Citation Nr: 21021552 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 16-12 530 DATE: April 13, 2021 ORDER Service connection for right below the knee amputation (BKA) is denied. Payment of special monthly compensation (SMC) based on the need for aid and attendance is denied. Payment of SMC based on housebound status is denied. Eligibility for specially adapted housing (SAH) is denied. Eligibility for a special home adaptation grant (SHA) is denied. Eligibility for financial assistance in the purchase of one automobile or other conveyance and/or automobile adaptive equipment is denied. FINDINGS OF FACT 1. The Veteran had active service from September 1949 to January 1954; he died in November 2016 and his surviving spouse has been properly substituted. 2. The Veteran did not sustain an injury or disease of the right leg in service. The right BKA was not causally or etiologically related to service and was not caused by or permanently worsened in severity by a service-connected disability. 3. Service connection was in effect for residuals of fracture of the left tibia nad fibula, degenerative arthritis of the left ankle, chronic osteomyelitis of the left tibia, hypertrophic arthritis of the right hip, right forehead scar, healed donor site skin graft of the right medial thigh, scar of the left lower tibia. The Veteran was not service-connected for disabilities of the upper extremities, eyes, severe burn injury, or amyotrophic lateral sclerosis (ALS). 4. The Veteran did not have anatomical loss or loss of use of both feet or of one hand and one foot, was not blind in both eyes, was not permanently bedridden, and was not so helpless as to be in need of regular aid and attendance of another person, as a result of service-connected disabilities; nor was he substantially confined to his house due to service-connected disabilities and did not have a single service-connected disability at 100 percent along with other unrelated disabilities that combined to at least 60 percent. 5. The Veteran did not have a disability rated as permanent and total due to the loss or loss of use of both upper extremities or loss or loss of use of both lower extremities, one lower extremity together with the residuals of organic disease or injury, or one lower extremity together with one upper extremity, any of which preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; nor does he have service-connected ALS, full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk, or loss of use of one lower extremity with blindness in both eyes that results in only having light perception. 6. The Veteran did not have permanent and total service-connected disability which included the anatomical loss or loss of use of both hands, or was due to burn injuries or residuals of an inhalational injury, nor did he have a service-connected disability due to blindness in both eyes, with corrected central visual acuity of 20/200 or less in the better eye. 7. The Veteran’s service-connected disabilities did not result in the physical loss or permanent loss of use of one or both hands or feet, ankylosis of one or both knees or hips, permanent impairment of vision in both eyes with corrected central visual acuity of 20/200 or less in the better eye or central visual acuity of more than 20/200 with a visual field defect of a degree specified by regulation. CONCLUSIONS OF LAW 1. Right BKA was not incurred in service and was not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.310a (2020). 2. The criteria for payment of SMC based on the need for regular aid and attendance of another person were not met. 38 U.S.C. §§ 1114, 1521, 5103, 5103A, 5107 (2012); 38 C.F.R. § 3.350, 3.352 (2020). 3. The criteria for payment of SMC at the housebound rate were met. 38 U.S.C. §§ 1114, 1521, 5103, 5103A, 5107; 38 C.F.R. § 3.350 (2020). 4. The criteria for eligibility for SAH have not been met. 38 U.S.C. §§ 2101, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.809 (2020). 5. The criteria for eligibility for SHA have not been met. 38 U.S.C. §§ 2101, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.809a (2020). 6. The criteria for eligibility for financial assistance in the purchase of an automobile or other conveyance and/or automobile adaptive equipment are not met. 38 U.S.C. §§ 3901, 3902, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.808 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran died in November 2016 while his appeals were pending. The appellant is his surviving spouse and has been properly substituted for all appeals pending before VA at the time of his death. These matters come to the Board on appeal of August 2014 and December 2014 rating decisions. In December 2018, the case was before the Board and remanded in its entirety for further development. It now returns to the Board for appellate review. In June 2017, the appellant appointed Disabled American Veterans (DAV) as her representative. In June 2019, another VA Form 21-22, Appointment of Veterans Service Organization was received, naming United States Air Forces as the new representative; however, United States Air Forces is not a VA-recognized service organization, and the form was not signed by a representative of any Veterans Service Organization. Moreover, the person listed as claimant and signee of the document was the Veteran’s daughter, and there are no documents of record showing that she had authority to act on behalf of the appellant before VA. Therefore, this form did not successfully revoke the appointment of DAV as representative, and DAV remains the claimant’s representative before VA at this time. Next, in the February 2021 Appellant’s Post-Remand Brief, the appellant argued that remand was warranted because the Agency of Original Jurisdiction (AOJ) did not obtain treatment records from St. Paul’s Hospital as directed by the Board’s December 2018 remand. St. Paul’s is a private hospital identified in October 2013 VA treatment notes; therefore, the appellant needed to submit the records directly to VA or provide VA authorization to obtain the records on her behalf. The appellant was asked to provide such authorization for the records and advised that it was her responsibility to ensure the records were received in a June 2019 letter. In July 2019, she submitted a release form identifying only treatment at the Dallas VA facility, and she did not submit a form for the St. Paul’s Hospital. The AOJ was, therefore, unable to obtain St. Paul’s hospital records. Further, the AOJ had no further obligation to attempt to do so. See Hyson v. Brown, 5 Vet. App. 262 (1993) (holding that the burden is on the appellant to keep VA apprised of his or her whereabouts); see also Wood v. Derwinski, “[t]he duty to assist is not always a one-way street. If an appellant wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.” 1 Vet. App. 190, 193, reconsidered, 1 Vet. App. 406 (1991)). VA treatment notes dated up to the Veteran’s death were already of record. Thus, the AOJ substantially complied with the Board’s December 2018 remand orders and additional remand is not necessary. Service Connection For a Right BKA Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran claimed entitlement to service connection for amputation of his right leg, to include as secondary to service-connected disabilities, in particular left tibia osteomyelitis. Turning to the evidence, the first element of direct service connection was met as the Veteran underwent a right BKA in October 2013. As to an in-service incurrence, while service treatment records (STRs) show that he was involved in a motor vehicle accident in November 1952 with subsequent development of osteomyelitis, no injury or involvement of the right leg was noted. Therefore, the second element of direct service connection was not met. As to secondary service connection, as noted, the Veteran was diagnosed with a BKA of the right leg. In addition, he had been service connected for the residuals of a fracture of the left tibia and fibula and left tibia inactive osteomyelitis for many years. Further, October 2013 treatment notes reflected that prior to the right BKA, he presented with right foot osteomyelitis. Thus, the underlying pathology which was service connected on the left leg (osteomyelitis) was present on the right foot prior to the BKA. As to a medical nexus between the two, an August 2019 VA opinion was obtained as to whether the right BKA was due to the service-connected left tibia osteomyelitis. The reviewer noted that the baseline for the Veteran’s right knee BKA was osteomyelitis of the right foot and found that the disability was not aggravated by the remote history of left leg fracture with complication of infection in service. In support of this opinion, the reviewer noted that the left leg infection resolved with antibiotics and the right foot disorder was due to diabetes mellitus, which the Veteran did not have in the 1950s. Therefore, the examiner concluded that the right BKA was not caused or aggravated beyond normal progression by the left leg disability. There is no other VA or private medical opinion that alleged any etiological connection between service or service-connected disability and the Veteran’s right BKA. As such, the medical evidence weighs against finding a nexus and does not support service connection on a direct or secondary basis. The Board has considered the lay statements that the Veteran’s right BKA was due to service or to a service-connected disability. Laypersons are competent to report symptoms experienced or observed because this requires only personal knowledge as it comes to them through their senses. However, laypersons are not competent to offer an opinion as to the etiology of a disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations and opinions obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. SMC for Aid and Attendance/Housebound Status In the December 2014 rating decision, special monthly pension (SMP) based on the need for aid and attendance was granted. SMC and SMP differ in that SMC is paid if the need for aid and attendance is due to service-connected disabilities, whereas SMP may be paid if the Veteran is entitled to pension benefits and is found in need of aid and attendance due to nonservice-connected disabilities. SMC is payable under several circumstances, including when a veteran is permanently bedridden or so helpless as to be in need of the regular aid and attendance of another person. 38 U.S.C. § 1114; 38 C.F.R. § 3.350. A veteran shall be considered to be in need of regular aid and attendance if: he is blind or 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; or is a patient in a nursing home because of mental or physical incapacity; or establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352. Determinations as to the need for aid and attendance are based on the actual requirements of personal assistance from others. In determining the need for regular aid and attendance, consideration will be given to the inability of the veteran to dress or undress himself, or to keep himself clean; frequent need of adjustment of any prosthetic which by reason of the disability cannot be done without aid; inability of the veteran to feed himself; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect himself from the hazards or dangers of his daily environment. Bedridden will be that condition which, through its essential character, actually requires that a veteran remain in bed. 38 C.F.R. § 3.352. It is mandatory for VA to consider the enumerated factors within the regulation, and at least one of the enumerated factors must be present. Turco v. Brown, 9 Vet. App. 222 (1996). SMC is also payable when a veteran has a single service-connected disability rated as 100 percent disabling, and, in addition: (1) has a service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability, and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when a veteran is substantially confined as a result of his service-connected disabilities to his dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). In this case, the Veteran was service-connected for residuals of fracture of the left tibia and fibula rated at 30 percent, degenerative arthritis of the left ankle rated at 20 percent, chronic osteomyelitis of the left tibia rated at 10 percent, and hypertrophic arthritis of the right hip rated at 10 percent. In addition, a right forehead scar, healed donor site skin graft of the right medial thigh, and scar of the left lower tibia are each service-connected at 0 percent. The Veteran’s combined schedular evaluation was 60 percent. The Board has reviewed all of the medical evidence of record but does not find that he meets the criteria for SMC based on the need for regular aid and assistance or by reason of being housebound. Entitlement to SMC must be based on impairment caused by service-connected disabilities. Here, the Veteran does not have a service-connected eye disability resulting in blindness or a disability of any upper or lower extremity which could result in anatomical loss or loss of use of a foot or hand. As determined above, his right BKA was not service-connected. In the context of SMC under 38 C.F.R. § 3.350(a)(2)(i), loss of use of a hand or a foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. Three VA examinations were conducted in November 2014 to assess the Veteran’s left lower extremity disabilities. None of the examiners found that the left tibia, ankle, or osteomyelitis resulted in a loss of effective functions such that he would have been equally well served by amputation or the use of a prosthetic. Further, the Board has considered all of the medical evidence of record, but the preponderance of the evidence shows that the Veteran’s left leg disabilities, skin graft, and scars, alone, were not so severe as to cause him to require regular aid and attendance or to be permanently bedridden. While the evidence indicates that the Veteran was in need of daily assistance, a September 2013 examination to assess his need for aid and attendance indicated that his impairment was caused by both service and nonservice-connected disorders. Specifically, the examination cited hypertension, DM, degenerative joint disease (DJD), history of stroke, gastroesophageal reflux disease, leg swelling, and allergic rhinitis. While service connection was in effect for DJD of the left ankle and other disabilities that may have been associated with the noted leg swelling, the other listed disabilities were not service-connected. Thus, while the Veteran was found to be in need of aid and attendance for the purposes of SMP, that need was not due to service-connected disabilities. Accordingly, SMC based on the need for aid and attendance is denied. The Veteran also did not meet any of the criteria for SMC under 38 U.S.C. § 1114(s). Specifically, he did not have a single service-connected disability rated as 100 percent disabling. Furthermore, the evidence did not suggest that he was at any time been permanently housebound by reason of service-connected disability. Prior to his right BKA, he was noted to use a walker and wheelchair and after the right BKA, used a wheelchair. However, he was not found to be unable to leave his home. Neither the Veteran nor the appellant indicated that he was substantially confined, as a result of his service-connected disabilities, to his dwelling and the immediate premises, nor was he institutionalized and confined to the ward or clinical areas. There is no other evidence or testimony showing that he met the criteria for SMC under 38 U.S.C. § 1114(s). As such, the evidence does not support SMC based on the need for aid and attendance of another person or due to being housebound. As the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt doctrine does not apply, and the appeal is denied. Specially Adapted Housing and Special Home Adaptation Grant SAH is available to a veteran who has a permanent and total service-connected disability due to: (1) ALS rated as 100 percent disabling under 38 C.F.R. § 4.124a , Diagnostic Code 8017; (2) blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; (3) full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk; or (4) the loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbows. SAH is also available to a veteran with a permanent and total disability that precludes locomotion without the aids of braces, crutches, canes, or a wheelchair due to: (5) the loss, or loss of use, of both lower extremities; (6) the loss or loss of use of one lower extremity, together with residuals of organic disease or injury which so affect the functions of balance and propulsion; or, (7) the loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion. 38 U.S.C. § 2101 (a); 38 C.F.R. § 3.809 (a), (b), (d). SAH may also be available to a veteran who served on or after September 11, 2001, who had a permanent disability that was incurred during such service, and which resulted in loss or loss of use of one or more extremities which so affects the functions of balance or propulsion as to preclude ambulating without the aids of braces, crutches, canes, or a wheelchair. See 38 U.S.C. § 2101 (a)(2)(C). The phrase “preclude locomotion” is defined as the necessity for regular and constant use of a wheelchair, braces, crutches, or canes as a normal mode of locomotion, although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809(c). If entitlement to SAH is not established, a veteran can qualify for a grant for necessary SHA if he/she has a service-connected disability that results in blindness in both eyes with 20/200 visual acuity or less in the better eye with the use of a standard correcting lens or a limitation in fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees; such a disability need not be permanent and total in nature. Additionally, a SHA is available for a veteran that has a permanent and total disability which: (1) includes the anatomical loss or loss of use of both hands; (2) is due to deep partial thickness burns that have resulted in contracture(s) with limitation of motion of two or more extremities or of at least one extremity and the trunk; (3) is due to full thickness or subdermal burns that have resulted in contracture(s) of one or more extremities or the truck; or, (4) is due to residuals of an inhalation injury (including, but not limited to, pulmonary fibrosis, asthma, and chronic obstructive pulmonary disease (COPD)). 38 C.F.R. § 3.809a(b). Generally, a veteran will be provided one-time only assistance with a SHA or SAH; however, issuance of a SHA before a veteran becomes eligible for SAH under 38 C.F.R. § 3.809 does not preclude a later grant for SAH. 38 C.F.R. § 3.809a(a). As noted above, the Veteran was service-connected for residuals of fracture of the left tibia and fibula rated at 30 percent, degenerative arthritis of the left ankle rated at 20 percent, chronic osteomyelitis of the left tibia rated at 10 percent, and hypertrophic arthritis of the right hip rated at 10 percent. In addition, a right forehead scar, healed donor site skin graft of the right medial thigh, and scar of the left lower tibia are each service-connected at 0 percent. The combined schedular evaluation was 60 percent. Therefore, he was not permanently and totally disabled due to service-connected disabilities, and entitlement to SAH or a SHA was not established on any basis requiring permanent and total disability. Service connection was not in effect for any disability of the eyes. Thus, entitlement to a SHA is not available on that basis. Consequently, the Veteran did not meet the criteria for funding for SAH or SHA. The preponderance of the evidence is, therefore, against the claims, and the appeals are denied. Financial Assistance with Purchase of Automobile or Adaptive Equipment Financial assistance may be provided to an “eligible person” in acquiring an automobile or other conveyance and adaptive equipment, or automobile adaptive equipment only. 38 U.S.C. § 3902(a)(b). Eligibility for financial assistance in the purchase of a vehicle or other conveyance and adaptive equipment is warranted where one of the following exists as the result of injury or disease incurred or aggravated during active service: (1) loss or permanent loss of use of one or both feet; (2) loss or permanent loss of use of one or both hands; (3) permanent impairment of vision of both eyes, meaning central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye; (4) severe burn injury precluding effective operation of an automobile; (5) ALS; or, (6) for adaptive equipment only, ankylosis of one or both knees or one or both hips. 38 C.F.R. § 3.808. Congress established the program authorizing funding for automobiles and adaptive equipment for veterans with certain service-connected disabilities. 38 U.S.C. §§ 3901-04. Pursuant to the authority established in 38 U.S.C. § 3902, the Secretary promulgated 38 C.F.R. § 3.808, which reiterated the § 3901(a) requirement that entitlement to automobile and adaptive equipment was warranted for “the loss or permanent loss of use” of one or both feet or one or both hands. 38 C.F.R. § 3.808 (b)(i), (ii). The regulation does not further define the phrase “loss or permanent loss of use.” Under the applicable eligibility criteria for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment, found in statutory § 3901 and regulatory § 3.808, it must be shown that a veteran lost their foot or hand or permanently lost the use of a foot or hand as a result of service-connected disability. The phrase “loss of use” is used in several places in the rating schedule. For SMC under 38 C.F.R. § 3.350(a)(2)(i), loss of use of a hand or a foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. A less restrictive definition is written into 38 U.S.C. § 2101 and 38 C.F.R. § 3.809 regarding SAH; that regulation specifies that “loss of use” was defined by the adjacent modifier, “such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair.” See Jensen v. Shulkin, 29 Vet. App. 66, 78-79 (2017). However, this modifier is noticeably absent from 38 U.S.C. § 3901 and 38 C.F.R. § 3.808 and had Congress or the Secretary of VA wished for such a definition to apply to these sections, it presumably would have been included. As such, loss of use under 38 C.F.R. § 3.808 will be taken to mean actual loss of functional use of the body part(s), with any need of assistive devices being relevant to, but not dispositive of the question of whether a veteran has permanent loss of use. Service connection was in effect for residuals of fracture of the left tibia and fibula, degenerative arthritis of the left ankle, chronic osteomyelitis of the left tibia, hypertrophic arthritis of the right hip, right forehead scar, healed donor site skin graft of the right medial thigh, scar of the left lower tibia. The Veteran was not granted service-connected benefits for disabilities involving burn injuries or ALS, or disability of the hands and/or upper extremities. Eligibility for financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment is therefore unavailable on these bases. The Veteran had service-connected disabilities of the left lower extremity that affected his functional ability to use his left foot. However, the weight of the evidence is against a finding that such functional limitation was so severe that it resulted in the loss of use of his left foot or right lower extremity. In this regard, initially, the Board observes that in none of the examinations discussed below did the examiner find that the left lower extremity disability resulted in function so diminished that amputation with prosthesis would equally serve the Veteran. Moreover, the evidence does not reflect that the right thigh resulted in functional impairment during the appeal period. Specifically, in a November 2014 examination of the left knee and lower leg, the Veteran reported flare-ups of pain occurring 2 times a month lasting a day. During this time, he reported that he could not move his leg. It was noted that he was wheelchair-bound. He was observed to have range of flexion to 90 degrees (normal endpoint was noted to be 140 degrees) with no objective evidence of painful motion and no limitation of extension. Repetitive motion reduced flexion to 80 degrees. The Veteran was noted to have less movement than normal and weakened movement following repetitive use testing. There was no tenderness or pain to palpation for the joint line or soft tissues of either knee. Muscle strength testing was 4/5 with both flexion and extension. Joint stability testing was normal and there was no evidence or history of recurrent subluxation or dislocation. The Veteran did not have any meniscal conditions or surgical procedures for a meniscal condition. In a November 2014 left ankle examination, range of plantar flexion was to 40 degrees while range of dorsiflexion was to 20 degrees. Following repetitive use testing, range of plantar flexion was reduced to 35 degrees while range of dorsiflexion was limited to 25 degrees. The examination report noted that normal endpoint of plantar flexion is 45 degrees and normal endpoint of dorsiflexion is 20 degrees. Range of motion testing was painful on active, passive, and/or repetitive use testing. There was no pain when the left ankle joint was used in weight bearing or nonweight-bearing and no localized tenderness or pain on palpation of the joints or soft tissue. The examiner estimated that range of motion due to pain and/or functional loss during flare-ups or when the joint was used repeatedly over a period of time would result in plantar flexion to 5 degrees and dorsiflexion to 0 degrees. There was no ankle instability or dislocation suspected. A review of treatment notes for the appeal period did not reflect symptoms or manifestations of the left lower extremity disability not found at VA examination. For the right thigh skin graft and scar disabilities, no VA examination specific to the right thigh and relevant to the period on appeal is of record. Nevertheless, a November 2014 VA osteomyelitis examination noted the right long bone of the leg but described no current symptoms. Neither treatment notes nor lay statements indicated that the right thigh disabilities resulted in the equivalent of loss of use of the right lower extremity. Further, a September 2013 examination for aid and attendance documented use of a wheelchair and walker but made no reference to the right lower extremity in doing so. Based on the above, the Veteran’s service-connected left tibia, left ankle, and right thigh disabilities did not result in such a severe degree of functional impairment as to approximate “loss of use” of a foot. He experienced pain, weakened movement, and limitation of motion of the joints and used a wheelchair constantly; however, there was no indication that, prior to the right BKA, the device was intended to take the place of either foot in terms of function, or after the right BKA, as a result of service-connected disabilities alone. Additionally, as noted the mere need for an assistive device does not itself constitute loss of use for the purposes of eligibility for automotive purchase and adaptation financial assistance. Finally, no examiner opined that any disability of the Veteran’s bilateral hips, knees, or ankles resulted in a degree of functional impairment such that he would have been equally or better served by amputation with use of suitable prosthesis. Therefore, the evidence weighs against a finding that he had permanent loss of use of a foot or ankylosis of a knee due to service-connected disability. Eligibility for the benefit sought in this case requires the Veteran have met at least one of the six criteria enumerated under 38 C.F.R. § 3.808. However, because he did not have service-connected disability resulting in the loss or permanent loss of use of one or both feet or loss of use of one or both hands, did not have ankylosis of his knees or hips, did not have loss of visual acuity resulting in no better than 20/200 corrected vision or visual field contraction to no more than 20 degrees and did not have any of the other physical disabilities listed among the relevant criteria, he did not qualify for eligibility for financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment under 38 C.F.R. § 3.808. As such, the claim must be denied. Finally, 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). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. M. Schaefer, 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.