Citation Nr: 21012858 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 14-31 912A DATE: March 5, 2021 ORDER Service connection for a respiratory disorder, on the basis of substitution, is denied. Service connection for vertigo, on the basis of substitution, is denied. Service connection for a dental disorder, on the basis of substitution, is granted. Special monthly compensation (SMC) based on the need for aid and attendance, on the basis of substitution, is denied. FINDINGS OF FACT 1. The Veteran’s respiratory disorder did not manifest in service or for many years thereafter and is not otherwise causally related to his military service. 2. Vertigo has not been present during the period of the claim. 3. The probative, competent evidence is at least in relative equipoise as to whether the Veteran’s dental disorder was caused or aggravated by his service-connected laryngeal cancer. 4. The Veteran’s service-connected disabilities did not result in the anatomical loss or loss of use of both feet or one hand and one foot, or blindness in both eyes, or render him permanently bedridden or so helpless as to have been in need of regular aid and attendance CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a respiratory disorder were not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for establishing entitlement to service connection for vertigo were not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for establishing entitlement to service connection for a dental disorder for VA compensation purposes were met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.150. 4. The criteria for entitlement to SMC based on the need for regular aid and attendance were not met. 38 U.S.C. §§ 1114, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active service in the United States Air Force from August 1960 to May 1964. Unfortunately, the Veteran passed away in May 2020. The appellant is the Veteran’s surviving child and was substituted with regard to the claims on appeal. In December 2019, the Board remanded the case for additional development. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). Additional disability resulting from the aggravation of a nonservice-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310 (b). See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (finding service connection presupposes a current diagnosis of the condition claimed). The requirement that a current disability be present is satisfied, “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim... even though the disability resolves prior to the Secretary’s adjudication of the claim.” McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). 1. Service connection for a respiratory disorder. The Veteran believed that he had developed a respiratory disorder as a result of his in-service exposure to asbestos. Factual Background The Veteran’s service treatment records are silent as to treatment for or a diagnosis of a respiratory disorder. A January 1999 chest x-ray revealed extensive infiltrates seen throughout both lung fields with incomplete visualization of the hemidiaphragms and costophrenic angles compatible with underlying effusion. The medical records also noted a past medical history that was remarkable for chronic obstructive pulmonary disease. A February 2008 computed tomography scan of the chest showed a lower paratracheal lymph node, no evidence of pericardial or pleural effusion, and emphysema of the mid and upper lungs. A July 2008 chest x-ray revealed mild left pleural effusion. The lungs were clear with no infiltrates. In a December 2009 statement, the Veteran’s former representative reported that his military occupational specialty as a water and waste specialist exposed him to asbestos, herbicides, insecticides, malathion, and cyanide. The representative also stated that the Veteran was found to have mild left pleural effusion and lung apices which revealed severe centrilobular emphysematous changes in August 2009. In June 2010, the Veteran reported in-service exposure to quinine, cyanide, myatheylene, chlorine, soda ash, asbestos, campeccina, trimesoprine, and Agent Orange. He also reported that he experienced shortness of breath and a lung disorder that he believed were secondary to his emphysema and service-connected laryngeal throat cancer. In October 2010, the Veteran was afforded a VA respiratory examination. He reported shortness of breath that started two months prior. His primary care doctor prescribed an inhaler, which improved his symptoms. A September 2010 chest x-ray did not show any evidence of infiltrates or pleural effusion. A September 2010 computed tomography scan of the thorax revealed mild to moderate emphysematous changes noted throughout the lungs, no pulmonary infiltrates, no pleural effusions, and no pulmonary nodules/masses. The diagnosis was emphysema. The examiner noted that there was no objective evidence of asbestosis. The examiner also indicated that there was mild left pleural effusion, centrilobular emphysema due to asbestos exposure. The examiner opined that the Veteran’s emphysema was less likely as not caused asbestos exposure during active duty because the service treatment records were silent for any respiratory symptoms. A March 2011 private treatment record from A.R., M.D. noted that the Veteran was a heavy smoker who stopped smoking approximately 12 years prior. The Veteran reported that he had been exposed to asbestos during service and Dr. R. noted that the Veteran worked with insulating pumps and reported dyspnea on exertion, cough productive of white phlegm, and wheezing. The impression was chronic obstructive pulmonary disease, history of laryngeal cancer, rule out alpha-1 antitrypsin deficiency, valvular heart disease, coronary artery disease, and a history of asbestos exposure. A June 2011 private medical record showed that the Veteran presented to the emergency room reporting shortness of breath. The diagnoses were severe COPD and shortness of breath. The discharge summary indicated that the Veteran had a history of asbestosis. The admission noted indicated that the Veteran had a long history of pulmonary fibrosis, lung carcinoma, and laryngeal cancer. A chest x-ray showed that his lungs were mildly hyperinflated which might have reflected a component of COPD. No gross focal infiltrates were seen. A computed tomography scan of the chest revealed extensive emphysema. The Veteran submitted a February 2012 medical record review completed by H.W., M.D., who is Board certified in anatomical pathology, clinical pathology, and addiction medicine. Dr. W. noted that a July 2011 chest x-ray showed the presence of small opacities in the lower lung zones consistent with pneumoconiosis of the asbestos variety. The x-ray also showed pleural plaques and calcification on both sides of the diaphragm. Dr. G. concluded that the Veteran inhaled significant amounts of particulate asbestos during the 1960s and 1970s and that his x-rays established the presence of bilateral asbestos related interstitial disease and bilateral asbestos related pleural disease. In March 2012, the Veteran stated that he developed mesothelioma, emphysema, lung cancer, COPD, pleural effusion, and asbestosis, all of which he believed were results of his asbestos exposure. A March 2012 private medical record showed that the Veteran presented with complaints of “asbestos cancer.” The doctor reviewed the Veteran’s records and found that the Veteran’s laryngeal cancer was successfully treated in 2008 and that he was not known to have any other malignancy. It was noted that the Veteran was diagnosed with asbestosis. A chest x-ray revealed pleural plaques along the diaphragm and left chest wall. The Veteran was found to have dyspnea with a history of asbestosis, obstructive lung disease, and chronic hypoxemic respiratory failure. In June 2012, the Veteran was found to have COPD, chronic obstructive bronchitis, chronic respiratory failure, asbestos exposure, and abnormal chest imaging. It was noted that his chest x-ray showed asbestos-related pleural disease. By history, he had interstitial lung disease related to asbestos. A July 2012 VA pulmonary consult noted the Veteran’s history of COPD, asbestos exposure, and laryngeal cancer. The Veteran believed that he developed mesothelioma as a result of asbestos and that he had lung cancer, but recent imaging did not show any evidence of asbestos related disease, mesothelioma, or active cancer. There was evidence of emphysema. The Veteran was convinced that asbestos was the reason he needed two heart valve replacement and also the reason several of his family members had asthma. He believed that there was a conspiracy to hide information from him and that the doctors were trying to poison him. The doctor strongly recommended a psychological evaluation due to suspected dementia and paranoia. The Veteran was afforded another VA examination in September 2012. The diagnoses were emphysema, COPD, and laryngeal cancer. The Veteran reported that he was exposed to asbestos during service during the 1960s. He was diagnosed with laryngeal cancer in 2009 and was told that he had emphysema and pleural effusion around that time. The Veteran’s pleural effusion resolved. He reported that he was diagnosed in February 2012 with mesothelioma due to asbestos exposure. The examination report included the results of a June 2011 chest x-ray which showed clear lungs. A May 2012 computed tomography scan showed moderate to severe centrilobular emphysema, mild right atypical scarring, mild dependent atelectasis, tiny pulmonary nodules, small secretions right posterior wall of the trachea, and no pleural effusion. A September 2010 computed tomography scan of the thorax showed mild to moderate emphysematous changes and no pulmonary infiltrates or pleural effusions. The examiner determined that there was no objective evidence of mesothelioma related asbestos exposure. The examiner stated that the Veteran’s claims file, including the most recent computed tomography scan of the chest, did not show pulmonary congestion/consolidation or pleural effusion. A December 2015 pulmonary consult noted that the Veteran had been recently treated in the emergency department due to complaints of chest and lower abdominal pain. During the pulmonary consult, he demanded oxygen although a recent test showed that he did not require oxygen. A December 2015 chest x-ray report included a diagnostic impression of COPD and malignant tumor of the lung. An April 2016 private treatment record noted that the Veteran was exposed to asbestos during service and that he was a previous tobacco user. His diagnoses included COPD. May 2016 clinical notes showed that his doctor questioned the Veteran’s report that he had lung cancer. The following month he told his doctor that he had proof that he had lung cancer. In June 2016, he was treated for acute bronchitis. In August 2016, the Veteran reported regular use of marijuana for many years. In October 2016, the Veteran requested treatment for asbestosis and continued to report a history of lung cancer, but his doctor noted that the Veteran had not provided any pathology reports to support diagnoses of asbestosis or lung cancer. The Veteran underwent another VA examination in May 2018. The Veteran reported that he received a diagnosis of mesothelioma. He reported that in 2012 he was told that he had asbestosis and was placed on oxygen. The Veteran stated that a subsequent biopsy revealed pleural effusion, emphysema, and mesothelioma. He was unable to provide any additional details about his claimed mesothelioma. The Veteran believed that he had cancer all over his body and that he passed the cancer on to his children and grandchildren. The examiner noted that a review of the medical records did not show any diagnosis of or treatment for mesothelioma. A December 2014 VA pulmonary note indicated that there was no evidence of mesothelioma. In July 2018, the Veteran was treated for acute hypercapnic respiratory failure, pneumonia, COPD exacerbation, and a history of laryngeal cancer. A February 2019 private medical record indicated that the Veteran had a history of throat cancer, asbestosis, and exposure to asbestos. He continued to report that he was diagnosed with mesothelioma as a result of his asbestos exposure. A January 2019 VA psychiatric note showed that the Veteran continued to believe that he had cancer and that his doctors were not doing enough to treat it. He referred to his COPD as cancer and stated that it was caused by exposure to asbestos. He also continued to report that his children and grandchildren had breathing problems because of him. The provider noted that the Veteran referred to all of his medical problems as cancer because he didn’t fully understand the relevant medical terminology. The evidence of record includes an August 2019 VA medical opinion that the Veteran’s respiratory disorder, to include emphysema, was less likely than not incurred in or caused by service. The rationale was that the examiner was unable to find any medical care for emphysema or any other respiratory disorder that was at least as likely as not incurred in or caused by service. There was no objective medical evidence establishing a direct cause and effect relationship between exposure to asbestos, herbicides, insecticides, malathion, cyanide, methylene, chlorine, soda ash, and any other chemical while working as a water and waste specialist during service. A February 2020 VA treatment record noted that a chest x-ray showed left lower lobe pleural fluid, atelectasis, or infiltrate. A computed tomography scan showed no pulmonary embolism, severe emphysema, and small to moderate left pleural effusion likely from atelectasis. The diagnosis was acute on chronic respiratory failure likely secondary to COPD and a component of reduced ejection fraction. During a February 2020 cardiology consult, the Veteran continued to report that he had mesothelioma and that his shortness of breath was related to asbestos exposure during service. The cardiologist noted that the medical records did not indicate such findings. A VA medical opinion was provided in March 2020. The examiner reviewed the Veteran’s medical records, including the multiple chest x-rays and lung computed tomography scans over the last 20 years. Notably, none of the records showed evidence of pulmonary asbestosis or mesothelioma of the pleura or peritoneum. The examiner noted that there was one exception, a note provided by Dr. Wells. All of the other medical records demonstrate that the Veteran had emphysema/COPD without any evidence of asbestosis or mesothelioma. Moreover, pulmonary function tests from September 2010 and September 2012 showed severe emphysema. The examiner addressed the June 2011 private medical record indicating that the Veteran had pulmonary fibrosis and asbestosis. The examiner explained that the Veteran was admitted for respiratory failure probably triggered by an upper respiratory infection, something very common among patients with advanced COPD. It was noted that the computed tomography scan of the chest performed during the admission completely contradicted the diagnosis of pulmonary fibrosis and asbestosis because it was interpreted as severe emphysema with no mention of pulmonary fibrosis. The examiner concluded that the private doctor diagnosed pulmonary fibrosis and asbestosis based on the Veteran’s reported history and ignored the objective findings. The examiner also addressed the February 2012 record review report completed by Dr. W. indicating that a July 2011 chest x-ray showed small opacities in the lungs consistent with pneumoconiosis of the asbestos variety. The examiner found that Dr. W.’s interpretation was strange given that his medical specialty did not involve face to face with patients and that Dr. W. was not a radiologist, but an anatomical and clinical pathologist. It was noted that anatomical and clinical pathologists specialized in laboratory type of medicine, as well as autopsies and biopsies. However, they were not trained to interpret x-rays. The examiner also questioned Dr. W.’s interpretation because asbestosis does not improve and disappear, and all of the subsequent x-rays and computed tomography scans completed after July 2011 did not show asbestosis. Therefore, the absence of asbestosis findings on the subsequent imaging studies indicated that what was observed on the July 2011 x-ray was something other than asbestosis. The examiner also addressed the conflicting evidence of record concerning the Veteran’s smoking history. It was noted that a January 1999 medical record noted that the Veteran recently stopped smoking in January 1999. A March 2011 medical record noted that he stopped smoking 12 years ago. Therefore, the examiner concluded that the Veteran was a heavy smoker for a minimum of 30 years, which the examiner concluded explained his severe respiratory problems. Based on the above, the examiner concluded that it was less likely than not that the Veteran suffered from an asbestos related lung disease. The examiner further explained that there was no radiological evidence of any type of asbestos related lung or pleural condition on any of the lung computed tomography scans or chest x-rays performed since 2008. Because asbestos is a condition that remains present in the lung tissue for the remaining of a person’s life, the radiological findings were objective evidence of the absence of an asbestos pulmonary or pleural disorder. The examiner also noted that the radiological studies were interpreted by at least 10 different board-certified radiologists from different hospitals and different cities. In November 2020, another examiner stated that they concurred with the March 2020 VA examiner and noted that the earlier opinion completely and extensively addressed the issue. The November 2020 examiner noted that the February 2020 chest computed tomography scan did not show asbestos-related pleural disease. Instead it revealed severe emphysema. Additionally, it revealed right and left pleural effusion, which suggested right heart failure. Analysis Upon consideration of the evidence, the Board finds that the preponderance of the evidence is against finding that the Veteran’s respiratory disorder is related to service, to include his claimed in-service exposure to asbestos. Initially, the Board finds that the competent, credible, and probative evidence establishes that the Veteran’s diagnosed respiratory disorder was COPD/emphysema and that the objective evidence does not show that the Veteran had an asbestos related respiratory disorder at any point during the appeal period. The Board affords significant probative value to the March 2020 VA medical opinion as it was supported by adequate rationale and a thorough review of the evidence. Specifically, the March 2020 VA examiner fully addressed the opposing medical findings that the Veteran had an asbestos related lung disorder and countered such findings with the overwhelming objective evidence of record. To the extent that the Veteran believed and contended that his respiratory disorder was related to service, the Board finds that such an opinion is more suited to the realm of medical, rather than lay, expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). There is no indication that the Veteran had any specialized education, training, or experience in determining the medical cause of respiratory medical conditions. Accordingly, the Board finds that the requirement of a causal link between service and the diagnosed disability has not been met. 2. Service connection for vertigo. An August 2010 VA examination for ear pain noted that the Veteran experienced dizziness in the distant past, but that it had resolved. He did not have vertigo at that time. A September 2012 VA aid and attendance examination report noted that the Veteran experienced dizziness less than weekly. An April 2017 VA treatment record indicated occasional dizziness associated with his heart. During an April 2018 VA audiological examination, the Veteran denied a history of dizziness. An April 2019 VA nursing noted indicated that the Veteran needed a consult for dizziness. All other VA treatment records showed that the Veteran denied dizziness. A November 2020 VA examination and medical opinion found that there was no objective evidence of a diagnosis of vertigo that was incurred in or caused by service. The examiner stated that the medical records were silent for the Veteran’s claimed vertigo or any associated condition, including related to the ear trauma during service. The examiner also found that the Veteran’s claimed vertigo was not proximately due to or aggravated beyond its natural progression by the Veteran’s service-connected disorders. The examiner referenced the August 2010 VA examination, which indicated that the Veteran denied dizziness at that time. It was also noted that there were no other references to a diagnosed vertigo disorder. Based on the above, the Board finds that the preponderance of the evidence demonstrates that the Veteran has not had vertigo at any point during the period of the claim. Pain (a symptom) may constitute a disability if it produces functional impairment in earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Even assuming that this rule could be extended to subjective reports of dizziness, the evidence does not show, and the Veteran did not assert that his subjective reports of dizziness resulted in functional impairment. Accordingly, the Board finds that the weight of the evidence does not establish a vertigo disability at any time during the period on appeal. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine does not apply, and service connection must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 3. Service connection for a dental disorder. A May 2009 private medical record showed that the Veteran presented with dental pain. An oral cavity examination did not reveal any lesions or masses in the oral cavity, oropharynx, or vocal cords. It was noted that the Veteran had poor dentition with attrition and periodontitis. He was referred to an oral surgeon. A May 2009 follow-up visit showed that the Veteran reported mouth pain since undergoing radiation treatment for his service-connected laryngeal cancer. He was referred for an oral surgery consult. The Veteran’s claims file includes a March 2020 VA medical opinion that the Veteran’s loss of teeth was at least as likely as not a residual of, proximately due to, or aggravated beyond its natural progression by the chemoradiation treatment for his service-connected laryngeal cancer. The examiner noted that the Veteran’s laryngeal cancer involved inner cartilage erosion. His laryngeal cancer treatment ended in August 2008 and it was documented that he required dental extractions. A November 2020 VA medical opinion found that there was no objective evidence that the Veteran’s loss of teeth was at least as likely as not a residual of, proximately due to, or aggravated beyond its natural progression by the Veteran’s laryngeal cancer, to include chemoradiation treatment. The rationale was that there were no dental notes in the Veteran’s medical records or any notes concerning loss of teeth, nor any evidence of a diagnosed dental condition. Upon review of the record, and resolving doubt in favor of the Veteran, the Board finds that service connection is warranted for the Veteran’s dental disorder. After reviewing the conflicting medical opinions of record, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran’s dental disorder is secondary to the chemoradiation treatment for his service-connected laryngeal cancer. The March 2020 VA medical opinion is probative as it was based on a review of the Veteran’s medical records and was supported by well-reasoned rationale. The Board notes that in order to establish service connection for dental trauma for compensation purposes, it must be found that the Veteran has a dental condition for which service-connected compensation benefits are available as set forth under 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Those conditions include loss of teeth only if such is due to loss of substance of body of maxilla or mandible. Moreover, for loss of the teeth, bone loss through trauma or disease, such as osteomyelitis, must be shown for compensable purposes. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See 38 C.F.R. § 4.150, Diagnostic Code 9913. Thus, the remaining question is whether the loss of teeth from dental trauma in service involved loss of substance of the maxilla or mandible. Here, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s chemoradiation for his laryngeal cancer caused bone loss. Accordingly, resolving the benefit of the doubt in the Veteran’s favor, the Board finds that the Veteran’s dental disorder is related to the chemoradiation therapy for his service-connected laryngeal cancer. Therefore, service connection for a dental disorder is warranted. Gilbert v. Derwinski, 1 Vet. App. 49, 53-56. 4. Special Monthly Compensation The Veteran sought SMC based on the need for regular aid and attendance. Legal Criteria The criteria for determining that a VA claimant is so helpless as to be in need of “regular aid and attendance” 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 U.S.C. § 1114(l); 38 C.F.R. §§ 3.350(b), 3.352(a). Being “bedridden” will also be a proper basis for finding that a VA claimant is in need of regular aid and attendance. The term “bedridden” means a condition which, through its essential character, actually requires that the claimant remain in bed. However, the fact that someone has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure is not sufficient. Factual Background In December 2009, the Veteran requested special monthly compensation based on deafness of both ears. Also in December 2009, the appellant reported that the Veteran was limited in his ability to care for himself. The appellant and the appellant’s siblings assisted the Veteran with grocery shopping, taking medications, attending doctor’s appointments, transportation, and household chores. The Veteran submitted a November 2011 aid and attendance examination completed by J.G., M.D. The examiner noted that his diagnoses were COPD, dyspnea, edema, laryngeal cancer, lumbar stenosis, hypertension, and angina. The Veteran’s nonservice-connected severe COPD restricted his activities and functions. Dr. G. noted that the Veteran was able to feed himself and prepare his own meals. He did not need assistance bathing or tending to other hygiene needs, was not legally blind, did not require nursing home care, and was able to manage his own financial affairs. The Veteran required medication management for his pain medication. Dr. G. found that the Veteran had poor gait only with exertion due to shortness of breath and restrictions with upper body strength due to poor endurance. He had dyspnea and diminished breath sounds due to disease process. The Veteran underwent a VA aid and attendance examination in September 2012. The Veteran was not bedridden or hospitalized and was able to travel beyond his current domicile. The Veteran reported difficulty standing due to weakness in the bilateral lower legs and that he needed help getting in and out of the shower. He was able to dress himself and had difficulty preparing his own meals. He had to manipulate his oxygen tank and oxygen cord around his daily activities. He could only stand for about 10 to 15 minutes without developing weakness or shortness of breath. The examiner found that the Veteran was unable to perform dressing, undressing, bathing, grooming, and toileting. The examiner noted that the functioning of the Veteran’s extremities was abnormal. His upper extremity caused some difficulty or mild to moderate impairment when completing activities of daily living. The Veteran submitted a March 2018 examination for housebound status or permanent need for aid and attendance completed by D.S., D.O. The diagnoses that resulted in the Veteran needing assistance were COPD, hypoxemia, and bacterial endocarditis. The Veteran was too weak to stand on the scale and he appeared malnourished. Dr. S. found that the Veteran’s severe hypoxemia restricted the Veteran’s activities and functions. It was noted that the Veteran’s severe weakness due to his hypoxemia resulted in him being homebound and needing help with his activities of daily living. The Veteran was unable to feed himself or prepare his meals. He needed assistance for his hygiene needs, medication management, and management of his financial affairs. Upon review of the evidence of record, the Board finds that SMC is not warranted in this case because the criteria regarding aid and attendance were not met. Significantly, there is no indication that the Veteran was rendered helpless as a result of his service-connected disabilities. While the Veteran needed help preparing his meals, attending to his hygiene needs, and assistance with other activities of daily living, this was predominantly due to his nonservice-connected respiratory disorder. Based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for SMC based on the need for aid and attendance. In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine does not apply and SMC must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. McKinley, 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.