Citation Nr: 21015295 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 99-13 785 DATE: March 17, 2021 ORDER Entitlement to special monthly compensation (SMC) based on aid and attendance is granted. FINDING OF FACT Due to his service-connected psychiatric disability, the Veteran requires the aid and attendance of another person. CONCLUSION OF LAW The criteria for SMC based on aid and attendance have been met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1980 to April 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by a Regional Office (RO) of the Department of Veterans Affairs (VA). In an August 2016 decision, the Board, in pertinent part, denied entitlement to special monthly compensation (SMC). The Veteran appealed the denial. In a September 2017 order, the United States Court of Appeals for Veterans’ Claims (Court) granted a joint motion of the parties and vacated and remanded the claim of entitlement to SMC based on regular aid and attendance/housebound status, back to the Board for action consistent with the joint motion. A March 2018 Board decision, in pertinent part, remanded entitlement to a SMC based on regular aid and attendance/housebound status in order to obtain current VA and non-VA treatment records and afford the Veteran an evaluation for SMC. There has been substantial compliance with the March 2018 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to special monthly compensation based on aid and attendance. SMC is warranted if, as a result of a service-connected disability, a veteran is permanently bedridden or so helpless as to be in need of regular aid and attendance of another person. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.352(a). SMC is warranted if a veteran has a service-connected disability rated as total and has additional service-connected disabilities independently rated as 60 percent or more, or by reason of such service-connected disabilities is permanently housebound. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). A higher level of compensation is payable to eligible veterans who, by reason of service-connected disability, require the regular aid and attendance of another person. The need for aid and attendance means helplessness or being so nearly helpless as to require the regular assistance of another person. In order to establish entitlement to an increased compensation based on the need for regular aid and attendance, a veteran must have an anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes of 5/200 or less or have a factual need for regular aid and attendance of another person. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.351(b), (c). Determinations as to need for aid and assistance must be based on actual requirements of personal assistance from others. In making such determinations, consideration is given to such conditions as: inability of the appellant 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; inability of the appellant 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 daily environment. 38 C.F.R. § 3.352(a). Performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his household will not prevent the granting of the additional allowance. 38 C.F.R. § 3.352(c). VA must consider the enumerated factors under 38 C.F.R. § 3.352(a); that eligibility requires at least one of the enumerated factors to be present; and that, because the regulation provides that the particular personal function which a veteran is unable to perform should be considered in connection with his condition as a whole, the particular personal function must be one of the enumerated factors. Turco v. Brown, 9 Vet. App. 222 (1996). It is not required that all of the disabling conditions enumerated above be found to exist before a favorable rating may be made; [i]t 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. Id. As of August 2019, the Veteran is service connected for unspecified psychosis, mood disorder, posttraumatic stress disorder (PTSD), personality disorder (100 percent) and atrial fibrillation (30 percent). The evidence shows that the Veteran needs the regular aid and attendance of another person due to his service-connected psychiatric disability. Specifically, his service-connected psychiatric disability limits and impairs the Veteran’s ability to perform activities of daily living and ability to keep himself ordinarily clean and presentable. The Veteran, through counsel, submitted the February 2021 private medical opinion of Dr. M. S., M.D. who stated in great detail that the Veteran’s psychiatric disability is not well-managed and requires the aid and attendance of another person on a regular basis. Dr. M.S. stated that the Veteran is unable to keep himself ordinarily clean and presentable, manage his medications, perform activities of daily living, nor protect himself from hazards and dangers incident to his daily environment. Dr. M.S cited several VA records in support of his finding. Notably, Dr. M.S. reference a March 8, 2009 VA examination report which noted that the Veteran has urges to hurt himself, hears voices all the time, exhibits inappropriate behavior and has major impairment in family relations, thinking, judgment, and mood. A May 11, 2011 VA report noted that the Veteran was unable to distinguish what is real from unreal and continued to experience auditory hallucinations. Furthermore, a February 10, 2015 VA treatment note reported that the Veteran demonstrated little or no insight into his ability to manage his own behavior and “has been unable to maintain independent living in the past.” Dr. M.S. concluded that the Veteran’s history of suicidal thoughts and attempts, homicidal thoughts, auditory and visual hallucinations, and inappropriate behavior indicate that the Veteran is a danger to himself and others. Therefore, he believes, it is at least as likely as not that the Veteran is in need of regular aid and attendance to protect himself from hazards or dangers incident to his daily environment. There are no opinions to the contrary. (Continued on the next page)   The Board acknowledges a March 2019 VA examination report which concluded that the Veteran’s atrial fibrillation did not impose any physical or behavior limitations which would compromise his health and activities of daily living so as to require the need for aid and assistance from others. The examiner did not address the impact the Veteran’s psychiatric disability. In light of the foregoing, the evidence of record demonstrates that the Veteran has a factual need for regular aid and attendance of another person. The criteria for SMC on that basis are met. J. NICHOLS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mohammad Mahmoudi, 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.