Citation Nr: 21075716 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 17-03 110 DATE: December 21, 2021 ORDER Entitlement to special monthly compensation (SMC) based on a need for aid and attendance is granted. FINDING OF FACT The Veteran's service-connected disabilities render him in need of regular aid and attendance of another person. CONCLUSION OF LAW The criteria for special monthly compensation based on the regular aid and attendance of another person have been met. 38 U.S.C. § 1114 (l); 38 C.F.R. §§ 3.102, 3.350, 3.352(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty for training (ACDUTRA) service in the United States Army from January 1999 to July 1999 and active duty from January 2003 to September 2003. In a July 2021 Board decision, the Board determined the issue of entitlement to SMC was raised by the record and remanded it for evidentiary development and for the AOJ to consider in the first instance. See Ackles v. Derwinski, 1 Vet. App. 118, 121 (1991). Entitlement to special monthly compensation (SMC) based on a need for aid and attendance The Veteran contends special monthly compensation is warranted because he needs the regular aid and attendance of another person due to the severity of his service-connected disabilities. SMC is payable at a specified rate if a VA claimant, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both feet, or of one hand and one foot; or is blind in both eyes, with visual acuity of 5/200 or less; or is permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). The criteria for determining that a VA claimant is so helpless as to be in need of "regular aid and attendance" are contained in 38 C.F.R. § 3.352 (a). In determining the need for regular aid and attendance, the Board must consider the following factors: (1) Inability of the claimant to dress or undress him or herself or to keep him or herself ordinarily clean and presentable; (2) Frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without assistance; (3) Inability of the claimant to feed him or herself through loss of coordination of upper extremities or through extreme weakness; (4) Inability to attend to the wants of nature; or (5) Incapacity, either physical or mental, that requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352 (a). The Veteran has the following service-connected disabilities: Posttraumatic stress disorder (PTSD), rated as 70 percent disabling; Right knee disability, rated as 20 percent disabling; Right knee limitation of motion, rated as 10 percent disabling; Left knee limitation of motion, rated as 10 percent disabling; Right knee instability, rated as 10 percent disabling; and Left knee instability, rated as 10 percent disabling. The Veteran has also been granted entitlement to a total disability based on individual unemployability (TDIU). Granting the Veteran the benefit of the doubt, the Board finds the service-connected disabilities render him in need of regular aid and attendance of another person. An April 2015 VA treatment record notes the Veteran continued to need assistance with transportation, medication management, and cooking tasks. The Veteran was able to perform basic self-care and hygiene for himself. An April 2016 VA treatment record noted the Veteran needed assistance with ambulation, bathing, and personal hygiene. An October 2016 VA treatment record noted the Veteran had to have his medication administered to him because he would forget to take it. He also had a caregiver manage his financial and household affairs. She helped him with meal preparation and transportation as the Veteran had difficulty with his memory. It was noted that he required assistance/supervision as a result of his delusions and hallucinations. An August 2017 VA treatment record continued to note the Veteran needed assistance bathing. It also added that he frequently falls and forgets where he is at times. He had two caregivers at home to assist him with daily living. A March 2018 VA treatment record noted the Veteran needed assistance getting to the restroom, help when falling due to his mental health condition, and bathing. A May 2018 VA record noted the Veteran needed help with medication management and continued assistance bathing. In August 2021 the Veteran underwent a VA examination for housebound status or permanent need for regular aid and attendance. The examiner noted the Veteran has a limp and relies on a cane to ambulate. His knee disabilities cause him to be unable to stand for prolonged periods of time and cause pain with ambulation. His back disability reduces his range of motion and his ability to bend forward. It was noted that the Veteran is able to feed himself, however he is unable to prepare his own meals as he cannot stand for prolonged periods of time in order to cook. He also needed mild to moderate assistance with bathing. Otherwise, it was noted the Veteran was able to feed himself, dress, undress, use the toilet, groom himself, take care of his medication, and manage his affairs. The examiner did note the Veteran had a history of falls. While the Veteran is not bedridden and can leave the house, the record indicates the Veteran is prone to falling, especially during bathing, and cannot prepare meals on his own. At times he also needed help managing his medication and financial affairs. Based on the evidence of record, and resolving any doubt in favor of the Veteran, the Board finds entitlement to SMC for aid and attendance is warranted. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Holcombe, 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.