Citation Nr: 21030385 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 17-64 346 DATE: May 18, 2021 ORDER Entitlement to special monthly compensation (SMC) based on aid and attendance is granted. FINDING OF FACT The Veteran's service-connected disabilities render him in need of regular aid and attendance of another person. CONCLUSION OF LAW The criteria for special monthly compensation based on the regular aid and attendance of another person have been met. 38 U.S.C. § 1114(l); 38 C.F.R. §§ 3.102, 3.350, 3.352(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 2000 to November 2000 and from March 2005 to March 2013. He was awarded the Combat Action Badge. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. The Veteran testified at a hearing before the undersigned in August 2020. A transcript of the hearing is of record. Special Monthly Compensation The Veteran contends special monthly compensation is warranted because he needs the regular aid and attendance of another person due to the severity of his service-connected disabilities. Special monthly compensation is payable at a specified rate if a VA claimant, as the result of service-connected disability, 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 visual acuity of 5/200 or less; or is permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350(b). The criteria for determining that a VA claimant is so helpless as to be in need of "regular aid and attendance" are contained in 38 C.F.R. § 3.352(a). In determining the need for regular aid and attendance, the Board must consider the following factors: (1) Inability of the claimant to dress or undress him or herself or to keep him or herself ordinarily clean and presentable; (2) Frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without assistance; (3) Inability of the claimant to feed him or herself through loss of coordination of upper extremities or through extreme weakness; (4) Inability to attend to the wants of nature; or (5) Incapacity, either physical or mental, that requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352(a). The Veteran has the following service-connected disabilities: Atrophic left kidney with chronical renal disease, rated 80 percent disabling; Major depressive disorder with posttraumatic stress disorder (PTSD), rated 70 percent disabling; Bladder dysfunction with urinary retention, rated 60 percent disabling; Left shoulder disability, rated 20 percent disabling; Tinnitus, rated 10 percent disabling; Low back disability, rated 10 percent disabling; Right ankle arthritis, rated 10 percent disabling; Left knee disability, rated 0 percent disabling; Scar, rated 0 percent disabling. Granting the Veteran the benefit of the doubt, the Board finds the service-connected disabilities render him in need of regular aid and attendance of another person. In September 2015, the Veteran submitted a VA examination for housebound status or permanent need for regular aid and attendance. Notably however, the examiner considered non-service-connected disabilities and did not distinguish the symptoms caused by the service-connected disabilities. He noted the Veteran's leg weakness limited his ability to bath and stand independently. However, it's not clear whether the leg weakness was caused by a service-connected disability. Accordingly, the examination report is of limited value. However, VA treatment records show the Veteran required his wife's help to complete many activities of daily living, including bathing, shaving, dressing, and managing his medication, due to his musculoskeletal, kidney, and psychiatric disabilities. For instance, an August 2015 VA treatment record notes the Veteran needed help transferring from the bed to a chair, to and from the toilet, and in and out of the bath because of right ankle and low back pain. A December 2016 VA treatment record shows the Veteran complained of back and right ankle pain. His gate was unsteady and he had generalized weakness of the right lower extremity due to the ankle disability. He was noted to need assistance with grooming, bathing, dressing, and using the bathroom. He underwent a right ankle fusion in December 2016. A January 2017 VA treatment record notes he couldn't put any weight on his right ankle so his spouse had to help him with most of the activities of daily living. An April 2017 VA treatment record notes the Veteran's spouse reported he wasn't getting out of bed due to pain. An October 2017 VA in-home assessment for VA's family caregiver program notes the Veteran needed assistance with bathing and dressing due to a limited range of motion and balance issues. His spouse also assisted with his daily self catheterizations and managing finances. The evaluating nurse noted he was totally dependent on his wife for preparing meals, completing house work, shopping, and managing medications. A March 2018 private physical therapy notes the Veteran had general lumbar spine deconditioning and other impairments, including pain, a reduced range of motion, muscle instability, and postural deficits, due to his service-connected disabilities. The physical therapist noted he was "severely functionally limited" in activity, such as walking, standing, transitional movements, and self-care. A September 2018 family caregiver certificate notes the Veteran underwent a left shoulder surgery in July 2018. His wife reported she now had to help him dress above the waist because of the shoulder disability. She also helped him put on his ankle, back, and shoulder braces and assisted with the self catheterizations. She noted she had to manage the Veteran's medications because of his short-term memory loss, which is associated with the Veteran's service-connected PTSD. A review committee found the Veteran was no longer eligible for the family caregiver program in November 2018, finding it appeared the Veteran was able to independently carry out the activities of daily living. However, the assessment noted certain disabilities, including the service-connected back disability and urinary retention, were not considered as part of the assessment. In fact, the evaluating physician noted the Veteran's wife helped him shave, bathe, dress, put braces on his right ankle and left shoulder, keep track of prescriptions, and assisted with the catheterizations as needed. An April 2019 VA treatment record notes the Veteran was seeking physical therapy for low back, left shoulder, and right ankle pain to improve his overall functioning in the activities of daily living. An August 2019 VA kidney examination report notes the Veteran experienced urinary retention, recurrent urinary tract infections, bladder spasms, and renal colic pain due to the service-connected kidney disability. He also had generalized poor health, lethargy, weakness, and limitation of exertion due to renal dysfunction. He had to self catheterize four times a day because he was no longer able to void on his own. An August 2019 VA PTSD examiner opined the Veteran's numerous medications sedated him throughout the day. At the August 2020 Board hearing, the Veteran reported his wife helped him with showering, managing his medications, and making meals. The Board acknowledges the November 2018 VA caregiver assessment report and a limited number of other VA treatment records that indicate the Veteran was able to function independently. However, as noted, the November 2018 report did not consider all of the Veteran's service-connected disabilities. Accordingly, the finding is of limited probative value. In addition, the Board finds there is no reason to conclude the other treatment providers' descriptions of the severity of the Veteran's service-connected disabilities are not competent and credible evidence or any less probative than the November 2018 caregiver assessment report and the treatment records that indicate the Veteran did not need aid and assistance. The Board finds the evidence for and against the claim is in relative equipoise and therefore resolves all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Entitlement to special monthly compensation for regular aid and attendance is granted. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board William A. Skowronski, 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.