Citation Nr: 21028000 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 18-46 293A DATE: May 10, 2021 ORDER Entitlement to service connection for a spinal cord injury (SCI), to include as secondary to a service connected back condition, is granted. Entitlement to service connection for loss of use of the right upper extremity, to include as secondary to the SCI, is granted. Entitlement to service connection for loss of use of the left upper extremity, to include as secondary to the SCI, is granted. Entitlement to service connection for loss of use of the right lower extremity, to include as secondary to the SCI, is granted. Entitlement to service connection for loss of use of the left lower extremity, to include as secondary to the SCI, is granted. Entitlement to service connection for a bladder condition, to include as secondary to the SCI, is granted. Entitlement to service connection for a bowel condition, to include as secondary to the SCI, is granted. Entitlement to special monthly compensation (SMC) on the basis of a need for regular aid and attendance (A&A) is granted. FINDINGS OF FACT 1. The Veteran's SCI was caused by the Veteran's service-connected back condition. 2. The Veteran's SCI caused the Veteran's quadriplegia of all four extremities. 3. The Veteran's SCI caused the Veteran's bladder condition. 4. The Veteran's SCI caused the Veteran's bowel condition. 5. The competent evidence of record shows that, as a result of the Veteran's service-connected disabilities, the Veteran is in need of regular aid and attendance. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a SCI have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. 2. The criteria for entitlement to service connection for loss of use of all four extremities have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. 3. The criteria for entitlement to service connection for a bladder condition. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. 4. The criteria for entitlement to service connection for a bowel condition have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. 5. The criteria for entitlement to SMC on the basis of A&A have been met. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Coast Guard from October 1970 to October 1974. The Veteran and his wife testified before the Board of Veterans' Appeals (Board) and the undersigned Veterans Law Judge in March 2021. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military, naval or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in active service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires medical evidence or, in certain circumstances, lay evidence of the following: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310(a). Furthermore, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. See 38 C.F.R. § 3.310(b). The Veteran is currently service connected for a back condition and left lower extremity radiculopathy secondary to the back condition. Dr. J.M.C provided a nexus opinion in April 2017 VA treatment notes. The Veteran's fall in June 2016, resulted in a SCI and paralysis. Patients with radiculopathy have diminished sensation in the area that corresponds with the injury. The diminished sensation can result in impaired perception and the inability to coordinate muscular function as commonly required for situations related to balance. This diminished sensation can therefore lead to the inability to restore balance and cause falls which result in significant injury. In addition to the radiculopathy, the Veteran's impaired lumbar mobility and function further predisposed the Veteran to loss of balance and the inability to recover from mild eccentric movements of his limbs or back. Therefore, the examiner determined the proximate cause of the Veteran's fall and resulting SCI with paralysis was related to the service-connected conditions. The Board notes that this opinion is highly detailed and contains a thorough description of the pertinent medical history. The Veteran was provided with a VA neck conditions examination in April 2017. The Veteran was diagnosed with a cervical spine injury, quadriplegia, and neurogenic bladder and bowel. In the opinion, the examiner noted the "condition claimed is less likely than not" a result of the Veteran's service-connected condition. Then the examiner noted the "SCI is at least as likely as not" caused by or a result of the service-connected back condition. The examiner continued in the rationale by noting the Veteran did not complain of imbalance at the anytime before the fall, and per the Veteran, the fall was accidental. The examiner found the worsening back condition with arthropathy may have caused some imbalance; and due to the Veteran's loss of consciousness after the fall, he may not have remembered the sequence of events before the fall. The examiner concluded by stating it was mere speculation to state the Veteran might have had some temporary imbalance due to the back condition. The VA examiner also provided a negative nexus opinion for the Veteran's bladder, bowel and quadriplegia conditions, finding the conditions were residuals of the SCI, and not the back condition. In reviewing the evidence, the Board finds the positive opinion in the VA treatment records was more probative than the VA opinion due to the extensive rationale based upon the Veteran's medical evidence. See Nieves-Rodriguez v. Peake,22 Vet. App. 295 (2008). The VA examiner provided conflicting opinions for the SCI issue, and the examiner was not able to resolve the SCI issue without resorting to mere speculation. Thus, the benefit of the doubt is afforded to the Veteran, and the Board finds that service connection for a SCI is established. As the decision herein finds service connection for the SCI is warranted, service connection is also warranted for the residual conditions of quadriplegia, a bladder condition, and a bowel condition. The VA examiner determined the conditions were all secondary and residuals of the SCI. Thus, service connection for quadriplegia, a bladder condition, and a bowel condition have been established, and the claims are granted in full. Aid and Attendance Special monthly compensation is an additional level of compensation to Veterans (above the basic levels of compensation payable based on disability ratings of 0 to 100 percent) for various types of anatomical losses or levels of impairment due solely to service-connected disabilities. See 38 U.S.C. § 1114(k-s). SMC for A&A is payable when, as a result of a service-connected disability, the Veteran has suffered 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 is so helpless (due to physical or mental incapacity), that he requires the aid of another person to perform the personal functions required in everyday living. 38 U.S.C. § 1114(l); 38 C.F.R. §§ 3.350(b), 3.351(b), 3.352(a). There is no schedular threshold for the award of SMC when granted on the basis of a need for regular aid and attendance. 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: inability of a claimant to dress or undress himself; to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliance which by reasons 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 tend to the wants of nature; or incapacity, physical or mental, that requires care and assistance on a regular basis to protect claimant from the hazards or dangers incident to his daily environment. "Bedridden" will be a proper basis for the determination and is defined as that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that the claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. It is not required that all the disabling conditions enumerated above be found to exist before a favorable rating may be made. The particular personal functions that the claimant is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establishes that the claimant is so helpless as to need regular aid and attendance, not that there is a constant need. 38 C.F.R. § 3.352(a). The probative evidence of record reflects that the Veteran meets the criteria for the need for aid and attendance due to his service-connected disabilities. As an initial matter, service connection is in effect for several conditions, to include quadriplegia, a bladder condition, and a bowel condition. The April 2017 VA examiner noted the Veteran needs total assistance for all activities of daily living and mobility. The Veteran's wife described the care she provides due to the Veteran's service-connected conditions during the March 2021 hearing. The Veteran's wife had to change his catheter once a month due to his bladder condition. She had to manage his bowel care daily, she monitored his skin for bed sores, she managed his medications, she made his meals, and she fed him. In view of the foregoing, and resolving all reasonable doubt in favor of the Veteran, the Board finds the competent and credible evidence of record reflects that the Veteran requires the regular aid and attendance of another person due to the service-connected disabilities granted herein. Thus, he is entitled to SMC, and the claim is granted in full. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. N. Quarles, 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.