Citation Nr: 21030614 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-03 162 DATE: May 19, 2021 ORDER Entitlement to special monthly compensation at the housebound rate is granted. FINDING OF FACT In affording the Veteran the benefit of the doubt, for the entire period on appeal, his service-connected posttraumatic stress disorder and dermatitis have substantially confined him to his house and prevented him from leaving his house to earn an income. CONCLUSION OF LAW The criteria for special monthly compensation at the housebound rate have been met for the entire period on appeal. 38 U.S.C. §§ 1114(s), 5107(b); 38 C.F.R. §§ 3.102, 3.350(i). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1968 to December 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran and Z.S. testified before the undersigned Veterans Law Judge (VLJ) during a June 2019 videoconference hearing. A transcript of that hearing is associated with the claims file. In an October 2019 decision, the Board denied the issue on appeal. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In an October 2020 Order, the Court remanded the claim to the Board for actions consistent with an October 2020 Joint Motion for Partial Remand filed by the parties. Entitlement to special monthly compensation (SMC) at the housebound rate The Veteran seeks special monthly compensation (SMC) benefits at the housebound rate due to his service-connected disabilities. The Veteran is currently service-connected for active dermatitis and posttraumatic stress disorder (PTSD). SMC at the housebound rate is payable where a veteran has a single service-connected disability rated as 100 percent 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. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). A veteran is permanently housebound when he or she is substantially confined as a direct result of service-connected disability or disabilities to his or her 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 or her lifetime. 38 C.F.R. § 3.350(i)(2). Leaving one's house for medical purposes cannot, by itself, serve as the basis for finding that one is not substantially confined for purposes of housebound benefits. Howell v. Nicholson, 19 Vet. App. 535, 540 (2006). Moreover, Congress intended to provide additional compensation for veterans who were unable to overcome their particular disabilities and leave the house in order to earn an income as opposed to an inability to leave the house at all. Id. Notably, total disability due to individual unemployability (TDIU) can be considered a single permanent disability of 100 percent if TDIU is based on a single disability. See Bradley v. Peake, 22 Vet. App. 280, 293 (2008). Here, the Board notes that the Veteran was awarded TDIU in August 1988, primarily related to his service-connected dermatitis. However, his remaining service-connected disability is PTSD, rated 50 percent disabling. Accordingly, the evidence of record must show that the Veteran is permanently housebound by reason of his service-connected disabilities to meet the requirements for housebound SMC benefits. See 38 C.F.R. § 3.351(d). There is conflicting evidence regarding whether the Veteran's service-connected disabilities render him homebound. The Veteran submitted an Examination for Housebound Status or Permanent Need for Regular Aid and Attendance dated in February 2014. The Veteran's diagnoses at that time included mild degenerative disc disease, impaired vision, photosensitivity, impaired mobility of an unknown etiology, and PTSD. The examiner noted that the Veteran was able to leave the home with the use of an assistive device and he used a scooter for ambulation. The Veteran further noted that his skin condition prohibited him from being in direct sunlight. The Veteran's treatment records include a March 2014 assessment by a nurse practitioner and social worker that the Veteran "is homebound". The evidence supporting such a finding includes a "mental health diagnosis [that] makes [it] unsafe for patient to leave home." An emergency department note from May 2014 notes that the Veteran requested a refill of his psychiatric medications. However, on examination, the Veteran was found psychiatrically stable and was discharged home with directions to return if he experienced psychiatric symptoms. A psychiatry outpatient note from May 2014 indicates that the Veteran stated that his anxiety symptoms were worse but that he just started receiving homemaker services that had improved his quality of life significantly. A note dated in June 2014 states that the Veteran required homemaker assistance about 5 hours, one day per week. His homemaker cooked meals to last for several days, cleaned, and grocery shopped for him. The records further reflect that the Veteran suffered a stroke in October 2014. In November 2014, the Veteran reported that he needed home health assistance after suffering a stroke. Thereafter, records reflect that he was moved into a nursing home related to his need for physical assistance and decreased cognition. On his October 2015 notice of disagreement, the Veteran's representative indicated that the Veteran had a stroke and subsequently received nursing home and rehabilitation services. The representative sought special monthly compensation from the date of application, "or at least at the time of the stroke". In a July 2016 statement, the Veteran reported that he was unable to leave his house without the physical assistance of a caregiver and that he was sensitive to sunlight. The Veteran submitted an Examination for Housebound Status or Permanent Need for Regular Aid and Attendance dated in August 2018. The Veteran's diagnoses were listed as cerebrovascular accident with left-sided hemiparalysis, in wheelchair, bladder and bowel incontinent, HLD, PTSD/insomnia, and chronic obstructive pulmonary disease. However, the examiner found that the disabilities restricting his activities and functions were his hemiplegia and being wheelchair-bound. The examiner noted that the Veteran required nursing home care and medication management. The examination report notes that the Veteran lived in a nursing home and came home on the weekends and holidays. He only went out for doctors' appointments. During the June 2019 Board hearing, the Veteran stated that prior to his stroke, he required aid and attendance related to his PTSD. He noted that he had resulting increased blood pressure and cardiovascular problems. He further attributed his stroke to overmedication followed by withdrawal when his PTSD medication was abruptly stopped. The Veteran submitted a final Examination for Housebound Status or Permanent Need for Regular Aid and Attendance dated in July 2019. The Veteran's diagnoses were listed as PTSD, cerebrovascular accident, vascular dementia, depression, chronic obstructive pulmonary disease, dermatitis, and bowel and bladder incontinence. He was found unable to travel alone and was only able to leave the home accompanied by a caregiver. After a review of the above, the Board finds that the evidence is in equipoise as to whether the Veteran has been homebound throughout the period on appeal related to his service-connected PTSD and dermatitis. The evidence of record shows that the Veteran could not leave his home without assistance. The record further shows that even prior to the Veteran's stroke, he required a homemaker to do grocery shopping and meal preparation as he only left home for medical appointments. The Board finds the March 2014 assessment that the Veteran was "homebound" at that time particularly persuasive, as it was completed prior to the Veteran's stroke and indicates the Veteran's mental disorder made it "unsafe" for him to leave the home. Further, the Veteran regularly noted that his dermatitis required him to avoid sunlight and made him particularly sensitive to being outside or leaving the house. As noted above, the Veteran was deemed unemployable related to his dermatitis for those reasons. In summary, in affording the Veteran the benefit of the doubt, the Board concludes that SMC for housebound status is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.