 2010 counseling report, it was noted that the Veteran was maintaining a therapeutic relationship with the Veteran Affairs Medical Center, and that he maintained academic success at Nash Community College in three classes. In January 2011 and January 2012, the Veteran was hospitalized for paranoia and substance abuse. The Veteran started his services with vocational rehabilitation and employment (VR&E) in September 2012, when it was determined that he had serious employment handicap due to issues related to his neuropsychiatric condition, difficulties with communicating, unstable work history, history of alcohol/drug abuse, lack of education and training that would lead toward suitable employment and a prior unsuccessful attempt in an individualized extended evaluation plan (IEEP). In December 2012, the Veteran was placed in another IEEP program that he successfully completed. Following the completion of this program, the Veteran enrolled in an Individualized Written Rehabilitation Program (IWRP) in August 2013 with the employment goal of an accountant bookkeeper. In this program, the Veteran completed his associate degree in accounting/auditing in December 2014 with a G.P.A. of 3.53. A couple of months after receiving his degree, he also attained employment. During the July 2015 rehabilitation closure statement, the Veteran reported that his condition has improved over past few years with getting a degree and gaining employment and because he has been focused on his job duties, and while at home he is caring for family members such as his parents. The Veteran stated that his position at the time was compatible with his limitations, and that his conditions were in no way aggravated by the duties of his job. The Veteran attended business school and no longer uses drugs. Furthermore, as a result of the Veteran's ability to attend school, the April 2019 VA psychiatrist stated that even though the Veteran is low functioning, he is still considered overall stable and was active and attending college. The July 2017, May 2018 and January 2019 VA neurologists reported that there were no issues with dressing or hygiene. The Veteran lives in a stable household and is not worried about becoming homeless. Again, to warrant SMC due to aid and attendance, the evidence would need to show that the Veteran's service-connected disability rendered him bedridden or so helpless as to be in need of regular aid and attendance of another person. As noted above, the Veteran is service connected for schizophrenia. Upon consideration of the evidence of record, the Board finds that the preponderance of the competent evidence does not indicate that service-connected disability either rendered the Veteran bedridden or caused a need for regular aid and attendance. First, there is no indication in the record, and the Veteran does not contend, that he is or ever was bedridden. The evidence indicates that the Veteran was hospitalized, but there is no evidence that the Veteran was confined to his bed. The Board therefore concludes that the Veteran is not bedridden due to his service-connected disability. The Board also finds that the Veteran's service-connected disability has not resulted in a need for regular aid and attendance at any point since December 1986. The Board does acknowledge that the Veteran has had hospitalizations due to his schizophrenia. However, these hospitalizations were brief and did not result in an inability to care for himself. The Board notes that the medical evidence of record consistently notes that the Veteran has been able to dress and bathe himself. Furthermore, the Veteran was still able to get an education and obtain employment. The Board also acknowledges that while the Veteran was previously in rehabilitation with serious symptoms, the counseling reports demonstrate that, with time, he progressively got better, and he is currently able to care for himself. Lastly, the Board acknowledges the Veteran's statements, but his inability to get a job due to his lack of qualification does not meet the criteria for aid and attendance. Based on the foregoing, the Board finds that the weight of the evidence demonstrates that the Veteran has been capable of performing all the activities of daily living. Thus, he is not entitled to SMC based on a need for regular aid and attendance nor is the Veteran bedridden under 38 U.S.C. § 1114(l). As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim is denied. The Board has also considered whether the Veteran is entitled to SMC based on housebound status. In this case, the Veteran is rated 100 percent for schizophrenia but does not have any additional service-connected disabilities ratable at 60 percent. Additionally, while the Veteran felt as though he was housebound due to his service-connected schizophrenia paranoid type when he was admitted to a VA facility several times, this was only on a temporary basis. To fit the criteria, the Veteran must be permanently housebound. As noted above, a veteran is "permanently housebound" if he is substantially confined to his dwelling and the immediate premises, and it is reasonably certain that the disability and resultant confinement will continue throughout his lifetime. 38 C.F.R. § 3.351(d)(2). In this regard, the evidence clearly shows that the Veteran could travel outside of his house as he was able to have vocational rehabilitation sessions, attend community college/business school classes and become employed. Similarly, the treatment records do not suggest that the Veteran is substantially confined to his dwelling or immediate premises. This information shows that the Veteran is not housebound. The Board finds that the preponderance of the evidence is against the claim for entitlement of SMC for any period from December 1986 and the claim must be denied. 38 U.S.C. § 5107(b). Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David M. Sebstead, Associate 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.