Citation Nr: 21025977 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 15-15 073 DATE: April 29, 2021 ORDER Entitlement to service connection for prostate cancer, status post radical prostatectomy, is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to special monthly compensation (SMC), based on the need for regular aid and attendance or at the housebound rate, is denied. FINDINGS OF FACT 1. The preponderance of the evidence shows that the Veteran did not have service in the Republic of Vietnam, in the demilitarized zone (DMZ) in Korea, in Thailand, or otherwise had actual herbicide agent exposure including during service Okinawa. 2. The Veteran’s diabetes mellitus and prostate cancer were not present during active service, they did not manifest to a compensable degree within one year of separation, nor are they shown to be causally related to his active service, and diabetes mellitus was not caused or aggravated by a service connected disability. 3. Throughout the rating period prior to his death the Veteran was not shown to be so helpless as to be in need of regular aid and attendance as a result of service-connected disabilities; he did not have a single disability ratable as 100 percent disabling, nor was he limited to the immediate premises of his home due to service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for diabetes mellitus and prostate cancer, status post radical prostatectomy, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 2. The criteria for an award of SMC based on the need for regular aid and attendance or on being housebound are not met at any time during the pendency of the appeal. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The moving party in this appeal was a Veteran who had honorable active service in the United States Marine Corps from August 1972 to May 1974. He also served in the United States Marine Corps Reserve. He died in October 2018. The Appellant in this case is the Veteran’s surviving spouse. She filed for substitution for the Veteran’s appellate claims in December 2018. In April 2020 the regional office (RO) issued a formal recognition of the Appellant as a valid substitute. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from September 2012 and May 2015 rating decisions. In July 2018 the Board of Veterans’ Appeal (Board), among other things, remanded the above claims for additional development. In this regard, the Board finds there has been substantial compliance with the prior remand directives because while the appeal was in Remand status the regional office (RO) contacting all appropriate repositories to obtain any outstanding records that pertain to the Veteran’s service in Okinawa, Japan including any records that relate to the bulldozer operations course the Veteran completed in August 1973 in the Pre-Discharge Education Program, and his alleged associated exposure to herbicide agents. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (a remand order by the Board confers on a claimant the right to compliance with that order); see also D'Aires v. Peake, 22 Vet. App. 97, 105 (2008) (holding it is “substantial compliance,” and not “strict” compliance that is the standard). The Service Connection Claims Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed in 38 C.F.R. § 3.309. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). Other specifically enumerated disorders will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In this regard, in order to establish service connection for the claimed disorders, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). As to herbicide exposure, VA laws and regulations provide that a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war (i.e., January 9, 1962, to May 7, 1975), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). The last date on which such a Veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he served in the Republic of Vietnam during the Vietnam war period. 38 C.F.R. § 3.307. For these Vietnam Veterans, diseases associated with exposure to certain herbicide agents will be presumed to have been incurred in service even though there is no evidence of that disease during the period of service at issue. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309. Effective February 24, 2011, VA amended its adjudication regulations to extend a presumption of herbicide exposure to certain Veterans who served in Korea. Specifically, a veteran who, during active military, naval, or air service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense (DoD), operated in or near the Korean demilitarized zone (DMZ) in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iv). As to herbicide exposure due to military service in Thailand, VA has determined that special consideration of herbicide exposure on a factual basis should be extended to veterans whose duties placed them on or near the perimeters of certain Thailand military bases where herbicide may have been sprayed. See Herbicide Use in Thailand During the Vietnam Era. Based on the manual and supporting material it is generally presumed that herbicide was hand sprayed around the perimeter of identified bases in Thailand during certain periods of the Vietnam War era. See 38 C.F.R. § 19.5. VA has not extended the same special consideration to all service members who had contact with a Thai base perimeter. The list of diseases associated with exposure to certain herbicide agents is as follows: parkinsonism, bladder cancer, hypothyroidism, AL amyloidosis, chloracne or other acneform disease consistent with chloracne, type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin’s disease, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina), all chronic B–cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia), multiple myeloma, non–Hodgkin’s lymphoma, Parkinson’s disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). 38 C.F.R. § 3.309(e). For purposes of applying the herbicide presumption, “service in Vietnam” includes service in the waters offshore or service in other locations if the conditions of service involved duty or visitation to Vietnam from January 9, 1962, to May 7, 1975. 38 U.S.C. § 1116(a)(3); 38 C.F.R. §§ 3.307(a)(6)(iii); 3.313(a). The availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a Veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Service connection may also be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). To establish secondary service connection, a Veteran must show: (1) the existence of a present disability; (2) the existence of a service-connected disability; and (3) a causal relationship between the present disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Ward v. Wilkie, 31 Vet. App. 233 (2019). The requirement of a current disability is “satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Entitlement to service connection for prostate cancer and diabetes mellitus Throughout the appeal, the Appellant and, previously, the Veteran have continuously maintained that the Veteran was exposed to herbicides while in service on Okinawa, Japan and this caused the prostate cancer and diabetes mellitus. As to diabetes mellitus, it was also claimed that it is due to the medication the Veteran took to treat his service-connected major depressive disorder. The Board first notes there are confirmed diagnoses in the record of prostate cancer and type II diabetes mellitus. As to the Veteran being presumed to have had herbicide exposure, the record shows that the Veteran did not have any service in the Republic of Vietnam or in any of the other circumstances enumerated in the regulations, including the Korean DMZ or in an Air Force unit that regularly and repeatedly operated and maintained C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam era. See 38 C.F.R. § 3.307(a)(6). Therefore, the presumptions do not apply, and the Veteran cannot be presumed to have been exposed to herbicides during service. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309. As to establishing service connection with proof of direct causation (see Combee, supra.), neither the Veteran or the Appellant ever claimed, and the record does not show, that the Veteran’s military service included service in Thailand. Instead, the Veteran during his lifetime and know the Appellant contend that he was exposed to Agent Orange while stationed in in Okinawa from 1973 to 1974. In statements, the Veteran asserted that he attended a school in Okinawa that was adjacent to a dump site. He further claimed that he buried Agent Orange drums in the dump site with bulldozers as part of a bulldozer operations course. The service records show that the Veteran was stationed at Camp Hansen, a United States Marine Corps base in Okinawa, Japan. From July 1973 to August 1973, the Veteran was enrolled in, and completed, a heavy equipment bulldozer operations course at Kubasaki high school in Okinawa. In support of the contention the Veteran encountered herbicides in Okinawa, he submitted several articles and reports. An article from The Japan Times dated January 2013, asserted that Pentagon papers disclosed that burials of unwanted herbicides took place on the premises of U.S. Marine Corps Air Station Futenma and on former military land in the town of Chatan, northeast of Naha, Okinawa’s capital. The article contained reports from former servicemembers and Okinawa residents of the storage of barrels of toxic munitions on the island from 1962 through the 1970s. Another article described Operation Red Hat, an effort to remove U.S.-owned chemicals from Okinawa. The Veteran also submitted a report that cited to an article titled “An Ecological Assessment of Johnston Atoll,” which discussed Operation Red Hat. This report, conducted by independent researchers, asserted that in 1972 the United States Air Force brought about 25,000 of Agent Orange, to Johnston Island from Okinawa. There was also an article regarding a VA grant of service connection for prostate cancer based on herbicide agent exposure at Kadena Air Base in Japan; an article that included a photograph of workers unearthing barrels of chemicals in Kadena Air Base on Okinawa in 2014; a web article asserting military contamination on Okinawa, with PCP and Agent Orange at Kadena Airforce Base during the 1960s, and; translated Japanese article regarding United States Military Defoliants on Okinawa, specifically Agent Orange. In response to the Veteran’s claim, VA attempted to verify his reported exposure while the appeal was in Remand status. In this regard, the National Archives and Records Administration reviewed at the Veteran’s unit history and noted no mention any bulldozer operations or use of Agent Orange. Additionally, a response from the Agent Orange Mailbox regarding the Veteran’s contention of exposure to Agent Orange, indicated that the Department of Defense did not show any use, testing, or storage of tactical herbicides at Okinawa, Japan. It was also noted that a recent report released in January 2013 confirmed that no tactical herbicides were transported to, used, stored, or buried on Okinawa, Japan. Additionally, the use of tactical herbicides in Vietnam was terminated in early 1971, therefore, shipments of Agent Orange to Vietnam after 1971 was unlikely. After careful review of all the evidence of record, the Board finds the Veteran’s asserted in-service exposure to herbicide agent cannot be substantiated. Aside from the general allegations of exposure to Agent Orange by the Veteran and the Appellant, there is no evidence of record establishing that the Veteran was actually exposed to Agent Orange during his active service. His general allegation of exposure do not outweigh the evidence provided by the Agent Orange Mailbox regarding the Department of Defense report that herbicide agents were not used, stored, or transported on Okinawa, and that the use of Agent Orange was discontinued in 1971, approximately two years before the Veteran arrived in Okinawa. The Board acknowledges the Veteran’s service in Okinawa, Japan, and his statements supporting that he was exposed to herbicides during service. The Board also notes the Veteran was competent to establish facts that can be observed by the use of a person’s five senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). He was competent to report the events that occurred during service, including the locations of such service and the duties during service. Id. The Board does not call into question the Veteran’s reports that he buried drums in a dump site as part of a bulldozer operations course at Kubasaki high school during service in Okinawa. However, the Board does not find that the Veteran established the competency to distinguish herbicide agents from other liquids or chemicals he may have witnessed or handled during service. Accordingly, the Veteran was not competent to say he was exposed to herbicides based on his handling of barrels of liquid because the Veteran has not been shown to have any specialized training that would allow him to identify a chemical such as herbicides by sight. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (a layperson’s assertions indicating exposure to gases or chemicals during service were not sufficient evidence alone to establish that such an event occurred during service). Further, the articles and reports the Veteran submitted in support of these claims do not establish that the Veteran was exposed to Agent Orange or other herbicide agents. The article discussing the discovery of chemical barrels does not specify when the barrels were present on Okinawa, much less that the Veteran was exposed to any of the contents of these barrels, and the article discussing Operation Red Hat is not applicable to whether the Veteran was exposed to herbicides, as Operation Red Hat dealt with nerve agents. Thus, neither of these articles is competent evidence that the Veteran was exposed to herbicide agents while stationed at Okinawa. The “Ecological Assessment” report alleges that 25,000 barrels of Agent Orange were transported to Johnston Island from Okinawa; however, the Department of Defense indicated that Agent Orange was not stored on Okinawa. The Board finds the Department of Defense report regarding the use, transportation and storage of Agent Orange to be the most probative evidence of record regarding the use and storage of Agent Orange on Okinawa because the Department of Defense was the agency charged with producing and distributing Agent Orange. Additionally, to the extent some articles asserted that barrels of chemicals, including Agent Orange, were stored in Kadena Air Base in Okinawa, there is no indication that the Veteran served at that location or any other where the articles suggest Agent Orange may have been stored. Even assuming there is sufficient evidence to demonstrate that barrels of Agent Orange were stored at Okinawa at some point, none of the articles provide competent evidence that the Veteran was actually exposed to the herbicides allegedly contained in the barrels. These articles and reports, either each alone or taken together, do not establish that the Veteran was exposed to herbicide agents as defined by VA regulations on Okinawa at the time the Veteran was serving there. The Board finds the response form the Agent Orange Mailbox discussing allegations of herbicide use on Okinawa to be highly probative, as it relies on and cites to documents clearly indicating where Agent Orange was authorized to be shipped, stored, and used. Its findings are consistent with the Department of Defense reporting that there are no records of Agent Orange on the island. Finally, the Board finds the National Archives and Records Administration’s response to be probative as well, as it relied on the unit history and documentation of the operations in which the unit participated, which it found did not corroborate exposure to Agent Orange. In this regard, the Board finds the statement from the Agent Orange Mailbox regarding the Department of Defense report that herbicide agents were not used, stored, or transported on Okinawa, and that the use of Agent Orange was discontinued in 1971 is very strong evidence against the claim that the Veteran had exposure to herbicides while service on Okinawa when service department records show that he did not start his service on Okinawa until 1973. See 38 C.F.R. § 3.203(a); Spencer v. West, 13 Vet. App. 376, 380 (2000) (VA is bound by service department findings); Duro v. Derwinski, 2 Vet. App. 530, 532 (1992) (“service department findings are binding on VA for purposes of establishing service in the U.S. Armed Forces”). Given the above, the Board finds the most probative evidence of record are the above service department records, National Archives and Records Administration records, and Agent Orange Mailbox records which shows that the Veteran was not exposed to herbicides on Okinawa despite the Veteran and the Appellant’s claims to the contrary and despite the articles the Veteran and/or the Appellant filed in support of this claim. As noted above, the Veteran’s lay statements of exposure are not competent evidence as he was not shown to have any specialized education or training that would allow him to identify herbicides by sight. The various reports and articles described above that appear to suggest that herbicides such as Agent Orange were either stored or used on Okinawa at some point are outweighed by the response from Agent Orange Mailbox that indicates that Agent Orange was not used or stored on Okinawa after 1917, which is consistent with Department of Defense reporting. As noted above, even if these articles demonstrated that Agent Orange or other herbicides were either used or stored at Okinawa at some point, they are nonetheless not sufficient to demonstrate that the Veteran was actually exposed to herbicide agents while stationed on Okinawa. Accordingly, the Board finds that the preponderance of the evidence is against the claim that the Veteran had actual exposure to tactical herbicide agents while on active duty including while serving in Okinawa, Japan. As to establishing service connection for diabetes mellitus and prostate cancer under 38 C.F.R. § 303(a) due to another in-service disease or injury, the Veteran’s service treatment records are silent for any complaints, treatment, or diagnoses of diabetes mellitus or prostate cancer. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). Accordingly, the Board finds that the most probative evidence of record shows that the Veteran did not develop diabetes mellitus and prostate cancer due to a disease or injury while on active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a); Colvin, supra. As to service connection for diabetes mellitus and prostate cancer based on the presumptions found at 38 C.F.R. § 3.309(a), neither the Veteran during his lifetime nor the Appellant claimed, and the record does not show, that either of these disabilities manifest to a degree of 10 percent or more in the first year following the Veteran’s separation from service. Therefore, the Board finds that these presumptions do not apply to the current appeal. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Next, the Board will consider whether service connection for diabetes mellitus and prostate cancer is warranted due to continuity of symptomatology under 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(b). In this regard, and as noted above, service treatment records are negative for complaints, treatment, or diagnoses of diabetes mellitus or prostate cancer. See Colvin, supra. Moreover, the Appellant does not claim, and the record does not show, that diabetes mellitus and prostate cancer that was diagnosed many years after service started on active duty and continued until the Veteran’s death. Therefore, the Board finds that the most probative evidence of record shows that the Veteran did not have a continued problem with diabetes mellitus and prostate cancer in and since his separation from service many decades. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(b). Furthermore, the Board notes that the record does not shows that the Veteran’s diabetes mellitus and prostate cancer are not due to his military service. See 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(d); also see Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992) (establishing service connection requires finding a relationship between a current disability and events in service or an injury or disease incurred therein). In this regard, the Board notes that a medical opinion was not obtained in connection with these claims. However, the Board finds that the criteria to obtain etiology opinions have not been met because the record does not document his complaints, diagnoses, or treatment for these disorders during service or for decades after service. See Duenas v. Principi, 18 Vet. App. 512, 519 (2004) (VA is not obligated to provide an examination for a medical nexus opinion where, as here, the supporting evidence of record consists only of a lay statement). The Board also finds that the Veteran, and know the Appellant, is not competent to provide the missing nexus opinions because they dos not have the required medical expertise to provide an answer to this complex medical question (i.e., what caused the diabetes mellitus and prostate cancer). See Davidson, supra. Likewise, the Board does not find the medical literature provided by the Veteran or the Appellant regarding Agent Orange exposure provides the missing nexus opinions because it is generic texts, which do not address the facts in this particular Veteran’s own case with a sufficient degree of medical certainty and therefore it does not amount to competent medical evidence of causality. See Wallin v. West, 11 Vet. App. 509 (1998); Sacks v. West, 11 Vet. App. 314 (1998); Libertine v. Brown, 9 Vet. App. 521 (1996); Beausoleil v. Brown, 8 Vet. App. 459 (1996). Therefore, the Board finds that the most probative evidence of record shows that the Veteran’s diabetes mellitus and prostate cancer are not due to a disease or injury while on active duty. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(d). The Board next finds that the preponderance of the evidence shows that the Veteran’s diabetes mellitus was not caused or aggravated by the medication he took to treat his already service-connected major depressive disorder. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310; Also see Allen, supra; Wallin, supra; Ward, supra. In this regard, the August 2014 VA examiner opined that the Veteran’s diabetes mellitus was not caused or aggravated by the medication he took to treat his service-connected major depressive disorder. Moreover, the Board finds this opinion the most competent and credible medical opinion of record because it was provided after a review of the record on appeal and an examination of the Veteran as well as because it is supported by citation to evidence found in the record and controlling medical literature and because it is supported by medical reasoning and not contradicted by any other medical evidence of record. See Owens, supra; Colvin, supra; Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) (“the probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators...”). In addition, the Board finds that neither the Veteran or now the Appellant is competent to provide the missing secondary nexus opinions because they do not have the required medical expertise to provide answers to these complex medical questions (i.e., what caused the diabetes mellitus). See Davidson, supra. Therefore, the Board finds that the most probative evidence of record shows that the Veteran’s diabetes mellitus was not secondary to an already service-connected disability. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310; Also see Allen, supra; Wallin, supra; Ward, supra. Accordingly, the Board finds that the preponderance of the evidence is against the claims of service connection for diabetes mellitus and prostate cancer. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. In reaching all the above conclusions, the Board considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the preponderance of the evidence is against the claims, the Board finds that the doctrine is not for application. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert, supra Entitlement to SMC SMC at the aid and attendance (A&A) rate under subsection (l) is payable when a veteran, due to service-connected disability, has the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, with 5/200 visual acuity or less, or is permanently bedridden or has such significant disabilities as to be in need of regular A&A. 38 C.F.R. § 1114 (i); 38 C.F.R. § 3.350 (b), 3.352(a). SMC at the housebound rate under subsection (s) is awarded where the veteran has a service-connected disability rated as total and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or (2) is permanently housebound due to such service-connected disability or disabilities. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). The following criteria will be considered in determining the need for regular A&A: inability of a 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; inability to feed himself through the 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 him from hazards or dangers incident to his daily environment. See 38 C.F.R. § 3.350 (b)(3), (4), 3.352(a). It is only necessary that the evidence establish that the veteran is so helpless as to need regular A&A, not that there be a constant need. See 38 C.F.R. § 3.352 (a). Importantly, in order for the Veteran to prevail in this claim, the evidence must show that it is a service-connected disability that has resulted in his being in need of regular A&A or being housebound. See Prejean v. West, 13 Vet. App. 444 (2000). In this case, the only disabilities for which service connection was granted are major depressive disorder rated as 60 percent disabled and erectile dysfunction rated as 0 percent disabled. The evidence, including a July 2014 VA Disability Benefits Questionnaire (DBQ) for Aid and Attendance, VA examination reports and VA treatment records, does not establish that the Veteran was blind or that he had suffered the anatomical loss or loss of use of both feet or one hand and one foot due to a service-connected disability. See Colvin, supra. While the July 2014 DBQ found that the Veteran required the need of aid and attendance, the medical evidence specifically demonstrates that this need was due to nonservice-connected prostate cancer. The evidence does not demonstrate that the Veteran met any of the criteria for SMC based on the need for A&A due to a service-connected disability. See Owens, supra. The Appellant does not contend that his service-connected disabilities caused his need for A&A. Based on the foregoing, the Board finds that the most probative evidence of record shows that the Veteran did not require care or assistance on a regular basis due to his service-connected disabilities, either with the activities of daily living or to protect himself from hazards or dangers incident to his daily environment. The record also does not show the Veteran was bedridden. Therefore, the claim for SMC based on the need for A&A is denied. 38 U.S.C. § 1114 (l); 38 C.F.R. §§ 3.350 (b), 3.352(a). The Board also notes that the evidence does not show that the Veteran was housebound or confined to his immediate premises due to his service-connected disabilities. Nor did the Veteran have a single service-connected disability rated as 100 percent disabling. Hence, there is no legal basis for awarding SMC based on being housebound, and the claim is denied. NEIL T. WERNER Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Azizi, T. 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.