Citation Nr: 21015044 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 17-59 244 DATE: March 16, 2021 ORDER Special monthly compensation based on housebound status or the need for aid and attendance is granted. FINDING OF FACT The competent medical and lay evidence, including a November 2017 examination and Board testimony from the Veteran and his sisters, in conjunction with the inherent severity of his symptoms due to his service-connected disabilities, support a finding that the Veteran unable to dress himself and keep himself ordinarily clean and presentable; the Veteran is unable to bathe himself and use the restroom without assistance; the Veteran is unable to feed himself without aid due to loss of coordination of the upper extremities; and that Veteran requires the use of a cane or other assistance in order to protect him from falling. CONCLUSION OF LAW The criteria for special monthly compensation based on housebound status or the need for aid and attendance have been met. 38 U.S.C. §§ 1114, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.351, 3.352, 4.3. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1977 to July 1997. This matter is before the Board of Veterans Appeals (Board) on appeal from a January 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, a Board hearing was held before the undersigned. Legal Criteria Special monthly compensation based on the need for aid and attendance will be granted when, as a result of a service-connected disability, the Veteran is so helpless (due to physical or mental incapacity), as to be bedridden or require the aid of another person to perform the personal functions required in everyday living. 38 U.S.C. § 1114 (l); 38 C.F.R. §§ 3.350 (b), 3.351(b)-(c), 3.352(a). The need for aid and attendance is a factual question based on the following factors: inability of claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which 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. § 3.351(c)(3). The definition of “bedridden” requires that the claimant remain in bed. It is not enough that a claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Factual Background The Veteran attended a November 2017 examination for housebound status or permanent need for regular aid and attendance. The conducting physician opined that the Veteran is confined to bed depending on his pain level due to his service-connected disabilities including lumbar intervertebral disc syndrome, cervical spine disorder, depression, hemorrhoids, sensory deficits of the bilateral lower extremities, radiculopathy of the bilateral upper extremities, and GERD. The physician indicated that the Veteran is unable to prepare his meals and feed himself due to the unsteadiness of his hands. The physician also indicated that the Veteran needs assistance in bathing and using the restroom. The physician noted that the posture of the Veteran is very poor and that he always requires the use of a cane. The Veteran indicated to the examiner that his pain level is constantly at a 15 on a scale from 1 to 10. The physician explained that the Veteran’s travel outside of the home is very limited and he is dependent on a caretaker to do so. In a November 2017 statement, the Veteran’s sister stated that the Veteran requires assistance with daily activities of living including getting dressed, bathing and using the restroom. The Veteran’s sister explained that the Veteran is unable to feed himself due to his hands shaking and that he is unable to stand for more than 5 to 10 minutes. The Veteran’s sister is responsible for taking him to his medical appointments and she reported that he spends most days tossing and turning in bed. At the February 2021 Board hearing, the Veteran’s two sisters testified that they have assumed caretaking responsibilities for the Veteran. Both sisters testified that they assist the Veteran with bathing, showering and making sure he can use the restroom safely. They also testified that they visit the Veteran to help him get out of bed occasionally, prepare his meals, take him to doctor’s appointments and prepare him for bed. Both sisters testified that the Veteran usually lies in bed and would not get out of bed without their help. The Veteran testified that he would stay in bed if he did not have his sisters helping him. The Veteran further testified that he is at risk for falls and needs someone to help him move in order to prevent bed sores. Finally, the Veteran testified that he used to have an aide but that his sisters started caring for him in 2016. Analysis The Board finds the Veteran and his sisters competent and credible to describe the Veteran’s symptoms and impairments of daily living. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Board assigns significant probative value to their testimony. The Board also assigns significant probative value to the findings of the November 2017 examiner because that examiner supported thee opinion with a thorough rationale. The Board finds that evidence of record supports a finding that the Veteran is unable to dress himself and keep himself ordinarily clean and presentable. The evidence also supports a finding that the Veteran is unable to feed himself without aid due to loss of coordination of the upper extremities. The evidence supports a finding that the Veteran is unable to bathe himself or use the restroom without assistance. Finally, the evidence supports a finding that the Veteran requires the use of a cane as well as the assistance of another person to protect him from falling whenever he is out of bed. [CONTINUED ON NEXT PAGE]   Considering the competent medical and lay evidence in conjunction with the inherent severity of his symptoms due to his service-connected disabilities, the Board finds the evidence is at least evenly balanced for and against (“in relative equipoise”) a finding that the impairment from the Veteran’s service-connected disabilities is consistent with the criteria laid out in 3.351(c)(3). VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alexander Bahus 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.