Citation Nr: 21012013 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 15-22 775A DATE: March 3, 2021 ORDER Entitlement to service connection for a respiratory condition is denied. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to tinnitus is denied. Entitlement to automobile and adaptive equipment or for adaptive equipment only is denied. Entitlement to special monthly compensation (SMC) based on aid and attendance is denied. FINDINGS OF FACT 1. The Veteran’s pulmonary nodules did not manifest during active service and are not otherwise related to active service. 2. The Veteran’s depression and/or alcohol use disorders did not manifest during active service, are not otherwise causally related to active service, and are not caused or aggravated by service-connected tinnitus. 3. The Veteran does not, due to service connected disorders, suffer from the loss or permanent loss of use of one or both feet; or loss or permanent loss of use of one or both hands; or permanent impairment of vision of both eyes; or severe burn injury; or amyotrophic lateral sclerosis; or ankylosis of a knee or hip, by reason of service-connected disability. 4. For the period on review, the Veteran has not required the regular need for aid and attendance. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a respiratory condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include as secondary to tinnitus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The eligibility criteria for financial assistance in acquiring an automobile or other conveyance or special adaptive equipment have not been met. 38 U.S.C. §§ 3901, 3902, 5107(a); 38 C.F.R. §§ 3.159, 3.808, 4.63. 4. The criteria for entitlement to SMC based on aid and attendance have not been met. 38 U.S.C. §§ 1114(k), 5107; 38 C.F.R. §§ 3.102, 3.350(a)(2), 4.63. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1961 to January 1964. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from May 2013 and July 2014 rating decisions. The Board remanded these matters in December 2017 and April 2019. The previously ordered development having been performed (to include record development and the obtaining of VA examinations and opinions), the matters may proceed to adjudication. Service Connection To establish direct service connection, there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disability that is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. Certain chronic diseases may be presumed to have been incurred in or aggravated by service if manifested to a compensable degree within one year of discharge from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307(d), 3.309(a). A showing of chronicity requires a combination of manifestations sufficient to identify a disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” 38 C.F.R. § 3.303(b). When a disease listed at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was shown in service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Id.; Savage v. Gober, 10 Vet. App. 488, 495-96 (1997); Walker v. Shinseki, 708 F.3d 1331, 1336, 1339 (Fed. Cir. 2013) (explaining that “shown as such in service” means “clearly diagnosed beyond legitimate question”). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker, 708 F.3d at 1338-39. Generally, a claimant has the responsibility to present and support a claim for benefits. All information, lay evidence and medical evidence in a case is to be considered by the Board in deciding the claim. When there is an approximate balance of positive and negative evidence regarding any material issue, the claimant is to be given the benefit of the doubt. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue.”). The Board has an obligation to provide reasons and bases supporting its decision, but there is no need to discuss, in detail, every piece of evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board’s analysis is to focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). 1. Entitlement to service connection for a respiratory condition is denied. The Veteran seeks service connection for a respiratory condition, which he contends is related to vehicle fume exposure during active service. Review of the service treatment records shows no diagnosis of, complaints of, or treatment for a respiratory condition. No breathing problems were noted at separation in 1964. There are no records documenting any complaints regarding any respiratory conditions during the four decades thereafter. On VA examination in January 2020, the Veteran was diagnosed with 3 lower left lobe pulmonary nodules and multiple smaller nodules scattered throughout both lungs, per a CT scan, but no other diagnosis was confirmed. Pulmonary function testing was performed, with December 2019 FEV-1 testing noted as most accurately reflecting the Veteran’s level of disability as being 88 percent predicted. The condition was noted not to impact the Veteran’s ability to work. The examiner reviewed the record, and noted the Veteran sought service connection as related to exposure to fumes while working as a vehicle mechanic during service. The examiner noted that the condition was first discovered in 2015, and the service treatment records did not show any diagnosed respiratory condition during active service or during the separation examination. The examiner explained that there are two types of pulmonary nodules, malignant and benign, and discussed the various causes of such. After the discussion of the multitude of potential causes, the examiner concluded that the condition was less likely than not related to active service. On review, the Board concludes that, while the Veteran has a current diagnosis of pulmonary nodules, and the claimed exposure to fumes is likely to have occurred, there is no credible link to the claimed incurrence. The preponderance of the evidence weighs against finding that the Veteran’s diagnosis of pulmonary nodules began during service or is otherwise related to an in-service injury, event, or disease. As noted on examination, there was no evidence of the claimed disability until 2015, over decades after his separation from service. When considering whether or not to grant a claim for service connection, the Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disorder at issue. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Forshey v. West, 12 Vet. App. 71, 74 (1998), aff’d sub nom. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (the definition of evidence encompasses “negative evidence” which tends to disprove the existence of an alleged fact, i.e., the lack of evidence is itself evidence). In the present case, the absence of treatment or documented complaints for respiratory conditions for decades following separation from active duty tends to indicate that this condition had not been chronic since separation from the military. Moreover, his claim of having breathing problems during service is contradicted by his report of medical history at separation, where he reported a number of issues but did not report breathing problems. Moreover, the Veteran is not competent to provide a diagnosis in this case or determine that any symptoms previously experienced were manifestations of pulmonary nodules. The issue of etiology of the condition is medically complex and is a question for a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The January 2020 VA examiner opined that the Veteran’s pulmonary nodules were not at least as likely as not related to an in-service injury, event, or disease, including the claimed fume exposure. The examiner’s opinion is probative, and is based on an accurate medical history and provides an explanation that contains clear conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). This opinion being the sole competent opinion of record (notably, despite being represented by an attorney, the Veteran’s representative submitted no evidence or argument as to this issue), such is given dispositive weight in this case on the question of medical nexus. Service connection for a respiratory condition, to include pulmonary nodules, is denied for lack of a medical nexus to the claimed in-service incurrence. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. Gilbert, 1 Vet. App. at 58. Accordingly, the Veteran’s claim for service connection for a respiratory disorder is denied. 2. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to tinnitus is denied. The Veteran seeks service connection for an acquired psychiatric disorder, alleging that this condition is secondary to his service-connected tinnitus. Service connection for certain identified chronic diseases, including psychoses, may also be established on a presumptive basis by showing that such a disease manifested itself to a compensable degree within a prescribed period following separation from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a). The term “psychosis” means any of the following disorders listed in the DSM-5: (a) Brief Psychotic Disorder; (b) Delusional Disorder; (c) Psychotic Disorder Due to Another Medical Condition; (d) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder; (e) Schizoaffective Disorder; (f) Schizophrenia; (g) Schizophreniform Disorder; and (h) Substance/Medication-Induced Psychotic Disorder. 38 C.F.R. § 3.384. However, the presumption of service connection for chronic diseases under 38 C.F.R. § 3.309(a) does not apply in this case because the record does not show any diagnosis of a psychosis during service or within one year of the Veteran’s separation from service. The enumerated diseases under 3.309 include psychoses, but do not include depression alcohol use disorders that have been diagnosed in this case. As such, there is no presumption of service connection for any of the conditions at issue. The Veteran’s service treatment and personnel records do not reflect any behavioral issues during his time on active duty. His separation examination notes no psychological problems. There are no references to a mental health condition until many years after separation; 2012 is the first reference to any treatment of record. In July 2012, the Veteran reported depression and passive suicidal ideation, as noted in a VA treatment note with a psychologist. The Veteran was noted to have normal clarify, rate, volume of speech, and no difficulties with cognition, oral, or written communication were observed or reported. The Veteran reported a brief history of depression in 1977 after divorce from his first wife, with recovery after that time. He reported alcohol abuse since 1977 with blackouts and tremors. He reported current depressive symptoms beginning in 1995 after his second divorce. Stressors were noted to be finances, daughter going through divorce, recent breakup with his girlfriend, prior divorces, and a history of alcohol abuse and dependence. He asked “help me understand why my friends are service connected an I am not. I need to know why my wives left me.” He also reported childhood sexual abuse. In a May 2016 private disability benefits questionnaire (DBQ), the clinician diagnosed the Veteran with depressive disorder due to another medical condition with depressed features. The Veteran reported that his tinnitus causes mood issues, low energy, low motivation, irritability, difficulty with communications, loss of interest in hobbies, and the Veteran reported dealing with it for so long. He reported his depression and anxiety were not present prior to military service. The clinician opined that the Veteran’s tinnitus was more than likely causing his unspecified depressive disorder and preventing him from maintaining substantially gainful employment. The clinician cited to literature showing “the existence of neural circuits that are activated both in depression and tinnitus,” and detailing “the association between tinnitus and comorbid psychological disorders,” noting the “consequences of tinnitus include emotional effects, reduced involvement in work-related activities, interpersonal problems and decreased opportunities to engage in previously enjoyable activities.” The clinician noted that the tinnitus was more likely than not causing his unspecified depressive disorder and preventing him from maintaining substantially gainful employment. In a November 2019 VA examination, the examiner noted a diagnosis of unspecified depressive disorder. The examiner noted the Veteran had difficulty comprehending questions a few times; the examiner noted the Veteran presented as depressed, with his depression related to fixed income and progressively worsening physical problems. The examiner noted there was not a pattern of consistent depression shown in the records; he was diagnosed with depression NOS in 2012, and the May 2016 DBQ was noted, but there were negative screens for depression in VA treatment notes dated August 2015, May 2016, and December 2017. The examiner critiqued the study cited in the private May 2016 DBQ to link tinnitus to depression, noting there was not consistency of results in different measures used in the study, and not enough clear evidence in this case to claim service connection for depressive disorder. Subsequently, in a November 2020 VA examination conducted by approved video telehealth, the examiner noted having performed a review of the VA e-folder. The examiner noted a diagnosis of alcohol use disorder that was mild and continuous; the Veteran reported that he did not start to consume alcohol until well after he was discharged from the Army. The Veteran reported tinnitus as a “hum in both ears” and, when asked if it bothered him, reported “Hell, I don’t know. Think it’s just part of getting old.” He described his mood as “funny all the time, happy” and when asked if he was ever depressed, he denied ever being depressed at any time in his life, and he commented on national politics. The examiner noted that depression was not found on examination, despite noting the prior diagnoses of depression by other clinicians. The examiner opined that it was less likely than not that depression (not found) was aggravated beyond its natural progression by tinnitus. The examiner opined that it was less likely than not that alcohol use disorder was aggravated beyond its natural progression by tinnitus. The examiner opined that the depression diagnoses of record were not confirmed on examination as the Veteran denied such. The examiner noted that there was no logical connection between alcohol use disorder and tinnitus and that tinnitus did not aggravate the Veteran’s alcohol use disorder. After careful consideration of the claims file, the Board concludes that the preponderance of the evidence is against finding that any acquired psychiatric disorder is related to service or service-connected tinnitus. Direct service connection for alcohol abuse is precluded by law; therefore, service connection for alcohol dependence is not warranted. 38 C.F.R. § 3.301. Regarding secondary service connection, the evidence of record does not suggest any credible link between the alcohol use disorder and tinnitus; the sole medical opinion on this point opined there was no causation or aggravation related to tinnitus. See November 2020 VA examination. The examiner considered the evidence of record, including the Veteran’s statements, prior to forming this opinion. The examiner supported their opinion with a sufficient rationale, and this opinion is accepted as dispositive on this point. Regarding a claim for depressive disorder, there is a conflict as to whether the Veteran had a current diagnosis of a depressive disorder during the pendency of the appeal. However, even if so, service connection for such is also not warranted. Review of the record, to include the VA examinations and private DBQ, and more particularly the relevant treatment notes for the depressive episode from July 2012 does not identify any in-service incurrence or service-connected condition related to the depressive episode or diagnosis. Accordingly, direct service connection is not warranted. Moreover, service connection for a depressive disorder as secondary to tinnitus is not warranted, as the credible evidence does not implicate tinnitus as a causal or aggravating factor. The treatment records available for review show a history of various events triggering depression (two divorces, a breakup with girlfriend, financial difficulty, childhood abuse) with no mention of tinnitus as a factor. On VA examination in November 2020, the examiner did not confirm a current diagnosis of a depressive disorder and opined that any depressive disorder was not caused or aggravated by tinnitus. The examiner considered the evidence of record, including the Veteran’s statements denying depression, prior to forming this opinion. The examiner supported their opinion with a sufficient rationale, and this opinion is accepted as the most credible and objective evidence of record. The May 2016 private opinion submitted by the Veteran was considered but is rejected as lacking objectivity or credibility. The opinion appears to be based on the Veteran’s self-reported medical history, which is inconsistent with treatment of record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). The clinician did not note having performed an in-person or video examination. Moreover, although generalized research was cited to draw a link between the disabilities, specifics and severity of the Veteran’s condition or the course of the alleged aggravation/causation were not discussed. The Veteran did not report, and the record does not show, a correlation between the claimed onset of tinnitus (service) and his depressive episodes which happened years after. Although the theory that tinnitus could aggravate depression could warrant further investigation (there are questions raised in the November 2019 VA examination as to the reliability of the studies citied by the private clinician), there is no rationale in the opinion showing why such theory of causation or aggravation would apply to the Veteran’s documented depressive episode. There were no specific complaints of tinnitus voiced by the Veteran when seeking treatment or any other time of record when recounting prior episodes. Moreover, the private opinion seems to exaggerate the severity of the Veteran’s tinnitus: he reported elsewhere that he “doesn’t know if it bothered him,” (See November 2020 VA examination) and that it “does not impact ordinary conditions of daily life” (see July 2018 VA examination). As such, the private clinician’s conclusion that the Veteran’s tinnitus was causing his unspecified depressive disorder and preventing him from maintaining substantially gainful employment is considered unsupported by objective evidence. The critique of the November 2019 VA examination and the findings of the November 2020 VA examination are accepted over the May 2016 private clinician’s findings as being more credible and more objective. The Veteran’s claims of any link between tinnitus and depression are not afforded any weight. First, the Veteran generally lacks credibility, having given varied statements of fact regarding a variety of relevant issues, to include whether he suffered from depression and suicidal ideation, and whether his tinnitus began in service or with old age. See 2012 VA treatment records (reporting suicidal ideation and depression); April 2013 VA examination (noting onset of tinnitus in service); May 2016 DBQ (reporting tinnitus causing depression); November 2020 VA examination (reporting no depression or suicidal ideation at any time and relating tinnitus to getting old). Moreover, credibility aside, although lay witnesses are competent to provide evidence regarding matters that can be perceived by the senses, they are not competent to provide an opinion concerning the etiology of complex medical issues. See Jandreau, 492 F.3d 1372 (lay testimony is competent to establish the presence of observable symptomatology). As such, while the Veteran is competent to report symptoms arising from his acquired psychiatric disorder, he is not competent to offer an opinion as to its cause. The weight of the evidence does not establish that the Veteran’s acquired psychiatric disorder is related to service or another service-connected disability. Since the preponderance of the evidence is against the claim, under any theory, the benefit of the doubt rule does not apply. Gilbert, 1 Vet. App. at 58. Accordingly, the Veteran’s claim for service connection for an acquired psychiatric disorder, claimed as secondary to service-connected tinnitus, is denied. 3. Entitlement to automobile and adaptive equipment or for adaptive equipment only is denied. In order to establish entitlement to an automobile and adaptive equipment under 38 U.S.C. § 3901, the evidence must demonstrate service-connected disability (or disabilities) resulting in the loss, or permanent loss of use, of at least one foot or a hand; permanent impairment of vision in both eyes, resulting in (1) vision of 20/200 or less in the better eye with corrective glasses, or, (2) vision of 20/200 or better, if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of the visual field subtends an angular distance no greater than twenty degrees in the better eye; a severe burn injury, where deep partial thickness or full thickness burns result in scar formation that causes contractures and limits motion of one or more extremities or the trunk and precludes effective operation of an automobile; or amyotrophic lateral sclerosis. 38C.F.R. § 3.808 (a), (b). A veteran is also entitled to adaptive equipment if he has ankylosis of at least one knee or one hip due to service-connected disability. 38U.S.C. § 3902 (b)(2); 38C.F.R. § 3.808 (b)(6). The term “permanent loss of use” is not defined in 38 C.F.R. § 3.808. The term “loss of use of a hand or foot” is defined as existing when “no effective function remains other than that which would be equally well served by an amputation stump at the site of election below the elbow or knee with the use of a suitable prosthetic appliance.” 38 C.F.R. §§ 3.350 (a)(2), 4.3. The determination as to whether such loss of use exists will be made on the basis of the actual remaining function, whether the acts of grasping, manipulation, etc., in the case of the hand, or balance, propulsion, etc., in the case of a foot, could be accomplished equally well by an amputation stump with prosthesis. Id. Examples given are extremely unfavorable complete ankylosis of the knee, complete ankylosis of two major joints of an extremity, shortening of the lower extremity of 3 inches or more, complete paralysis of the external popliteal nerve, and consequent foot drop accompanied by characteristic organic changes. The Veteran does not have the qualifying service-connected disability for this benefit. The benefit sought requires having clearly enumerated qualifying service-connected disabilities, as listed above. The Veteran is service connected for service connected for bilateral hearing loss evaluated as 20 percent disabling, tinnitus evaluated as 10 percent disabling, right knee arthritis evaluated as 10 percent disabling, left knee arthritis evaluated as 10 percent disabling, right carpal tunnel syndrome evaluated as 10 percent disabling, and left carpal tunnel syndrome evaluated as 10 percent disabling, and has a combined service-connected evaluation of 60 percent. No specific arguments justifying entitlement to the benefit sought are advanced on appeal, and review does not show competent evidence of record that any of the service-connected conditions have resulted in loss of use of any foot or hand. See November 2020 VA Medical Opinion (noting the Veteran continues to work on classic cars). As such, the criteria for financial assistance in acquiring an automobile or other conveyance or special adaptive equipment are not met, and the appeal for these benefits is denied. 4. Entitlement to special monthly compensation (SMC) based on aid and attendance is denied. Special monthly compensation is payable if a veteran, 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). Here, the Veteran is service connected for service connected for bilateral hearing loss evaluated as 20 percent disabling, tinnitus evaluated as 10 percent disabling, right knee arthritis evaluated as 10 percent disabling, left knee arthritis evaluated as 10 percent disabling, right carpal tunnel syndrome evaluated as 10 percent disabling, and left carpal tunnel syndrome evaluated as 10 percent disabling, and has a combined service-connected evaluation of 60 percent. The assigned ratings to the service-connected disabilities are not suggestive of needing aid and attendance, and the Veteran has not suffered the anatomical loss or loss of use of both feet, or of one hand and one foot; is not blind in both eyes, with visual acuity of 5/200 or less; nor is he permanently bedridden. Instead he has claimed that he is need of regular aid and attendance. The criteria for determining that a veteran is so helpless as to be in need of “regular aid and attendance” are contained in 38 C.F.R. § 3.352 (a). Those criteria include: (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). On review, the record does not credibly indicate any instances where the Veteran was unable to dress or undress himself or keep himself presentable. He is consistently noted as being able to attend to his activities of daily living, including dressing, feeding, and cleaning himself. The Veteran does not have a special prothetic and does not have any orthopedic appliance that needs frequent adjustment. There is no indication the Veteran has been incapacitated by any service-connected disability on a regular basis. See November 2020 VA Medical Opinion (noting the Veteran continues to work on classic cars). No specific argument has been advanced on appeal as to this benefit, and the weight of credible evidence in the record does not indicate the Veteran met the criteria to show the need for aid and attendance. Therefore, the entitlement to SMC based on need for aid and attendance is not warranted and the appeal is denied. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. C. KING, 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.