Citation Nr: 21069609 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 17-44 978 DATE: November 19, 2021 ORDER Special monthly compensation (SMC) based on the need for regular aid and attendance or by reason of being housebound is denied. FINDING OF FACT The Veteran's service-connected disabilities have not been shown to render her bedridden, confined to her immediate premises, or unable to care for her daily needs without requiring the regular aid and attendance of another person. CONCLUSION OF LAW The criteria for SMC based on the need for regular aid and attendance or by reason of being housebound have not been met. 38 U.S.C. §§ 1114, 5103, 5103A, 5107; 38 C.F.R. §§ 3.350, 3.351, 3.352. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the U.S. Navy from October 1982 to September 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2016 rating decision. The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in June 2021. Special Monthly Compensation Aid and Attendance SMC is payable to a veteran who, because of service-connected disabilities, is so helpless as to need or require the regular aid and attendance of another person. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b)(3). A veteran will be considered in need of regular aid and attendance if he or she is: (1) is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to five degrees or less; (2) is a patient in a nursing home because of mental or physical incapacity; or (3) establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352(a). 38 C.F.R. § 3.351(c). Factual need for aid and attendance is based on the following criteria: the inability of the veteran to dress or undress himself or herself, or to keep himself or 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 (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); the inability of a veteran to feed himself or herself through the loss of coordination of upper extremities or through extreme weakness; the inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect a veteran from the hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352(a). The Veteran is presently service-connected for posttraumatic stress disorder (PTSD), pituitary adenoma with hypothyroidism, migraine headaches and dizziness, hiatal hernia, sinusitis, and hemorrhoids. The evidence does not show, and the Veteran does not otherwise contend, that she is blind or nearly blind, or a patient in a nursing home. The pertinent question is whether a factual need for aid and attendance has been shown. Unfortunately, the Board must conclude that SMC based on aid and attendance is not warranted. The Veteran's primary contention is that such benefits are warranted because of impairment from swelling in her lower extremities, diagnosed as lymphedema. VA treatment records show that she was diagnosed and treated for the condition during the appeal period. In various statements and testimony, the Veteran asserted that lymphedema impaired her mobility and prevented her from being able to attend the wants of nature, bathe, perform household tasks and chores, and engage in other basic activities. An April 2016 disability benefits questionnaire completed by a VA nurse practitioner addresses the impact of lymphedema on the Veteran's need for aid and attendance. However, because the Veteran is not service-connected for lymphedema, impairment from that disability cannot be considered in determining her need for aid and attendance. The Board acknowledges evidence submitted by the Veteran, including a June 2021 letter from her VA psychiatrist, that her lymphedema is associated with stress, and therefore there may be some relationship between lymphedema and PTSD. Nevertheless, the Board only has jurisdiction over her claim for SMC, which is based solely on her currently service-connected disabilities. It would be premature for the Board to make a finding in this decision that lymphedema is a service-connected disability to be considered in evaluating the SMC claim. The appropriate action is for the Veteran to claim service connection for lymphedema secondary to PTSD. The remaining evidence does not show that the Veteran's PTSD, hypothyroidism, headaches, or other service-connected disabilities satisfy the criteria for a factual need for aid and attendance as outlined above. The Veteran, alone, regularly attended outpatient treatment sessions and engaged with her treatment providers. Her son testified that he helped her to remember things related to her daily business and appointments. Even if this was required based on memory impairment associated with PTSD, it does not, by itself, establish the Veteran's need for regular aid and attendance of another. Similarly, the Veteran described an August 2017 incident while driving which could be characterized as a panic attack. However, such incidents are contemplated by her 70 percent rating for PTSD, and did not occur with sufficient frequency to require the aid and attendance of another. Therefore, SMC based on aid and attendance is not warranted in this case. Housebound A veteran will be determined to be permanently housebound when he or she is substantially confined to the house (or ward or clinical areas, if institutionalized) or immediate premises due to disability or disabilities which it is reasonably certain will remain throughout his or her lifetime. 38 U.S.C. § 1502(c); 38 C.F.R. § 3.351(d)(2). As noted above, the Veteran went to VA medical appointments alone. Although she and her son presented evidence that he assisted her in a variety of ways, VA treatment records show that she continued to attend appointments while he recovered from a broken leg or foot. Therefore, the evidence is against a finding that the Veteran was confined to her house or immediate premises due to disability. SMC at the housebound rate can also be awarded when a veteran has a single disability rated as totally disabling, plus additional disabilities which combine to at least 60 percent. The Veteran does not meet these criteria. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shamil Patel, 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.