Citation Nr: 21072246 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 12-29 300 DATE: December 2, 2021 ORDER Entitlement to specially adapted housing is denied. Entitlement to a special home adaptation grant is denied. REMANDED Entitlement to an evaluation in excess of 30 percent for service-connected posttraumatic stress disorder (PTSD) prior to June 20, 2013 is remanded. Entitlement to an evaluation in excess of 50 percent for PTSD since June 20, 2013 is remanded. FINDINGS OF FACT 1. The Veteran does not have a disability rated as permanent and total due to the loss or loss of use of both upper extremities or loss or loss of use of both of his lower extremities, one lower extremity together with the residuals of organic disease or injury, or one lower extremity together with one upper extremity, any of which preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; nor does he have service-connected amyotrophic lateral sclerosis, full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk, or loss of use of one lower extremity with blindness in both eyes that results in only having light perception. 2. The Veteran does not have a permanent and total service-connected disability which includes the anatomical loss or loss of use of both hands, or that is due to burn injuries or residuals of an inhalational injury, nor does he have a service-connected disability due to blindness in both eyes, with corrected central visual acuity of 20/200 or less in the better eye. CONCLUSIONS OF LAW 1. The criteria for eligibility for assistance in acquiring specially adapted housing have not been met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. §§ 3.102, 3.809. 2. The criteria for eligibility for a special home adaption grant have not been met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. §§ 3.102, 3.809a. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1966 to June 1968. He is the recipient of the Vietnam Service Medal, the Vietnam Campaign Medal, the Combat Infantry Badge, and the Purple Heart. This matter comes before the Board of Veterans' Appeals (Board) on appeal from multiple rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before a now-retired Veterans Law Judge (VLJ) at an October 2014 Board hearing, which included testimony as to his PTSD. In an August 2021 correspondence, the Veteran was given the opportunity to request another hearing. The record reflects that the Veteran received a letter indicating that he could request a virtual tele-hearing instead of waiting for a travel board hearing. In September 2021, the Veteran returned the letter, indicating he does not wish for another Board hearing. Therefore, he does not have a pending hearing request. He provided testimony in a hearing as noted in October 2014 and has not requested a new one following the Board remands. The Board has considered the transcript of that hearing as evidence in making its decision. This appeal has a long procedural history. First, in March 2016, the Board remanded, in part, the above claims for additional development. Thereafter, in January 2019, the Board remanded the claims again for a supplemental statement of the case to consider the 2018 VA examination in the first instance; and granted the claim for service connection for a liver disorder. As such, that claim is no longer on appeal before the Board. As for the claim for higher evaluations for PTSD, the Board finds additional development is necessary for the claim as substantial compliance with the prior remands' directives were not met. See remand discussion below. However, it was specifically noted by the VA examiner that the Veteran's mental health disability does not affect his claim for specially adapted house or the special home adaption grant; as such, those claims are discussed below. Additionally, in a September 2018 Board remand, the Board remanded the Veteran's claim addressing the issue of entitlement to large scale home modifications as part of an Independent Living plan under the Home Improvements and Structural Alterations (HISA) grant program. See 38 U.S.C. §§ 1710(a), 1717(a)(2); 38 C.F.R. § 17.3100. According to internal appeals monitoring records, the Agency of Original Jurisdiction granted this benefit in September 2019. If that is not the case, the Veteran should contact his local Regional Office or the nearest VA Medical Center for additional assistance. Finally, other than as discussed in the remand below regarding the Veteran's mental health records, the Veteran has not raised any issues with the duty to notify or duty to assist in obtaining documentary evidence. Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Thus, the Board need not discuss any potential issues in this regard. Further, neither the Veteran nor his representative has alleged any deficiency with the conduct of the Board hearing as to the duties discussed in Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). Special Adapted Housing The Veteran argues that he is entitled to specially adapted housing due to his service-connected disabilities. Specifically, the Veteran applied for eligibility for a grant for specially adapted housing or special home adaptation and contends that his bilateral upper and bilateral lower peripheral neuropathy affects his mobility so that he needs a wheelchair or scooter to get around and needs to renovate his home to make it safer and more accessible. He has written that the pain in his feet is so severe that he has effective loss of use of these extremities, and that he is unable to walk without assistance. Specially adapted housing is available to a veteran who has a permanent and total (P&T) service-connected disability due to: (1) amyotrophic lateral sclerosis (ALS) rated as 100 percent disabling under 38 C.F.R. § 4.124a , Diagnostic Code 8017; (2) blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; (3) full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk; or (4) the loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbows. See 38 U.S.C. § 2101(a); 38 C.F.R. § 3.809(a), (b), (d). Specially adapted housing is also available to a veteran with a permanent and total (P&T) disability that precludes locomotion without the aids of braces, crutches, canes, or a wheelchair due to: (5) the loss, or loss of use, of both lower extremities; (6) the loss or loss of use of one lower extremity, together with residuals of organic disease or injury which so affect the functions of balance and propulsion; or, (7) the loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion. See 38 U.S.C. § 2101(a); 38 C.F.R. § 3.809(a), (b), (d). The term preclude locomotion means the necessity for regular and constant use of a wheelchair, braces, crutches, or canes as a normal mode of locomotion although occasional locomotion by other methods may be possible. See 38 C.F.R. § 3.809(c). "Loss of use" exists if a veteran has a deprivation of the ability to use a lower extremity so severe that it precludes perambulating without one of the required assistive devices. That definition indicates that locomotion is precluded even if a veteran is capable on occasion of moving about unaided. In addition, functional impairment caused by pain, weakness, or incoordination should be taken into account when making that determination. However, that does not mean that every time an individual is prescribed an assistive device in conjunction with a lower extremity disability that the individual would automatically be eligible to receive specially adapted housing. To receive specially adapted housing based on loss of use, an individual must (1) have a permanent and total disability (2) due to a disorder that (3) involves both lower extremities and (4) causes a loss of use so severe that it precludes locomotion without the regular and constant use of assistive devices. Jensen v. Shulkin, 29 Vet. App. 66 (2017); 38 U.S.C. § 2101(a)(2)(B). In Jensen, the Court clarified that the standard for "loss of use of the feet" under 38 C.F.R. §§ 3.350(a)(2)(i) and 4.63 is not the same as "loss of use of the lower extremities" for purposes of entitlement to specially adapted housing under 38 C.F.R. § 3.809(b). That is, "loss of use of the feet" is a more stringent standard for a veteran to meet than "loss of use of the lower extremities." Id. The Jensen Court did note, however, that "loss of use" in a general sense was the "deprivation of the ability to avail oneself" of that extremity. Id. The ultimate responsibility for determining whether there is loss of use rests with the adjudicator and is a conclusion of law. Floore v. Shinseki, 26 Vet. App. 376, 381 (2013) (medical examiners are responsible for providing a 'full description of the effects of disability upon the person's ordinary activity, 38 C.F.R. § 4.10, but it is the rating official who is responsible for interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present). Upon review of the evidence of record, the Board finds that entitlement to specially adapted housing is not warranted. See 38 U.S.C. § 2101(a); 38 C.F.R. § 3.809(b). First, some of the criteria applicable to entitlement to specially adapted housing are not applicable in this case. Specifically, the Veteran is not service connected for amyotrophic lateral sclerosis, for subdermal burns, or for an inhalation injury. See 38 C.F.R. §§ 3.809, 3.809a. The Veteran is service connected for the following disabilities: central retinal artery occlusion associated with hypertension rated at 70 percent; PTSD currently rated at 50 percent; renal insufficiency rated at 30 percent; coronary artery disease rated at 10 percent; liver disorder rated at 30 percent; diabetes mellitus type II with erectile dysfunction rated at 20 percent; left upper extremity diabetic neuropathy rated at 20 percent; right upper extremity peripheral diabetic neuropathy rated at 20 percent, right lower extremity peripheral diabetic neuropathy rated at 20 percent; left lower extremity peripheral diabetic neuropathy rated at 20 percent; hypertension rated at 10 percent; grenade fragment wound in the left thumb rated at 10 percent; scars on the right flank rated at 10 percent; tinnitus rated at 10 percent; shell fragment on the right buttock rated at 10 percent; and noncompensable rating for tinea-like lesions on the neck. He is also in receipt of special monthly compensation (SMC) for loss of use of a creative organ and TDIU. His combined evaluation is 100 percent since July 30, 2018. First, a January 2007 letter from Dr. B.C. stated that the Veteran cannot stand on his feet secondary to his neuropathy, and the pain has caused him to be unemployable. In a follow up letter in October 2007 from Dr. B.C., he again stated that the Veteran cannot work eight hours a day at a desk because he cannot sit for more than 20 to 30 minutes as he has cramping and pain in his legs and needs to lie down. The April 2007 examination of the lower extremities found no muscle wasting and the power in his lower extremities was graded as good to normal. Sensation to pinprick, and proprioception was intact. The examiner's impression was no functional deficit despite history of peripheral neuropathy. A September 2007 statement from Dr. B.C. indicated that the Veteran has atrophy on the left lower calf and knee reflexes were symmetrical. His ankle reflexes were symmetrical. He had good flexion and extension of the knees and decreased sensation below the right knee and had decreased sensation from the knee down on the left extremity. Dr. B.C. noted he was unable to walk on his heels and toes and stated that because of his neuropathy, ambulation and standing was very difficult. A statement from his vocational rehabilitation specialist, S.U., indicated that he has difficulty getting around with peripheral neuropathy, vascular insufficiency, arthritis, and flat feet. She felt that making the proposed modifications in the Veteran's residence would help him remain independent. A VA podiatry note dated February 2008 shows sensation was diminished of the lower extremities, but muscle strength was 5/5 and range of motion of the ankle joints was within normal limits. The February 2009 VA examination showed that the Veteran could rock up on his heels and rise up on his toes and take several steps forward without difficulty. He was able to tandem walk. He had monofilament deficits on the plantar aspects of both feet, but his strength was normal. The PTSD VA examination in February 2009 indicated that the Veteran reported that he and his brother go fishing and go to car shows and he and his wife ate meals out and went shopping together. He also reported that he had a home woodshop and made cabinets and bookcases. He stated typical days include reading the newspaper, doing some chores, and going for a walk. The August 2009 PTSD VA examination noted that the Veteran reported being able to flower garden and he went fishing with his brother and attended car races. He also stated that he typically goes for a short walk, emphasizing that he cannot go very far because of weakness, pain, mobility problems generally in the lower part of his body. The examiner noted that the Veteran presented to the examination making use of a walker, and that he walked with some difficulty. A December 2009 vocational rehabilitation assessment noted he used a walker, and it took him a few minutes to come to the door. It was also noted that he used the walker to walk through the house. In March 2010, it was noted that it was recommended by his primary care doctor that he be provided a riding mower with snow blower to accommodate his disabilities. In his February 2010 notice of disagreement, the Veteran stated he should qualify for specially adapted housing due to his neuropathy because he cannot rock up on his heels and rise up on his toes without difficulty; cannot tandem walk without loss of balance; he used one cane for walking, then two canes, and now uses a walker from losing balance when walking. He reported that his "severe loss of balance" caused him to fall and fracture his hip. He also stated that he cannot stand for long periods of time due to the pain, loss of balance and numbness, and that standing for short periods of time also hurts as he has cramping and pain in his legs/lower extremities. The May 2011 VA examination indicated that the Veteran described tingling of the toes and then pain across the arches of his feet, along with numbness, but he was able to rock up on his heels and raise up on his toes. He could tandem walk without loss of balance and sensory was grossly absent on the distal half of the lower legs and feet. In August 2011 VA medical records, it was noted that he has VA issued motorized scooter and needs a ramp for his house. In November 2011, he was approved for a ramp to get his scooter in the house for storage purposes. Mayo clinic records show in March 2012, he was biking two miles a day and walking one mile a day for exercise. His gait was normal, and he had normal sensation to light touch on his feet for no sensation to vibration on the feet. In December 2012, the Veteran's muscle VA examination indicated that while the Veteran does use a walker, it is for his right femur fracture and not for his other muscle injuries. The Veteran reported that he has pain in his right buttock that limits walking and sitting. It was noted he used a cane constantly and that his hip, knee, and ankles had some resistance in strength. The examiner found that the Veteran's muscle injury was not so damaged, such that he was unable to rise from a seated and stooped position and to maintain postural stability without assistance of any type. In March 2012, it was noted that he was not using assistive devices. In April 2012, his VA primary medical records showed that he had been exercising quite well until the bike accident that caused his fracture. In a June 2013 mental health examination, he reported that he occasionally does some volunteer work around town, cleaning up parks. November 2013 VAMC records show that the Veteran reported that he walks and bikes every morning. In the March 2014 mental health VA examination, the Veteran reported that he enjoys fishing, gardening, and attending flea markets as well as car or gun shows. He also reported that he assists a car dealer as needed by driving cars to other locations within an hour or two. The examiner noted that the Veteran also indicated that he has sufficient energy to engage in activities like fishing or attending public events without difficulty. In an October 2015 statement, the Veteran reported that he was and still is using a wheelchair, wheeled walker, cane and knee brace at different times, depending on the day. He stated that every day he has to assess and determine what assistance is needed through the day to help balance and walk. In the June 2016 VA examination for peripheral nerves, it was noted that he has severe bilateral lower extremity with constant pain, paresthesias, and numbness. His muscle strength was noted to be normal, and he had no muscle atrophy. His reflex examination showed hypoactive reflexes, and his sensory examination showed decreased sensation for light touch in the hand and fingers, and the foot and toes, but normal lower leg/ankle and thighs and knees. He had no trophic changes and a normal gait, and his nerve groups were all noted to have NO paralysis (complete or incomplete). The Veteran reports that his pain resulted in him retiring in 2003 secondary to bilateral pain in the feet which limits him on walking more than half a block, climbing a ladder, limits on gardening, and limits on bending down and up. He did report that he is able to complete activities of daily living, such as fixing his own food, doing dishes, and do light housework around the home such as dusting. He also reported that in 2012, he fell off a bike and fractured his right hip and right patella. The examiner further noted that there was no special equipment required in the home as the Veteran is not using a wheelchair around the home (he noted that following the Veteran's hip fracture and patella fracture, he was using one, but he is not currently using one on a regular basis). In the June 2016 examination for the lower legs, the Veteran again reported that he is limited on walking more than half a block due to the pain in the knee. He also reported that he is limited on walking up the stairs secondary to the right hip knee and hip pain. The examiner opined that the Veteran's current complaints of his right knee are secondary to a 2012 bike injury and less likely from any service-connected issues, and that his current disabilities do not indicate that he requires any special equipment around the home. In the June 2016 heart VA examination, following Metabolic Equivalency of Task (MET) testing, his MET levels were found to be consistent with activities such as light yard work (weeding), mowing lawn (power mower), brisk walking (4 mph). In June 2017, VAMC records show he reported that he works with his extensive flower beds that have over 500 flowers as well as peppers, tomatoes, and cucumbers. He was also commended for walking several miles a day and with helping local farmers trap varmints that disturb the fields. In September 2018 peripheral neuropathy examination, it was noted that the Veteran reported that his condition had gotten worse and that he stated that "it feels like someone is stabbing a knife into my feet all the time. My feet are always throbbing...The tops of my feet have throbbing pain all the time." Following testing, the examiner marked that the Veteran had moderate bilateral lower extremity intermittent pain and mild paresthesias, but he does not have constant pain or numbness. He had normal strength, normal tendon reflexes, decreased sensation in the ankle/lower leg and foot/toes, but he had normal position sense. He does not have muscle atrophy or any trophic changes. He had incomplete paralysis in the sciatic nerve in the bilateral lower extremities that was mild in severity and several nerves in the upper extremities had incomplete paralysis which were all mild in severity. The sensation to light touch for the right upper and left upper anterior thighs were normal. In the December 2018 VA examination for his muscle disabilities, it was noted that the impact of the muscle injuries on the Veteran's ability to work is he is limited in prolonged sitting / standing, distance ambulation, and prolonged driving. In April 2020 VAMC records, it was noted that the Veteran has many assistive devices for ambulation, and a scooter, but he does not typically use them at this time, but he does have them if he needs them. He did report an occasional use when he is feeling unsteady and that he sometimes feels dizzy when he stands. The Veteran reports that he has not had a fall in over a year and believes it has been 5-6 years, possibly even longer. The Veteran also denied any difficulty with entering or leaving his home. He participates in grocery shopping and denies any difficulty with this; engages in bed mobility and transfers with no difficulty. It was also noted that he has been sleeping on his couch because he does not have a restroom upstairs, so he sleeps on the couch. However, while options were discussed in regard to allowing him to sleep upstairs, including urinals, an m-rail, and a commode, the Veteran reported that he largely prefers sleeping on the couch. The Veteran denied any difficulty with dressing, with fasteners, buttons, shoes, or socks; he denied any difficulty with transfers when using the toilet; and stated he has a tub/shower combination which has a shower chair that he does not always use, even though he does not have any grab bars in his shower. In May 2020 VA medical records, the Veteran expressed appreciation for his occupational specialist for arranging for him to have grab bars in his bathroom; he also stated that he regrets he cannot walk as well as he formerly did due to having fallen and broken his hip and hurt his knee, then reinjuring them so they have not healed optimally. The examiner noted that he still enjoys outdoor activities and that he gets out, walks and gardens as much as he can. In June 2020, the Veteran reported that he is walking every day, approximately 20-30 minutes a day. His sensation was noted to be grossly intact in the bilateral upper extremities, with reduced sensation over bilateral feet due to diabetic neuropathy, but the other lower extremities sensation was grossly intact. His muscle strength and reflexes were normal in both the bilateral upper and lower extremities. Later that month, he reported that he is walking approximately five blocks every day, with pain in the bilateral feet after walking. In July 2020 he reported problems walking with pain noted in the sole and outside of foot after walking for extended periods of time. However, he also reported that he is walking about five blocks daily. It was also noted that the Veteran received grab bars in his shower and was able to demonstrate a safe transfer into and out of the shower using the grab bars with modified independence. He was also able to sit all the way down in his tub and stand using the grab bars, as well. In another session that month, it was noted that the Veteran reported that his quad cane was a large improvement over his last cane and is feeling much steadier and more stable. He denies any concerns regarding his quad cane and denies having any falls. Based on the above, there is no dispute that the Veteran's service-connected disabilities have a significant impact on his lower extremities and his ability to ambulate. However, as will be explained below, the Board is bound by the law and regulations when determining whether the Veteran is eligible for assistance in acquiring specially adapted housing. First, the Board acknowledges that the Veteran regularly uses a wheelchair, scooter, or cane. However, though the Veteran uses a wheelchair in order to better ambulate, the probative evidence does not illustrate that the Veteran's service-connected disabilities preclude locomotion without the use of the aid of braces, scooter, canes, or a wheelchair. The Board acknowledges the Veteran's contentions that he is often wheelchair bound. However, there is no probative evidence of record to reflect that without the use of mechanical aids the Veteran would be precluded from movement. As such, though he has reduced function of the lower extremities, the Veteran maintains functioning above that required for there to be entitlement to specially adapted housing. There is not loss of use of his leg or foot due to service-connected disabilities, as there is not "deprivation of the ability to avail oneself" of an extremity. Jensen, 29 Vet. App. at 78-79. Specifically, as noted above, at worst, his bilateral lower extremities were mild in severity and while the Veteran is service connected for peripheral diabetic neuropathy of the bilateral lower extremity rated as 20 percent disabling for both the left lower extremity and right lower extremity, this disability does not equate to the loss or loss of use of one lower extremity. As noted in the records above, while the Veteran does use a scooter and a cane to help ambulate, it was also reported several times that he walks five blocks every day and has not had a fall from being unsteady in over five years. He also reported being able t]o garden, clean up parks, drive cars, and that he is able to stand in the shower. While the Board acknowledges the Veteran's difficulty with prolonged weightbearing activity, such as walking and standing, and that he uses assistive devices, such as a cane and scooter, such impairment is not so severe as to establish actual loss of use of a lower extremity as is required for purposes of granting specially adaptation housing. With respect to the upper extremities, the Veteran is service connected for diabetic neuropathy of the bilateral upper extremities. The record shows that the Veteran's upper extremity is active, with normal to slightly reduced strength testing in both extremities. The probative evidence does not illustrate the loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbow. The Veteran did report not being able to do heavy lifting. However, not being able to handle weight overhead does not equal to preclusion of the arms at or above the elbow. While the record shows reduced functioning of the upper extremities, the Veteran maintains functioning above that required for there to be entitlement to specially adapted housing. There is not loss of use of a limb or hand due to service-connected disabilities, as there is not "deprivation of the ability to avail oneself" of an extremity. Jensen, 29 Vet. App. at 78-79. Specifically, as noted above, at worst, the Veteran's bilateral upper extremities were mild in severity and his grip strength was noted as slight less than normal. His deep tendon reflexes were also normal, though his hands and fingers were noted to have decreased light touch results. Further, the aforementioned evidence indicates that the Veteran denied any difficulty with dressing, with fasteners, buttons, shoes, or socks; he denied any difficulty with transfers when using the toilet; and stated he has a tub/shower combination which has a shower chair that he does not always use, even though he does not have any grab bars in his shower. He also reported being able to garden, fish, and was not precluded from activities of daily living. Moreover, even if his service-connected diabetes mellitus and hypertension were organic diseases which affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair, he would still be ineligible as there is no loss or loss of use of one lower extremity. He is therefore ineligible for specially adapted housing under §3.809(b)(3). It is neither shown, nor has the Veteran asserted, that his service-connected disabilities involve blindness, burn injuries, or amyotrophic lateral sclerosis. Moreover, even though the Veteran has service-connected disabilities affecting his bilateral lower extremities and bilateral upper extremities, the evidence does not otherwise demonstrate that either the peripheral diabetic neuropathy of the bilateral lower extremities, or diabetic neuropathy of the bilateral upper extremities rise to the level of loss of use of both upper extremities; the loss of use of both lower extremities; such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; or loss of use of one upper extremity together with loss of use of one lower extremity which so affect the functions of balance or propulsion. Additionally, as noted, the probative evidence does not show loss of use of one lower extremity together with the residuals of an organic disease or injury. The Board acknowledges and has considered the Veteran's contentions and the arguments made by the Veteran's representatives that he should be eligible for specially adapted housing due to his pain in the lower extremities, especially as it is hard for him to walk or stand for long periods of time without pain. He is competent in his description of the symptoms he experiences such as intermittent pain, swelling, numbness, and trouble walking long distances. The descriptions of his symptoms are also credible. Nevertheless, the evidence does not show that he has been deprived of his ability to avail himself the use of his lower extremities absent the use of an assistive device and his disabilities are not shown to have resulted in loss or loss of use of either lower extremities. As such, the Board is precluded by statute and regulation from finding that the Veteran is eligible for specially adapted housing. Further, there is no contrary evidence of record showing that the Veteran requires assistive devices to ambulate for any service-connected disability reason other than for his vision disability. Although the Board is sympathetic to the Veteran's concerns and how much his disabilities of the bilateral lower extremities have impacted his daily activities and overall quality of life, it is bound by applicable law and regulations when determining a claim for VA benefits. The facts are not in dispute, and application of the law to the facts is dispositive. Where there is no entitlement under the law to the benefit sought, the appeal must be denied. Accordingly, the preponderance of the evidence is against entitlement to specially adapted housing and the claim is denied. See 38 U.S.C. §§ 2101(a), 5107(b); 38 C.F.R. §§ 3.102, 3.809(b). Special Home Adaptation If entitlement to specially adapted housing is not established, a veteran may qualify for a grant for necessary special home adaptations if he has a service-connected disability that results in blindness in both eyes with 20/200 visual acuity or less in the better eye with the use of a standard correcting lens or a limitation in fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees (such a disability need not be permanent and total in nature); a permanent and total disability which: (1) includes the anatomical loss or loss of use of both hands; (2) is due to deep partial thickness burns that have resulted in contracture(s) with limitation of motion of two or more extremities or of at least one extremity and the trunk; (3) is due to full thickness or subdermal burns that have resulted in contracture(s) of one or more extremities or the truck; or, (4) is due to residuals of an inhalation injury (including, but not limited to, pulmonary fibrosis, asthma, and chronic obstructive pulmonary disease (COPD)). See 38 C.F.R. § 3.809a(b). As discussed in greater detail above, the Board finds that the weight of the evidence demonstrates that although the Veteran is service connected for peripheral neuropathy of the bilateral upper extremities, he does not have complete paralysis of either the left hand or right hand; rather, his neuropathy was noted to be mild in severity. As such, there is not the anatomical loss or loss of use of both hands. Additionally, his service-connected disabilities do not include burn injuries, an inhalation injury, or loss of vision. Ultimately, the Veteran does not have a permanent and total disability causing any of the enumerated conditions under 38 C.F.R. §§ 3.809a. As such, he ineligible for a special home adaptation. The appeal is therefore denied. REASONS FOR REMAND Entitlement to an increased rating for posttraumatic stress disorder, rated as 30 percent prior to June 20, 2013 and as 50 percent since June 20, 2013 is remanded. By way of history, in May 2009, VA continued a 30 percent rating for posttraumatic stress disorder. The Veteran disagreed with the decision and perfected this appeal. In April 2014, the rating was increased to 50 percent effective June 20, 2013 resulting in staged ratings. Thereafter, the issues were remanded in March 2016 and again in January 2019. Following completion of the requested development, the issues returned to the Board. However, it does not appear the Veteran's complete VAMC records have been obtained. The Veteran reported receiving primary care mental health integration (PCHMI) treatment at the Minneapolis VAMC; while some of the records were obtained, the full records have not been associated with the file. Specifically, the records that were obtained all state: "please see PCMHI tele primary care notes... for details." As such, while the Board sincerely appreciates the Veteran's patience, another remand is warranted to obtain the full record regarding his mental health as he has consistently reported it has worsened. Additionally, the last VA examination was in September 2018, at this point, three years ago. As such, as a remand is warranted to obtain updated records, the RO should also schedule the Veteran for a more contemporaneous mental health evaluation to determine the current severity. Snuffer v. Gober, 10 Vet. App. 400 (1997); see also Caffrey v. Brown, 6 Vet. App. 377, 381 (1994). The matters are REMANDED for the following action: 1. Obtain the Veteran's VA medical treatment records, in particular those records from the Minneapolis VAMC as where he is receiving counseling a copy of the full record and notes must be included in the file. The RO must also contact the VA Community-Based Outpatient Clinic located in Mason City, Iowa, and request they also provide copies of any and all records of their treatment of the Veteran since 2020 for his mental health disability. 2. Then, schedule the Veteran for a VA examination to determine the current severity for his PTSD. RAY BARTO SLABBEKORN, JR. Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G.Hoy, 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.