Citation Nr: 21025389 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 17-32 362 DATE: April 28, 2021 REMANDED Entitlement to special monthly compensation based on housebound status or the need for aid and attendance is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1979 to December 1983. This matter comes before the Board on appeal from a March 2017 Regional Office (RO) rating decision. In February 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. 1. Entitlement to special monthly compensation based on housebound status or the need for aid and attendance is remanded. Compensation at the aid and attendance rate is payable when a veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114(l). Determinations as to the need for aid and attendance 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 claimant to dress or undress himself/herself or to keep himself/herself 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 claimant to feed himself/herself 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 the hazards or dangers inherent in his/her daily environment. It is only necessary that the evidence establish that the claimant is so helpless as to need regular aid and attendance, not that there be a constant need. 38 C.F.R. § 3.352(a). Entitlement to additional compensation by reason of being housebound is awarded where the veteran has a service-connected disability evaluated as 100 percent disabling under VA’s Schedule for Rating Disabilities, and (1) has additional disability or disabilities independently ratable at 60 percent or more; or (2) is permanently housebound by reason of service-connected disability or disabilities (i.e., the veteran is substantially confined to his/her dwelling and the immediate premises or, if institutionalized, to the ward or clinical area, and it is reasonably certain that the service-connected disability or disabilities and resultant confinement will continue throughout his/her lifetime). 38 U.S.C. § 1114. In the case at hand, service connection is currently in effect for (1) right knee degenerative arthritis, status post arthroplasty, rated as 30 percent disabling; (2) bilateral pes planus, rated as 30 percent disabling; (3) degenerative arthritis of the left knee, status post arthroplasty, chondromalacia, rated as 30 percent disabling; (4) right ankle valgus strain, rated as 10 percent disabling; (5) lumbar strain, rated as 10 percent disabling; and (6) left ankle, posterior tibial tendon dysfunction, rated as 10 percent disabling. In addition to the above disabilities, the Veteran and his spouse have indicated that left foot drop constitutes a major factor in his need for aid and attendance or housebound benefits. (See January 2017 personal statements from the Veteran and his spouse.) As a specific example, the Veteran has testified that he cannot balance or push off of his left foot due to his left foot drop. (See Board hearing transcript, page 4.) It is unclear from the evidence whether the Veteran’s left foot drop is related to one of his service-connected disabilities. Neither his private medical records nor VA medical records that are currently associated with the claims file provide an etiology of the left foot drop. The only mention of the left foot drop in any of the VA examination reports appears in a May 2017 VA back conditions examination report. In this report, a VA physician of unknown specialty stated that “I cannot identify an anatomic lesion to explain the veteran’s decreased sensation left foot.” Given the significance of the left foot drop to this claim, the Board finds it appropriate to remand this claim so that the Veteran may undergo a VA neurology examination by a neurologist to determine the etiology of this disability. In addition, in light of the additional relevant testimony since the February 2017 VA aid and attendance and housebound examination, including the Veteran’s February 2020 Board hearing testimony, the Board finds that, on remand, a new VA aid and attendance examination to obtain updated findings is appropriate. The matters are REMANDED for the following action: 1. Obtain all relevant VA and private treatment records not currently associated with the claims file, to include any VA medical records that were created since the Veteran’s records were last obtained. 2. Schedule the Veteran for a neurology examination with a neurologist (M.D.) to determine the nature and etiology of any current left foot drop. The Veteran should be interviewed, and all indicated tests and studies should be accomplished. All findings should be reported in detail. The Veteran’s claims folder must be reviewed by the examiner in conjunction with the examination. The examiner should diagnose all current disabilities manifesting in left foot drop. For each diagnosed disability, the examiner should opine as to whether it is at least as likely as not (a 50 percent probability or greater) that any such disability is caused by or aggravated by service-connected back, knee, ankle, and pes planus disabilities. Any opinion expressed by the VA examiner should be accompanied by a complete rationale that includes discussion of the facts of the Veteran’s case and pertinent medical principles. 3. Thereafter, schedule the Veteran for an appropriate examination to determine eligibility for special monthly compensation based on the need for aid and attendance of another person or by reason of being housebound due to his service-connected disabilities. Service connection is currently in effect for (1) right knee degenerative arthritis, status post arthroplasty, rated as 30 percent disabling; (2) bilateral pes planus, rated as 30 percent disabling; (3) degenerative arthritis of the left knee, status post arthroplasty, chondromalacia, rated as 30 percent disabling; (4) right ankle valgus strain, rated as 10 percent disabling; (5) lumbar strain, rated as 10 percent disabling; and (6) left ankle, posterior tibial tendon dysfunction, rated as 10 percent disabling. The examiner should be notified if service connection is granted for any other disabilities prior to this examination. The claims file must be provided to and reviewed by the examiner. Any appropriate evaluations, studies, and testing deemed necessary by the examiner should be conducted at this time, and the results should be included in the examination report. The examiner must specifically address the following questions regarding the Veteran’s service-connected disabilities: (a.) Is the Veteran unable to dress or undress himself and keep himself ordinarily clean and presentable? (b.) Does the Veteran require frequent adjustment of any special prosthetic or orthopedic appliances that cannot be done without aid? (c.) Is the Veteran unable to feed himself through loss of coordination of upper extremities or through extreme weakness, or is he unable to attend to the wants of nature? (d.) Does the Veteran have incapacity, physical or mental, that requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment? (e.) Does the Veteran have any disability that requires that he remain in bed? (f.) Is the Veteran substantially confined to his dwelling and the immediate premises? The examiner should provide a medical rationale for all opinions expressed. (continued on next page) TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Elizabeth Jalley, 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.