Citation Nr: 21015574 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 16-44 751 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 disabilities, the Veteran is so helpless as to be in need of regular aid and attendance of another person. CONCLUSION OF LAW The criteria for SMC based on the need for regular aid and attendance have been met. 38 U.S.C. §§ 1114, 1154, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.351, 3.352. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1964 to April 1966, including service in the Republic of Vietnam, and his decorations include the Combat Infantryman Badge. This case was previously before the Board in August 2018 and remanded for additional development. SMC aid and attendance The Veteran’s seeks SMC based on the need for aid and attendance of another person. In support, the record shows that the severity of his service-connected disabilities render him in need for aid and attendance in his daily care, including constant care, grooming, cooking, showering, toileting, medication management, getting dressed and other daily activities. See VA medical examinations (May 2019 and December 2020). Special monthly compensation is payable at a specified rate if the veteran, as the result of service-connected disability, is in need of regular aid and attendance. Need for aid and attendance means helplessness or is so nearly helpless as to require the regular aid and attendance of another person. A veteran will be considered to be in need of regular aid and attendance if he or she is blind or is 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; if the veteran is a patient in a nursing home because of mental or physical incapacity; or if the evidence establishes a factual need for aid and attendance or “permanently bedridden” status under the criteria set forth in 38 C.F.R. § 3.352(a). See 38 U.S.C. § 1114(l); 38 C.F.R. § 3.351(b). The following will be accorded consideration in determining the need for regular aid and attendance: 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. “Bedridden” will be a proper basis for the determination. See 38 C.F.R. § 3.352(a). A veteran will be found to be bedridden if the condition actually requires that he remain in bed, but not if he voluntarily stays in bed or if a physician merely recommends bed rest. It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions that the veteran is unable to perform should be considered in connection with his or her condition as a whole. 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. Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant’s condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others. Id. Furthermore, the performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance. See 38 C.F.R. § 3.352 (c). The Board finds that SMC for aid and attendance is warranted. On May 2019 and December 2020 VA examiners noted that the Veteran needs others to assist him in mostly all daily activities. Additionally, the examiners noted that the Veteran is a risk for falls, unable to dress and undress, bath, groom, prepare meals, self-feed, medication management, toileting and needs assistance from others to walk. Moreover, he gets dizzy from getting up, often forget where he is, extremely wabbly, cannot manage his financial affairs and depends of his family members for his daily activities. See VA medical examinations (May 2019 and December 2020). Indeed, the medical and lay evidence of record shows that the Veteran needs assistance from his family to manage his daily living activities. The Board acknowledges the RO stated that the Veteran’s service-connected PTSD does not meet the requirements of aid and attendance. The RO also stated that his nonservice-connected dementia meets the aid and attendance requirements. See SSOC (December 2020). The United States Court of Appeals for Veterans Claims (Court) held that if it is possible to separate symptoms between a non-service-connected and a service-connected disorder, then for rating purposes VA may (indeed must) ignore the symptoms associated with the non-service-connected condition. Mittleider v. West, 11 Vet. App. 181 (1998). Here, because on the current record, the separate effects of his service-connected condition psychiatric disability, i.e., PTSD, from any nonservice-connected condition, i.e. dementia, have not been disassociated, the Board resolves all reasonable doubt in the Veteran’s favor and all such signs and symptoms will be attributed to the service-connected condition. See Mittleider v. West, 11 Vet. App. 181 (1998). Additionally, although a veteran need not show all of the disabling conditions identified in 38 C.F.R. § 3.352(a) to establish entitlement to aid and attendance, the Court has held that it is logical to infer there is a threshold requirement that “at least one of the enumerated factors be present.” See Turco v. Brown, 9 Vet. App. 222, 224 (1996). Accordingly, the Board finds that with resolution of all reasonable doubt in the Veteran’s favor, the criteria are satisfied to award special monthly compensation based on the need aid and attendance of another person. (Continued on the next page)   As the manifestations of the Veteran's service-connected disabilities meet the pertinent requirements, as demonstrated by the noted medical reports and consistent lay statements, SMC based on the aid and attendance of another person is warranted. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Alvarado- 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.