Citation Nr: A21020017 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 200401-75852 DATE: December 15, 2021 ORDER Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance or housebound status is denied. New and relevant evidence having been received, readjudication of the claim of entitlement to service connection for a skin disability is warranted, and to that extent only, the appeal is granted. REMANDED Entitlement to service connection for a skin disability is remanded. FINDINGS OF FACT 1. The evidence does not demonstrate that the Veteran is housebound or in need of regular aid and attendance as a result of his service-connected disabilities. 2. New and relevant evidence was received in conjunction with the December 2019 supplemental claim for service connection for a skin disability. CONCLUSIONS OF LAW 1. The criteria for an award of SMC based on housebound status or the need for aid and attendance as a result of service-connected disabilities have not been met. 38 U.S.C. §§ 1114 (2018); 38 C.F.R. §§ 3.102, 3.350, 3.352 (2020). 2. New and relevant evidence has been received to warrant readjudication of the claim of entitlement to service connection for a skin disability. 38 C.F.R. §§ 3.156, 3.2501 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active naval service from October 1967 to October 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from a March 2020 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appealed that decision to the Board and elected the direct review option. Therefore, the Board will consider the evidence of record at the time of the March 2020 rating decision on appeal. 38 C.F.R. § 20.300 (2020). The Board notes that the Veteran previously filed claims for service connection for chloracne, a lipoma of the left upper extremity, and an unspecified skin disability characterized as a rash. Entitlement to service connection for chloracne, a lipoma, folliculitis, lichen simplex chronicus, and intertrigo were previously denied by the Agency of Original Jurisdiction (AOJ) in various decisions. In the March 2020 rating decision, the AOJ considered the claim for service connection for chloracne and various unspecified rashes on a de novo basis, thereby implicitly finding that new and relevant evidence had been submitted. The Board is bound by the AOJ's favorable findings. 38 U.S.C. § 5104A (2018); 38 C.F.R. § 3.104(c) (2020). Special Monthly Compensation Aid and Attendance The Veteran contends that he is eligible for SMC as he is unable to care for himself and requires the aid and attendance of another as a result of impairment caused by his service-connected disabilities. SMC is payable where a veteran suffers from a service-connected disability that renders him permanently bedridden or so helpless as to need regular aid and attendance. 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/she 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 5 degrees or less; or 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(a). See also 38 C.F.R. § 3.351(c). 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 themselves, or to keep 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 themselves; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect themselves from the hazards or dangers of the daily environment. Bedridden will be that condition which, through its essential character, actually requires that the claimant remain in bed. 38 C.F.R. § 3.352(a). It is mandatory for VA to consider the enumerated factors within the regulation, and that at least one of the enumerated factors be present. Turco v. Brown, 9 Vet. App. 222 (1996). In order for the Veteran to prevail in the claim, the evidence must show that it is a service-connected disability that has resulted in the need for regular aid and attendance. Prejean v. West, 13 Vet. App. 444 (2000). Housebound status is warranted if a veteran has a single service-connected disability rated as 100 percent and either of the following are met: (1) there is additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or (2) he/she is permanently housebound because of service-connected disability or disabilities. 38 U.S.C. § 1114(s). The Veteran is currently service connected at 70 percent for posttraumatic stress disorder (PTSD) and has been so rated since October 1998. There are no additional service-connected disabilities. Initially, the Board notes that the Veteran's service-connected disabilities have not resulted in his being 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 5 degrees or less; nor is he a patient in a nursing home because of mental or physical incapacity. Regarding the question of whether the Veteran requires the regular aid and attendance of another person, he submitted a questionnaire completed by a private physician in May 2018. It was noted that the Veteran could feed himself, did not require assistance in bathing and hygiene, did not need nursing home care, and could manage his own finances. It was noted that the Veteran was unable to prepare his own meals. Regarding the ailments that impacted his ability to perform self-care, the physician only noted a right ankle disability. The Veteran's right ankle is not service connected and therefore should not be considered when determining if he is entitled to SMC. The Veteran has submitted no additional documentation explaining why he should receive SMC as a result of his service-connected PTSD. The Veteran's most recent PTSD VA examination was conducted in March 1999 and indicated that he attended a weekly therapy group. He stated that he stopped working in September 1998 due to the anxiety related to his PTSD and had not started a new job. There is nothing in this examination report that indicated the Veteran was unable to leave the house or to physically care for himself. Based on the foregoing, the Board finds that the Veteran is not housebound. He is capable of feeding himself, does not require assistance in bathing and hygiene, does not need nursing home care, and can manage his own finances. There is no indication that he requires aid and attendance as a result of his service-connected PTSD. The Board acknowledges that the Veteran experiences impairment in various activities due to his service-connected PTSD. However, this impairment is considered in the Veteran's current 70 percent PTSD rating. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to SMC based on the need for the regular aid and attendance of another person or by reason of being housebound is not warranted. 38 U.S.C. § 5107(b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the appeal must be denied. Readjudication New and Relevant Evidence The Veteran initially filed a claim for an unspecified skin condition in July 1980. At that time, the evidence showed that he had been diagnosed with folliculitis, intertrigo, and lichen simplex chronicus. In a December 1980 rating decision, the RO denied service connection, finding that there was no link between those skin conditions and service. In April 1986, the Veteran filed a claim for chloracne and a lipoma of the left upper extremity. The RO denied service connection, finding that there was no evidence of a current disability involving chloracne and that there was no link between the lipoma and service. The Veteran filed requests to reopen the previously denied claims for a skin disability on multiple occasions. Most recently, in a December 2004 rating decision, the RO denied service connection for folliculitis, intertrigo, and lichen simplex chronicus because new and material evidence had not been received showing a link between those disabilities and service. In December 2019, the Veteran filed a supplemental claim for service connection for a skin disability. He has asserted that his current skin disability is related to in-service exposure to Agent Orange. In January 2020, the AOJ determined that the Veteran had been exposed to herbicides during his naval service and conceded exposure. That evidence was not already of record and may prove or disprove entitlement. Therefore, readjudication of the claim is warranted. REASONS FOR REMAND Service Connection Skin Disability The Board finds that additional development is required to correct a duty to assist error that occurred prior to the March 2020 rating decision on appeal. The AOJ did not provide the Veteran with a competent VA examination prior to the March 2020 rating decision on appeal. The Veteran asserts that his various skin conditions are related to his active service. Specifically, the Veteran asserts that his skin conditions are due to his exposure to Agent Orange. The Veteran was afforded a VA examination in July 1986. This examination discussed the Veteran's claimed persistent skin rash that he indicated began in 1970. This examination also discussed lipoma (benign tumors of fat) that were noted on the Veteran's arm and seemed to be growing. The July 1986 VA examiner did not provide a diagnosis with regard to the Veteran's rash. As the Veteran has claimed both chloracne and eczema, it was unclear as to which ailment the examiner was discussing. Furthermore, the examination report failed to include an opinion as to whether the skin rash was related to the Veteran's exposure to Agent Orange or otherwise related to his time in service. Therefore, the Board finds this VA examination to be inadequate for rating purposes. In light of the Veteran's persistent complaints of skin issues, as well as the history of benign skin growths; the Board finds that the Veteran should be afforded a new VA examination to determine the nature and etiology of any currently present skin conditions. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: Schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the nature and etiology of any currently present skin disability. The claims file must be made available to, and reviewed by, the examiner. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or better) that any diagnosed skin disability is etiologically related to his active service, to include exposure to Agent Orange. A rationale for all opinions expressed must be provided. Sonja A. Mishalanie Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.